Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like D*

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

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
20	Fee-for-Service	1548205818	1548205818	1	1	DAVIS HOSPITAL & MEDICAL	6/12/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER LP	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
47	Fee-for-Service	1033569173	1033569173	1	1	DASHJIAN, LAUREN T PHD	7/21/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
68	Fee-for-Service	1144225426	1144225426	1	7	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	3630 IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
101	Fee-for-Service	1285661777	1285661777	1	1	DOYLE, NORA M MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129103	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	SUITE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
143	Fee-for-Service	1447327168	1447327168	1	2	DERMATOLOGY MEDICAL GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1025 CALIMESA BLVD	STE 6	CALIMESA	CA	92320	1146	33	06065	33.99998425	-117.0603297	Riverside County
169	Fee-for-Service	1447327168	1447327168	1	1	DERMATOLOGY MEDICAL GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1666 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5113	36	06071	34.129395	-117.2788075	San Bernardino County
177	Fee-for-Service	1144225426	1144225426	1	1	DESERT TRAUMA SURGEONS INC	2/3/1994	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
190	Fee-for-Service	1366174120	1366174120	1	1	DURKIN, DANIELLE LMFT	3/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
219	Fee-for-Service	1811253750	1811253750	1	1	DAMOND, TAMIKA PHD	4/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
230	Fee-for-Service	1508148610	1508148610	1	1	DESMET, SARA LMFT	9/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 SPECTRUM CENTER	None	IRVINE	CA	92618	4962	30	06059	33.65093115	-117.7468638	Orange County
241	Fee-for-Service	1922442938	1922442938	1	1	DIZON, JONATHAN G MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
260	Fee-for-Service	1104896513	1104896513	2	1	DAO, SOPHIE KIEU-LIEN OD	3/15/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	991 MONTAGUE EXPRESSWAY	SUITE 111	MILPITAS	CA	95035	6809	43	06085	37.41304686	-121.8852862	Santa Clara County
284	Fee-for-Service	1629575907	1629575907	1	1	DECKER, SAMUEL I MD	6/1/2021	207P00000X	NA	Other	026	PHYSICIANS	165813	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
308	Fee-for-Service	1548205818	1548205818	1	1	DAVIS HOSPITAL & MEDICAL	12/5/2002	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER LP	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
332	Fee-for-Service	1104357441	1104357441	1	1	DU, WEINING MD	8/3/2021	207L00000X	NA	Other	026	PHYSICIANS	159824	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
356	Fee-for-Service	1144225426	1144225426	1	7	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	3630 IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
411	Fee-for-Service	1578577102	1578577102	1	1	DEL PERO, ROBERT A MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	47676	18	Ophthalmology	0	In state provider	None	950 THARP ROAD	STE 1500	YUBA CITY	CA	95993	8352	51	06101	39.13941973	-121.6485656	Sutter County
423	Fee-for-Service	1215965967	1215965967	2	1	DANNER LABORATORY INC	1/21/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	5230 CARROLL CANYON ROAD	SUITE 114	SAN DIEGO	CA	92121	1779	37	06073	32.89120199	-117.1944156	San Diego County
465	Fee-for-Service	1144225426	1144225426	1	1	DESERT TRAUMA SURGEONS INC	10/26/2022	163W00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP INC	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
533	Fee-for-Service	1629383153	1629383153	1	1	DHAMIJA, SULAKSHNA MD	12/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185226	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
535	Fee-for-Service	1487803391	1487803391	1	1	DRISCOLL, ALISE L MSW LCSW	6/17/2022	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
548	Fee-for-Service	1821382805	1821382805	1	1	DOBBINS, PAMELA J LMFT	4/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4164 BROCKTON AVE	None	RIVERSIDE	CA	92501	3400	33	06065	33.98077024	-117.3813862	Riverside County
554	Fee-for-Service	1518963578	1518963578	1	1	DAVIDIAN, MARK M MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73533	30	Radiology	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
564	Fee-for-Service	1780029116	1780029116	1	1	DU-LIN, STEPHANIE N MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134468	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
572	Fee-for-Service	1558100461	1558100461	1	1	DICKERSON, JANECE LCSW	7/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
617	Fee-for-Service	1689016156	1689016156	1	1	DUTT, LAKSHA DPM	9/2/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
633	Fee-for-Service	1871634162	1871634162	1	1	DALLA TOR, NELSON E MD	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	64802	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
644	Fee-for-Service	1144225426	1144225426	1	7	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ICAL GROUP INC	3630 IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
712	Fee-for-Service	1023296449	1023296449	3	1	DRG PHARMACY LLC	10/4/2010	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 N LOMBARD ST	A	OXNARD	CA	93030	8032	56	06111	34.20565597	-119.1489085	Ventura County
723	Fee-for-Service	1669623773	1669623773	1	1	DAY, LUKEJOHN W MD	4/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93534	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
759	Fee-for-Service	1144225426	1144225426	1	1	DESERT TRAUMA SURGEONS INC	2/3/1994	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
763	Fee-for-Service	1528396579	1528396579	1	1	DEDINI, RUSSELL D MD	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110297	None	None	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
771	Fee-for-Service	1700110087	1700110087	1	1	DASGUPTA, RIA MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129468	05	Anesthesiology	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
793	Fee-for-Service	1255755443	1255755443	1	1	DARNELL, REBECCA D CRNA	6/23/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
811	Fee-for-Service	1205895869	1205895869	1	1	DAVITA-RIVERSIDE, LLC	12/20/2002	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LAKE ELSINORE DIALYSIS	32291 MISSION TRL	BLDG S	LAKE ELSINORE	CA	92530	2304	33	06065	33.6528426	-117.2966393	Riverside County
844	Fee-for-Service	1528024924	1528024924	1	1	DIXON, ALBERT A MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	48020	14	Neurological Surgery	0	In state provider	None	160 E ARTESIA ST	STE 360	POMONA	CA	91767	2921	19	06037	34.07556833	-117.7507835	Los Angeles County
938	Fee-for-Service	1164088548	1164088548	1	1	DIAZ, GUADALUPE Y DO	7/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22524	08	Family Practice	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
968	Fee-for-Service	1528143203	1528143203	1	1	DING, XIUFEN MD	10/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81838	34	Urology and Urological Surgery	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
983	Fee-for-Service	1508967753	1508967753	1	1	DESERT ORTHOPEDIC CENTER	4/22/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	#201WB	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
999	Fee-for-Service	1669886206	1669886206	1	1	DANI, SVETLANA V MD	9/21/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163484	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
1010	Fee-for-Service	1669623773	1669623773	1	1	DAY, LUKEJOHN W MD	4/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93534	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
1014	Fee-for-Service	1487902433	1487902433	1	1	DOMINGUEZ, JOEL A LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
1024	Fee-for-Service	1205324423	1205324423	1	1	DEBBI, EYTAN M MD	9/15/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	153913	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
1051	Fee-for-Service	1508849860	1508849860	1	1	DEGALAN, STEVEN B MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	53602	41	Internal Medicine	0	In state provider	None	27206 CALAROGA AVE	STE 116	FREMONT	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
1056	Fee-for-Service	1528086675	1528086675	1	1	DOUNDOULAKIS, STEPHEN H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7435 W TALCOTT AVE	None	CHICAGO	IL	60631	3707	00	None	41.98844808	-87.81251188	Cook County
1089	Fee-for-Service	1720548464	1720548464	1	1	DHILLON, KIRANJIT K DO	8/20/2022	207R00000X	NA	Other	026	PHYSICIANS	19757	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
1093	Fee-for-Service	1508220328	1508220328	1	1	DAO NGUYEN, TRINH T MD	1/17/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162225	08	Family Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
1114	Fee-for-Service	1730397944	1730397944	1	1	DANIEL'S CARE CENTER	12/11/2002	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1309 W 159TH STREET	None	GARDENA	CA	90247	4323	19	06037	33.88650254	-118.2982069	Los Angeles County
1132	Fee-for-Service	1023533387	1023533387	1	1	DE ZOYSA, MADUSHKA Y MD	5/13/2020	390200000X	NA	Other	026	PHYSICIANS	152455	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
1153	Fee-for-Service	1518990415	1518990415	1	1	DESAI, JAY D MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	78344	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
1186	Fee-for-Service	1083293252	1083293252	1	1	DHILLON, MANVIR S MD	7/1/2024	208M00000X	NA	Other	026	PHYSICIANS	183658	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
1206	Fee-for-Service	1750451985	1750451985	1	1	DUENAS, DAVID J OD	5/23/2006	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	114 N GARFIELD AVE	None	MONTEBELLO	CA	90640	3808	19	06037	34.01543376	-118.1297518	Los Angeles County
1229	Fee-for-Service	1518140979	1518140979	1	1	DETRICK, KIMBERLYN V DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14589	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
1267	Fee-for-Service	1508967753	1508967753	1	1	DESERT ORTHOPEDIC CENTER	7/3/1990	207XS0106X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	#201WB	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
1298	Fee-for-Service	1316188048	1316188048	1	1	DIBIASE, MICHAEL J MD	4/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106846	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
1306	Fee-for-Service	1619383734	1619383734	1	1	DION, JESSE MD	2/9/2024	207R00000X	NA	Other	026	PHYSICIANS	169245	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
1335	Fee-for-Service	1942899984	1942899984	1	1	DAUGHENBAUGH, REBECCA J LCSW	2/18/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
1338	Fee-for-Service	1083732853	1083732853	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ST ELIZABETH COMM HOSP	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
1339	Fee-for-Service	1508849860	1508849860	1	1	DEGALAN, STEVEN B MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	53602	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27206 CALAROGA AVE	STE 116	FREMONT	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
1358	Fee-for-Service	1417510983	1417510983	1	1	DALAL, AVANI A MD	11/14/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178810	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
1363	Fee-for-Service	1902075203	1902075203	1	1	DIABETES & ENDOCRINOLOGY	9/24/2009	207RE0101X	NA	Endocrinology	026	PHYSICIANS	9323	41	Internal Medicine	0	In state provider	CENTER INC	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
1364	Fee-for-Service	1376711754	1376711754	1	1	DIXON, BARBARA LMFT	1/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	848 WEST LANCASTER BLVD	SUITE 102	LANCASTER	CA	93534	3443	19	06037	34.69727236	-118.1462398	Los Angeles County
1388	Fee-for-Service	1841484235	1841484235	1	1	DESERT CITIES ALLERGY OTOLAR	7/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48866	01	General Practice	0	In state provider	YNGOLOGY INC	39000 BOB HOPE DR	PROBST 202	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
1389	Fee-for-Service	1508354358	1508354358	1	1	DRAGAN, MARCIN R MD	9/25/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	174193	68	Hematology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
1394	Fee-for-Service	1972644797	1972644797	1	1	DOWLATSHAHI, MORTEZA M D INC	8/15/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 JOSE FIGUERES AVE	STE 199	SAN JOSE	CA	95116	1599	43	06085	37.36122014	-121.8505998	Santa Clara County
1422	Fee-for-Service	1013340827	1013340827	1	1	DOMUE, NADINE PSYD	12/15/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
1435	Fee-for-Service	1477116051	1477116051	1	1	DENNY, SEAN P MD	3/20/2023	207P00000X	NA	Other	026	PHYSICIANS	182139	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
1441	Fee-for-Service	1518990415	1518990415	1	1	DESAI, JAY D MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	78344	79	Neurology-Child	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
1442	Fee-for-Service	1801089065	1801089065	1	1	DEGUZMAN, JADE Q MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102678	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
1472	Fee-for-Service	1205152295	1205152295	1	1	DIMA, JACOB J DO	8/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12687	08	Family Practice	0	In state provider	None	2660 WEST COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
1473	Fee-for-Service	1730633587	1730633587	1	1	DENNY, KATHERINE G PHD	8/23/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
1475	Fee-for-Service	1043406895	1043406895	1	1	DELTA OFFICE CONSULTANTS	11/2/2010	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
1477	Fee-for-Service	1578902961	1578902961	1	1	DETWILER, DIANA E MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142818	01	General Practice	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
1489	Fee-for-Service	1629431341	1629431341	1	1	DAYAL, NIRMAAN K MD	9/12/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	181032	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
1522	Fee-for-Service	1548422314	1548422314	1	1	DE BEAUVOIR, TEDDI M LMFT	2/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ING COURAGE THERAPY	43537 RIDGE PARK DR	None	TEMECULA	CA	92590	3613	33	06065	33.49569085	-117.159969	Riverside County
1530	Fee-for-Service	1114955119	1114955119	1	1	DUHAMEL, EINAT R MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80241	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3998 VISTA WAY	STE C202	OCEANSIDE	CA	92056	4518	37	06073	33.18370179	-117.292963	San Diego County
1534	Fee-for-Service	1265571699	1265571699	1	1	DELLEFIELD, PASCALE T LMFT	4/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
1555	Fee-for-Service	1508967753	1508967753	1	1	DESERT ORTHOPEDIC CENTER	4/13/2022	207XS0106X	NA	Orthopedic Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	#201WB	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
1572	Fee-for-Service	1336143882	1336143882	1	1	DHARAN, MURALI MD	8/9/2006	174400000X	NA	Other	026	PHYSICIANS	52856	33	Thoracic Surgery	0	In state provider	None	5201 NORRIS CANYON RD	STE 330	SAN RAMON	CA	94583	5405	07	06013	37.77779028	-121.9600626	Contra Costa County
1596	Fee-for-Service	1497882914	1497882914	1	1	DONALDSON, ARTHUR MD INC	3/1/1999	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	940 SYLVA LN	STE G	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
1621	Fee-for-Service	1952716409	1952716409	1	1	DUDA, JULIAN C MD	2/4/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	152348	13	Neurology (M.D. only)	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
1626	Fee-for-Service	1083732853	1083732853	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ST ELIZABETH COMM HOSP	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
1651	Fee-for-Service	1902075203	1902075203	1	1	DIABETES & ENDOCRINOLOGY	9/24/2009	207RE0101X	NA	Endocrinology	026	PHYSICIANS	9323	67	Endocrinology	0	In state provider	CENTER INC	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
1661	Fee-for-Service	1609800622	1609800622	1	1	DIAZ, SABRINA G MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72139	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
1677	Fee-for-Service	1306924295	1306924295	1	1	DANZEISEN, DAVID J MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85148	08	Family Practice	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
1682	Fee-for-Service	1962560326	1962560326	1	1	DICKENS, CHRISTOPHER MD	6/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52201	18	Ophthalmology	0	In state provider	None	491 30TH ST	STE 103	OAKLAND	CA	94609	3235	01	06001	37.81935528	-122.2667902	Alameda County
1690	Fee-for-Service	1134277932	1134277932	1	1	DULA, ANYA M DO	11/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7767	08	Family Practice	0	In state provider	None	27141 HIDAWAY AVE	None	CANYON COUNTRY	CA	91351	4131	19	06037	34.41483	-118.469039	Los Angeles County
1756	Fee-for-Service	1871014472	1871014472	1	1	DOAN, ANNIE	8/31/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
1760	Fee-for-Service	1205152295	1205152295	1	1	DIMA, JACOB J DO	8/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12687	01	General Practice	0	In state provider	None	2660 WEST COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
1787	Fee-for-Service	1982730230	1982730230	1	1	DIBELLA, GEOFFREY A	3/1/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21681	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
1807	Fee-for-Service	1326234170	1326234170	1	1	DHAWALE, ROSHAN MD	2/24/2023	207RR0500X	NA	Other	026	PHYSICIANS	183356	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
1818	Fee-for-Service	1629326418	1629326418	1	1	DAVID, SHANE LMFT	8/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6097 CLAREMONT AVE	None	OAKLAND	CA	94618	1299	01	06001	37.84917709	-122.2525307	Alameda County
1828	Fee-for-Service	1295758118	1295758118	1	1	DOZZI, PAULA A MD	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52456	08	Family Practice	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
1837	Fee-for-Service	1831215821	1831215821	1	1	DIETZ, LAUREL R LVN	1/1/2003	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1615 N HOMSY AVE	None	CLOVIS	CA	93619	3725	10	06019	36.86015261	-119.7161772	Fresno County
1931	Fee-for-Service	1669420956	1669420956	1	1	DE MARCO, TERESA A MD	3/31/1986	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52404	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	# 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
1956	Fee-for-Service	1275679946	1275679946	1	1	DSP HOME HEALTH, INC	3/14/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1815 E WORKMAN AVE	SUITE D	WEST COVINA	CA	91791	1423	19	06037	34.0755005	-117.9067905	Los Angeles County
2011	Fee-for-Service	1780119412	1780119412	1	1	DAVIS, JESSIE S DO	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	16770	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
2050	Fee-for-Service	1912107376	1912107376	1	1	DIAMOND, SUSAN P LMFT	10/23/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100515	-	NOT APPLICABLE	0	In state provider	None	11643 GLENOAKS BLVD	None	PACOIMA	CA	91331	1050	19	06037	34.28133474	-118.4198166	Los Angeles County
2063	Fee-for-Service	1770838104	1770838104	1	1	DAM-PEARSON, VI NP	7/12/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
2080	Fee-for-Service	1720168867	1720168867	1	1	DOLICH, MATTHEW O MD	10/31/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86284	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	BLDG 10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
2094	Fee-for-Service	1407399678	1407399678	1	1	DIGNITY HEALTH	8/16/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14921426	-122.2216794	Tehama County
2102	Fee-for-Service	1184781403	1184781403	1	1	DER, ROBERT	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
2110	Fee-for-Service	1548484835	1548484835	1	1	DUFFY, ALLISON K MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98122	05	Anesthesiology	0	In state provider	None	2420 CAMINO RAMON	STE 270	SAN RAMON	CA	94583	4319	07	06013	37.77229042	-121.9634581	Contra Costa County
2161	Fee-for-Service	1336907625	1336907625	1	1	DOULA SISTERS, LLC	6/19/2024	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
2164	Fee-for-Service	1780936906	1780936906	1	1	DOUS, GEORGE V MD	8/8/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	132794	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	999 S FAIRMONT AVE	STE 130	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
2204	Fee-for-Service	1104003185	1104003185	1	1	DANG, VIET VAN MD INC	2/1/2012	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48829	18	Ophthalmology	0	In state provider	None	10301 BOLSA AVE	SUITE 104	WESTMINSTER	CA	92683	2683	30	06059	33.74508782	-117.9495976	Orange County
2215	Fee-for-Service	1306464326	1306464326	1	1	DESERT AIDS PROJECT	3/2/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1695 N SUNRISE WAY	SUITE 201 AND 203	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
2221	Fee-for-Service	1972609568	1972609568	1	1	DATE, USHA V MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	33895	08	Family Practice	0	In state provider	None	6550 KNOTT AVE	None	BUENA PARK	CA	90621	2612	30	06059	33.86549373	-118.0112071	Orange County
2335	Fee-for-Service	1669834602	1669834602	1	1	DOUZJIAN, DANIEL J MD	8/17/2020	390200000X	NA	Other	026	PHYSICIANS	155754	05	Anesthesiology	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
2343	Fee-for-Service	1376754721	1376754721	1	1	DEUTSCHE, MARY A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	17402	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
2344	Fee-for-Service	1043820723	1043820723	1	1	DESTINY HOME HEALTH INC	7/22/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10201 RIVERSIDE DR	STE 200	TOLUCA LAKE	CA	91602	2538	19	06037	34.15223447	-118.3530465	Los Angeles County
2347	Fee-for-Service	1568696789	1568696789	1	1	DAO, HARRY MD	8/30/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	161936	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
2354	Fee-for-Service	1568573889	1568573889	2	1	DUNCANSON, SANDRA L B MD	4/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68308	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	136 NORTH SAN MATEO DR	SUITE 101	SAN MATEO	CA	94401	2779	41	06081	37.56923131	-122.3291888	San Mateo County
2361	Fee-for-Service	1790196731	1790196731	1	1	DAMEFF, CHRISTIAN J MD	6/23/2017	207P00000X	NA	Other	026	PHYSICIANS	149897	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
2368	Fee-for-Service	1134449994	1134449994	1	1	DEEPTI BODDUPALLI MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	3742	00	None	33.480864	-112.0795155	Maricopa County
2380	Fee-for-Service	1326090705	1326090705	1	1	DONAHUE, MARY JO MD	9/30/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43741	08	Family Practice	0	In state provider	None	20911 EARL ST	STE 400	TORRANCE	CA	90503	4355	19	06037	33.840459	-118.3580985	Los Angeles County
2381	Fee-for-Service	1174660385	1174660385	1	1	DELOATCH, CANDYCE J MD	8/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125972	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
2382	Fee-for-Service	1407399678	1407399678	1	1	DIGNITY HEALTH	8/16/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14921426	-122.2216794	Tehama County
2398	Fee-for-Service	1184057119	1184057119	1	1	DUVAL, MORGAN A LMFT	6/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
2419	Fee-for-Service	1518206424	1518206424	1	1	DENTONI-LASOFSKY, DENNIS R N	10/19/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2431	Fee-for-Service	1356875454	1356875454	1	1	DAVOODI, AUVA MD	10/13/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169477	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
2441	Fee-for-Service	1437163334	1437163334	1	1	DA LIO, ANDREW MD	8/1/1995	2086S0122X	NA	General Surgery	026	PHYSICIANS	78770	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
2467	Fee-for-Service	1245313964	1245313964	1	1	DILLON, CATHERINE H MD	3/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137977	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1311 E DATE ST	None	SAN BERNARDINO	CA	92404	4233	36	06071	34.14124247	-117.2585115	San Bernardino County
2503	Fee-for-Service	1306464326	1306464326	1	1	DESERT AIDS PROJECT	3/2/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1695 N SUNRISE WAY	SUITE 201 AND 203	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
2536	Fee-for-Service	1275613317	1275613317	1	1	DOW, EMILY EUNMEE	6/6/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77592	None	None	0	In state provider	None	1510 SAN PABLO ST	STE 143	LOS ANGELES	CA	90033	5321	19	06037	34.06287152	-118.2029433	Los Angeles County
2565	Fee-for-Service	1922060367	1922060367	1	1	DAVID PEASE MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
2576	Fee-for-Service	1629293204	1629293204	1	1	DOUMANIAN, LEO R MD	11/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55863	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
2650	Fee-for-Service	1851484562	1851484562	1	1	DAMON, JULIANA L MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	76398	40	Pediatrics	0	In state provider	None	5700 TELEGRAPH AVE	SUITE 100	OAKLAND	CA	94609	1710	01	06001	37.84323585	-122.2614659	Alameda County
2660	Fee-for-Service	1285386821	1285386821	1	1	DEL FIERRO MONROY, KAREN LC	2/14/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
2714	Fee-for-Service	1912135120	1912135120	1	1	DAVID Q. BELL M.D.	6/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
2729	Fee-for-Service	1558447250	1558447250	2	1	DEOL, SHIVINDER S MD	4/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	37723	08	Family Practice	0	In state provider	None	4000 STOCKDALE HWY	STE D	BAKERSFIELD	CA	93309	2059	15	06029	35.35429352	-119.0531115	Kern County
2753	Fee-for-Service	1053440446	1053440446	1	1	DUNAVAN, CHAE K LAC	3/2/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER ROAD	SUITE 122	TEMECULA	CA	92590	4858	33	06065	33.52030169	-117.1659061	Riverside County
2759	Fee-for-Service	1952599722	1952599722	1	1	DETORRES, JESSE A JR	7/1/1994	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	1236 N EL DORADO ST	STE 3	STOCKTON	CA	95202	1324	39	06077	37.96528882	-121.293196	San Joaquin County
2768	Fee-for-Service	1649203167	1649203167	1	1	DUTT, PHILIP L MD	11/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80286	22	Pathology (M.D. only)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
2782	Fee-for-Service	1548286172	1548286172	1	1	DRISCOLL CHILDREN'S HOSPITAL	10/10/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3533 SOUTH ALAMEDA ST	None	CORPUS CHRISTI	TX	78411	1721	00	None	27.7492523	-97.38499549	Nueces County
2792	Fee-for-Service	1568025856	1568025856	1	1	DOOLEN, CHRISTIN D LMFT	10/1/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4344 LATHAM ST	110	RIVERSIDE	CA	92501	1773	33	06065	34.00198519	-117.3739252	Riverside County
2798	Fee-for-Service	1780974626	1780974626	1	1	DIFFLEY, JAMES M MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114288	40	Pediatrics	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
2846	Fee-for-Service	1730323775	1730323775	1	1	DZENG, ELIZABETH W MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137585	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
2865	Fee-for-Service	1255340568	1255340568	1	1	DAVAINIS, PAUL C MD	12/26/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80205	08	Family Practice	0	In state provider	None	560 HOSPITAL LN	None	SUSANVILLE	CA	96130	4809	18	06035	40.40754008	-120.6666326	Lassen County
2871	Fee-for-Service	1134100597	1134100597	1	1	DAVID K HARRIS MD	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 MEDICAL PKWY	STE 570	AUSTIN	TX	78705	1024	00	None	30.30500791	-97.74430984	Travis County
2910	Fee-for-Service	1255738423	1255738423	1	1	DEL ROSARIO, GELEN R MD INC	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113471	None	None	0	In state provider	None	502 SOUTH EUCLID AVE	SUITE 300	NATIONAL CITY	CA	91950	2931	37	06073	32.68505421	-117.0832793	San Diego County
2920	Fee-for-Service	1326015975	1326015975	1	1	DAWSON, LINDSEY M MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93310	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2954	Fee-for-Service	1003005117	1003005117	1	1	DEMBNER, JEFFREY M MD INC	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74580	14	Neurological Surgery	0	In state provider	None	2617 E CHAPMAN AVE	SUITE 201	ORANGE	CA	92869	3226	30	06059	33.7878445	-117.8254845	Orange County
2957	Fee-for-Service	1922022441	1922022441	1	1	DING, JEAN MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78679	20	Orthopedic Surgery	0	In state provider	MEDFORD ORTHO MED CORP	723 S GARFIELD AVE	STE 301	ALHAMBRA	CA	91801	4430	19	06037	34.08841931	-118.1231009	Los Angeles County
2975	Fee-for-Service	1679692321	1679692321	1	1	DUSSEAU, LAURA R CRNA	1/9/2018	367H00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
2980	Fee-for-Service	1346783487	1346783487	1	1	DEYOE, EMILY PT	5/15/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
2983	Fee-for-Service	1780095430	1780095430	1	1	DESAI, RINI A MD	5/1/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	184538	None	None	0	In state provider	None	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
3069	Fee-for-Service	1548286172	1548286172	1	1	DRISCOLL CHILDREN'S HOSPITAL	10/10/2008	282NC2000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3533 SOUTH ALAMEDA ST	None	CORPUS CHRISTI	TX	78411	1721	00	None	27.7492523	-97.38499549	Nueces County
3085	Fee-for-Service	1497752877	1497752877	1	1	DAVIS, GREGORY L MD INC	4/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73638	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	111 RALEY BLVD	STE 220	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
3123	Fee-for-Service	1700871175	1700871175	1	1	DIKIN, MATTHEW S DO	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
3215	Fee-for-Service	1962650754	1962650754	1	1	DIAZ, SUSAN A NP	12/9/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
3241	Fee-for-Service	1922022441	1922022441	1	1	DING, JEAN MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78679	46	Hand Surgery	0	In state provider	MEDFORD ORTHO MED CORP	723 S GARFIELD AVE	STE 301	ALHAMBRA	CA	91801	4430	19	06037	34.08841931	-118.1231009	Los Angeles County
3242	Fee-for-Service	1124034285	1124034285	1	1	DRAKE, DAVID A MD	8/21/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	37207	10	Gastroenterology (M.D. only)	0	In state provider	None	2880 ATLANTIC AVE	STE 100	LONG BEACH	CA	90806	1739	19	06037	33.809382	-118.185001	Los Angeles County
3262	Fee-for-Service	1063096477	1063096477	1	1	DAN LE CARDIOLOGY	6/9/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	None	9500 BOLSA AVE	SUITE P	WESTMINSTER	CA	92683	5943	30	06059	33.74475113	-117.9634694	Orange County
3267	Fee-for-Service	1861601148	1861601148	1	2	DURIAN, BRADFORD	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
3280	Fee-for-Service	1952458549	1952458549	1	1	DIAZ, LISA M MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	51213	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
3291	Fee-for-Service	1710924006	1710924006	1	1	DOMINGUEZ, VICTOR G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55866	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
3304	Fee-for-Service	1750693925	1750693925	1	1	DALIA MIKHAEL M.D.	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
3305	Fee-for-Service	1760913867	1760913867	1	1	DURAN, JUAN MD	10/18/2023	2084N0402X	NA	Neurology	026	PHYSICIANS	187347	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
3329	Fee-for-Service	1134345622	1134345622	1	1	DECKER, DONALD E MD	8/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101962	None	None	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
3339	Fee-for-Service	1528323698	1528323698	1	1	DUNLOP, JAMES D MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129960	07	Dermatology	0	In state provider	None	2950 RESEARCH PARK DRIVE	None	SOQUEL	CA	95073	2000	44	06087	36.98692657	-121.9685264	Santa Cruz County
3368	Fee-for-Service	1205880796	1205880796	1	1	DEPINERES, TERESA MD	1/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84354	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	# 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
3407	Fee-for-Service	1619768629	1619768629	1	1	DOULA TE-RUCK LLC	5/16/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
3433	Fee-for-Service	1548259435	1548259435	1	1	DAVIS, MICHAEL E D.O.	2/6/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	567300	01	General Practice	0	In state provider	None	1010 CASS ST	STE D2	MONTEREY	CA	93940	4515	27	06053	36.59171985	-121.8968501	Monterey County
3435	Fee-for-Service	1467063479	1467063479	1	1	DC3 THERAPEUTICS LLC	5/27/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	163 W HARRIS AVE	None	SOUTH SAN FRANCIS	CA	94080	6008	41	06081	37.65051275	-122.4013953	San Mateo County
3502	Fee-for-Service	1649858150	1649858150	1	1	DAO, ANNIE M PT	12/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
3528	Fee-for-Service	1578694014	1578694014	1	1	DYER, LANITA P MFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82475	-	NOT APPLICABLE	0	In state provider	None	515 E 6TH STREET	None	LOS ANGELES	CA	90021	1009	19	06037	34.04209683	-118.2449329	Los Angeles County
3565	Fee-for-Service	1689039349	1689039349	1	1	DESROSIERS, KAYLEIGH A PT	8/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
3566	Fee-for-Service	1700948262	1700948262	1	1	DUPONT, DEBORAH R CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
3568	Fee-for-Service	1952458549	1952458549	1	1	DIAZ, LISA M MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	51213	15	Obstetrics (D.O. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
3593	Fee-for-Service	1275042178	1275042178	1	1	DUNN, MIKAELA O	3/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
3653	Fee-for-Service	1609960897	1609960897	1	1	DAI AN CORP	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10507 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1128	30	06059	33.77417854	-117.9492568	Orange County
3657	Fee-for-Service	1033175765	1033175765	1	1	DESAIBRO,LUCIANA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1350 E MEDICAL CTR DR	None	ST GEORGE	UT	84790	2122	00	None	37.09977964	-113.5541375	Washington County
3661	Fee-for-Service	1972043164	1972043164	1	1	DIAZ, SUSANA P LCSW	5/4/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
3680	Fee-for-Service	1346213329	1346213329	1	1	DOBECKI, DOUGLAS MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81761	05	Anesthesiology	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
3697	Fee-for-Service	1801936331	1801936331	1	1	DAS, SHEEJA MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92077	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
3721	Fee-for-Service	1548259435	1548259435	1	1	DAVIS, MICHAEL E D.O.	2/6/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	567300	08	Family Practice	0	In state provider	None	1010 CASS ST	STE D2	MONTEREY	CA	93940	4515	27	06053	36.59171985	-121.8968501	Monterey County
3734	Fee-for-Service	1861805939	1861805939	1	1	DO, HIEU DUC N MD	6/28/2018	390200000X	NA	Other	026	PHYSICIANS	138071	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90809	1701	19	06037	33.808185	-118.1850575	Los Angeles County
3835	Fee-for-Service	1578692141	1578692141	1	1	DELGADO, JANET M NP	1/17/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE.	SUITE 202	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
3868	Fee-for-Service	1871160713	1871160713	1	1	DING, LI MD	3/11/2024	207P00000X	NA	Other	026	PHYSICIANS	183216	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
3898	Fee-for-Service	1609315746	1609315746	1	1	DAWES, TRACY NP	6/30/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	560 N ARROWHEAD AVE	2B	SAN BERNARDINO	CA	92404	4234	36	06071	34.109496	-117.289667	San Bernardino County
3931	Fee-for-Service	1548894066	1548894066	1	1	DEAN, EVAN C CNP	12/8/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	54	06107	36.330327	-119.351943	Tulare County
3945	Fee-for-Service	1609960897	1609960897	1	1	DAI AN CORP	5/10/2002	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10507 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1128	30	06059	33.77417854	-117.9492568	Orange County
4007	Fee-for-Service	1982680864	1982680864	1	1	DOLAN, JANICE M	6/10/2003	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1832 B ST	None	HAYWARD	CA	94541	3140	01	06001	37.68193983	-122.0671071	Alameda County
4068	Fee-for-Service	1295203131	1295203131	1	2	DONN & DOFF INC	2/12/2024	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	THETICS	574 MANZANITA AVE	SUITE 11	CHICO	CA	95926	1369	04	06007	39.75539805	-121.8433306	Butte County
4162	Fee-for-Service	1437320660	1437320660	1	1	DAT DUONG, MD, INC.	4/17/2008	207R00000X	NA	Other	026	PHYSICIANS	77545	None	None	0	In state provider	None	13926 BEACH BLVD	None	WESTMINSTER	CA	92683	4037	30	06059	33.7606257	-117.9894811	Orange County
4176	Fee-for-Service	1811232887	1811232887	1	1	DAFTARIAN, ZAHRA NP	6/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
4233	Fee-for-Service	1730164237	1730164237	1	1	DEWEERD, JOHN MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	STE 13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
4237	Fee-for-Service	1245487982	1245487982	1	1	DESADIER, LAURA L K DO	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14045	01	General Practice	0	In state provider	None	3907 WARING ROAD	SUITE 2	OCEANSIDE	CA	92056	4454	37	06073	33.18780783	-117.2918439	San Diego County
4246	Fee-for-Service	1447333497	1447333497	1	1	DAO,HUY D MD	4/25/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60118	None	None	0	In state provider	None	20 ALLEN ST	STE 300	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
4248	Fee-for-Service	1063621308	1063621308	1	1	DRUCKER, STANTON M	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	419 CHESTNUT ST	SUITE 4	MOUNT SHASTA	CA	96067	2290	47	06093	41.31492405	-122.3131185	Siskiyou County
4280	Fee-for-Service	1609008143	1609008143	1	1	DHANASEKARAN, RENUMATHY MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136461	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4358	Fee-for-Service	1598129223	1598129223	1	1	DASGUPTA, DEBORSHI DPM	1/5/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
4360	Fee-for-Service	1881662161	1881662161	1	1	DIEM, LAURIE L DO	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7699	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
4373	Fee-for-Service	1942720164	1942720164	1	1	DEUTSCH, JOSHUA L MD	9/18/2020	390200000X	NA	Other	026	PHYSICIANS	162840	08	Family Practice	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
4408	Fee-for-Service	1548946049	1548946049	1	1	DAY, CAROLYN	10/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
4494	Fee-for-Service	1245438787	1245438787	1	2	DEGUZMAN MEDICAL CORP	10/13/1999	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1525 SUPERIOR AVE	STE 200	NEWPORT BEACH	CA	92663	3639	30	06059	33.6297071	-117.9300427	Orange County
4496	Fee-for-Service	1124151360	1124151360	1	1	DEEL, MARGARET G MD	6/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51529	08	Family Practice	0	In state provider	None	593 E ELDER ST	SUITE B	FALLBROOK	CA	92028	5000	37	06073	33.3801147	-117.2453962	San Diego County
4497	Fee-for-Service	1497151435	1497151435	1	1	DUONG, LEANNE K NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
4507	Fee-for-Service	1164416517	1164416517	1	1	DRUMMOND, HARRY MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29685	08	Family Practice	0	In state provider	None	2950 SYCAMORE DR	STE 300	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
4510	Fee-for-Service	1861595779	1861595779	1	1	DEARMOND, DANIEL T MD	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95907	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
4519	Fee-for-Service	1780822809	1780822809	1	1	DANA CLAIRE GINGELL M.D.	12/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1372 S 300 E	# SOUTH	SALT LAKE CTY	UT	84115	1502	00	None	40.73992899	-111.882527	Salt Lake County
4572	Fee-for-Service	1417994708	1417994708	1	1	DIALLO, DIANNA L MD	3/2/2009	174400000X	NA	Other	026	PHYSICIANS	86861	40	Pediatrics	0	In state provider	None	20 UPPER RAGSDALE ROAD	B-210	MONTEREY	CA	93940	4507	27	06053	36.57475942	-121.8102251	Monterey County
4638	Fee-for-Service	1528122330	1528122330	1	1	DAVALLE, BRANDON L DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12924	05	Anesthesiology	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
4684	Fee-for-Service	1689646952	1689646952	1	1	DO, JACQUELINE	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	78274	41	Internal Medicine	0	In state provider	None	3333 SKYPARK DR	None	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
4699	Fee-for-Service	1275191850	1275191850	1	1	DAROUICHI, JOLINE N MD	10/16/2024	208M00000X	NA	Other	026	PHYSICIANS	176945	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
4700	Fee-for-Service	1750541728	1750541728	1	1	DESILVA, NEFERTITI	4/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
4718	Fee-for-Service	1730495201	1730495201	1	1	DUBE, SUTAPA MD	4/11/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	143282	36	Psychiatry	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
4766	Fee-for-Service	1801085394	1801085394	1	1	DENHAM, CARI LMFT	8/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
4781	Fee-for-Service	1245438787	1245438787	1	2	DEGUZMAN MEDICAL CORP	10/13/1999	193200000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1525 SUPERIOR AVE	STE 200	NEWPORT BEACH	CA	92663	3639	30	06059	33.6297071	-117.9300427	Orange County
4795	Fee-for-Service	1164416517	1164416517	1	1	DRUMMOND, HARRY MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29685	01	General Practice	0	In state provider	None	2950 SYCAMORE DR	STE 300	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
4798	Fee-for-Service	1164884284	1164884284	1	1	DUONG, NIKKI K MD	12/29/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	192254	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
4808	Fee-for-Service	1932368560	1932368560	1	1	DE VIDO, JEFFREY J MD	11/20/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	126745	-	NOT APPLICABLE	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
4820	Fee-for-Service	1548453574	1548453574	1	1	DELTA CARE INC	12/12/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4705 N SONORA AVE	113A	FRESNO	CA	93722	3966	10	06019	36.806112	-119.8659475	Fresno County
4923	Fee-for-Service	1104985852	1104985852	1	1	DAWSON, KELLY J MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73958	41	Internal Medicine	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
4936	Fee-for-Service	1801866058	1801866058	1	1	DUPREZ, DENEL L LCSW	9/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8253 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10363411	-117.5643979	San Bernardino County
4991	Fee-for-Service	1831600204	1831600204	2	1	DUARTE, TAMMY C HAD	2/20/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2530 ATLANTIC AVENUE	SUITE D	LONG BEACH	CA	90806	2741	19	06037	33.803172	-118.185004	Los Angeles County
5006	Fee-for-Service	1730495201	1730495201	1	1	DUBE, SUTAPA MD	4/11/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	143282	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
5066	Fee-for-Service	1902802192	1902802192	1	1	DONNELLY, MARK E MD	12/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
5073	Fee-for-Service	1730184896	1730184896	1	1	DUMAS, ARMEN J MD	6/30/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37346	25	Physical Medicine and Rehabilitation	0	In state provider	None	9545 RESEDA BLVD	STE 4	NORTHRIDGE	CA	91324	2351	19	06037	34.24381621	-118.5361155	Los Angeles County
5085	Fee-for-Service	1063571818	1063571818	1	1	DAETZ, EFUA S	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
5095	Fee-for-Service	1891975538	1891975538	1	1	DE CLERCK MATTHIEU MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101627	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
5097	Fee-for-Service	1932368560	1932368560	1	1	DE VIDO, JEFFREY J MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126745	36	Psychiatry	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
5267	Fee-for-Service	1821063710	1821063710	1	1	DULOS, RONALD G MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87602	41	Internal Medicine	0	In state provider	None	6405 DAY STREET	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
5272	Fee-for-Service	1528233731	1528233731	1	1	DOLGASHEVA, ASSOL D MD	2/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101337	40	Pediatrics	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
5293	Fee-for-Service	1730495201	1730495201	1	1	DUBE, SUTAPA MD	4/11/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	143282	13	Neurology (M.D. only)	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
5376	Fee-for-Service	1417397555	1417397555	1	1	DE NITTO, LAUREN N LCSW	6/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3401 GLENDALE	B	LOS ANGELES	CA	90039	1814	19	06037	34.12026367	-118.2585836	Los Angeles County
5429	Fee-for-Service	1821623281	1821623281	1	1	DELAPENA, RINA NP	12/17/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
5452	Fee-for-Service	1639221872	1639221872	1	1	DOWNS, PAMELA C	12/26/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	22550 E SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4670	30	06059	33.87448406	-117.7441707	Orange County
5463	Fee-for-Service	1366079600	1366079600	1	1	DIAMOND CARE PHARMACY, INC.	4/13/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21337 COLD SPRING LN	None	DIAMOND BAR	CA	91765	3443	19	06037	33.9733362	-117.8400213	Los Angeles County
5509	Fee-for-Service	1366903825	1366903825	1	2	DERMA NOOR INC	9/26/2022	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	14331 EUCLID STREET	SUITE 104	GARDEN GROVE	CA	92843	6509	30	06059	33.754329	-117.9376195	Orange County
5538	Fee-for-Service	1295766442	1295766442	1	1	DOUTY, REGAN S DO	5/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7064	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
5544	Fee-for-Service	1619090198	1619090198	1	1	DHARMADAS, SANDHYA	7/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
5618	Fee-for-Service	1699981704	1699981704	1	1	DANGARAN, KAROL D MD	7/1/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	73555	07	Dermatology	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
5631	Fee-for-Service	1841781499	1841781499	1	1	DR. BLINK OPTOMETRY	2/27/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	605 FLETCHER PKWY	None	EL CAJON	CA	92020	2522	37	06073	32.8075167	-116.9697503	San Diego County
5636	Fee-for-Service	1295844264	1295844264	1	1	DAVID PAUL T	2/28/1994	207P00000X	NA	Other	026	PHYSICIANS	37841	66	Emergency Medicine (Urgent Care)	0	In state provider	LOS ROBLES EMERGENCY	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
5659	Fee-for-Service	1861475683	1861475683	1	1	DOLKAR, DECHEN MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54946	78	Neoplastic Diseases/Oncology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
5667	Fee-for-Service	1053873315	1053873315	1	2	DOYLE, KIERAN S MD	7/31/2022	207R00000X	NA	Other	026	PHYSICIANS	179956	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
5689	Fee-for-Service	1730305855	1730305855	1	2	DADASHI, HAMID R LMFT	12/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
5730	Fee-for-Service	1902088438	1902088438	1	1	DITTMAR, KRISTIN M MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91001	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
5804	Fee-for-Service	1558605816	1558605816	1	1	DAVIS-BURKETT FOOD CORP	6/16/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	495 N STATE ST	None	LA VERKIN	UT	84745	5124	00	None	37.21040203	-113.2722183	Washington County
5814	Fee-for-Service	1689606949	1689606949	1	1	DAVID ANDREW SAMS, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1530 9TH ST N	None	ST PETERSBURG	FL	33704	4202	00	None	27.78664382	-82.64678576	Pinellas County
5830	Fee-for-Service	1184731580	1184731580	1	1	DYKES, JENNIFER L MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80441	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
5839	Fee-for-Service	1306039300	1306039300	1	1	DAHIYA, SHYAM L MD INC	12/1/2022	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3650 SOUTH ST	STE 412	LAKEWOOD	CA	90712	1500	19	06037	33.86019847	-118.149255	Los Angeles County
5844	Fee-for-Service	1174151492	1174151492	1	1	DATTA, SORABH MD	9/22/2023	207R00000X	NA	Other	026	PHYSICIANS	187357	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
5857	Fee-for-Service	1922472331	1922472331	1	1	DELUCA, SARAH M PSYD	8/13/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
5897	Fee-for-Service	1619174992	1619174992	1	1	DR. SHRUTI SAWHNEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	0000	00	None	45.720117	-122.647986	Clark County
5943	Fee-for-Service	1861475683	1861475683	1	1	DOLKAR, DECHEN MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54946	30	Radiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
6049	Fee-for-Service	1093201170	1093201170	1	1	DING, ANDREW MD	9/3/2022	207L00000X	NA	Other	026	PHYSICIANS	166276	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
6078	Fee-for-Service	1215086996	1215086996	1	1	DAVI, JODI A MD	1/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80461	40	Pediatrics	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
6095	Fee-for-Service	1598904112	1598904112	1	1	DAHLIN, SARA P MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93712	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
6097	Fee-for-Service	1114003043	1114003043	1	1	DAILEY, THOMAS MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61739	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
6127	Fee-for-Service	1306039300	1306039300	1	1	DAHIYA, SHYAM L MD INC	12/1/2022	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3650 SOUTH ST	STE 412	LAKEWOOD	CA	90712	1500	19	06037	33.86019847	-118.149255	Los Angeles County
6128	Fee-for-Service	1124034707	1124034707	1	1	DAVID K. ESPEY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
6135	Fee-for-Service	1215942818	1215942818	1	1	DANTHUY,DAO N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEDIATRIC HOSP OS AZ	19829 N 27TH AVE	None	PHOENIX	AZ	85027	0000	00	None	33.665616	-112.116267	Maricopa County
6173	Fee-for-Service	1720178619	1720178619	1	1	DOUGLAS S DIEKEMA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
6176	Fee-for-Service	1457396012	1457396012	1	1	DOBBS, SARA E MD	9/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78107	01	General Practice	0	In state provider	None	2191 MOWRY AVE	STE 600C	FREMONT	CA	94538	1702	01	06001	37.55710897	-121.9814562	Alameda County
6194	Fee-for-Service	1073604666	1073604666	1	1	DEEKS, STEVEN G MD	12/31/1991	207R00000X	NA	Other	026	PHYSICIANS	73895	41	Internal Medicine	0	In state provider	None	1 CENTRAL AVE	None	SAN FRANCISCO	CA	94117	4114	38	06075	37.7690226	-122.443365	San Francisco County
6264	Fee-for-Service	1053929604	1053929604	1	1	DE LEON, ELSA A	7/24/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	635 CORONADO AVE	APT 1	LONG BEACH	CA	90814	5045	19	06037	33.77423574	-118.1535636	Los Angeles County
6274	Fee-for-Service	1013624030	1013624030	1	1	DIKE, ABIGAIL	8/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13455 GETTYSBURG ST	None	FONTANA	CA	92336	5469	36	06071	34.11595248	-117.5116905	San Bernardino County
6282	Fee-for-Service	1912362377	1912362377	1	1	DT PHARMACY CORPORATION	8/3/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5507 EL CAJON BLVD	STE E	SAN DIEGO	CA	92115	3624	37	06073	32.75824665	-117.0763619	San Diego County
6295	Fee-for-Service	1225424914	1225424914	1	1	DIETRICH, ELISABETH M MD	8/28/2018	390200000X	NA	Other	026	PHYSICIANS	144592	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
6332	Fee-for-Service	1821289323	1821289323	1	1	DELGADO, CYNTHIA MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100452	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6353	Fee-for-Service	1851333686	1851333686	1	1	DANA-FARBER CANCER INSTITUTE	12/21/2022	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	450 BROOKLINE AVE	None	BOSTON	MA	02215	5418	00	None	42.33808422	-71.10808576	Suffolk County
6389	Fee-for-Service	1023042496	1023042496	1	1	DANOFF, DUDLEY S MD	11/27/1985	208800000X	NA	Other	026	PHYSICIANS	10704	34	Urology and Urological Surgery	0	In state provider	None	8631 W 3RD ST	STE 915E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
6443	Fee-for-Service	1891372819	1891372819	1	1	DIRECT CARE HOME HEALTH	8/25/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	17622 SHERMAN WAY	None	VAN NUYS	CA	91406	3509	19	06037	34.20105757	-118.5171089	Los Angeles County
6475	Fee-for-Service	1548787559	1548787559	1	1	DURAN, ELISA G	8/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119405	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
6478	Fee-for-Service	1053478784	1053478784	1	1	DIMMER, BRIAN M MD	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133299	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
6511	Fee-for-Service	1538327721	1538327721	1	1	DHILLON, HARKANWAL MD	7/21/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	120757	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
6517	Fee-for-Service	1083927552	1083927552	1	1	DE ST MAURICE, ANNABELLE M	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149993	77	Infectious Disease	0	In state provider	MD	10833 LE CONTE AV	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6553	Fee-for-Service	1053929604	1053929604	1	1	DE LEON, ELSA A	7/24/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	635 CORONADO AVE	APT 1	LONG BEACH	CA	90814	5045	19	06037	33.77423574	-118.1535636	Los Angeles County
6561	Fee-for-Service	1013624030	1013624030	1	1	DIKE, ABIGAIL	8/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13455 GETTYSBURG ST	None	FONTANA	CA	92336	5469	36	06071	34.11595248	-117.5116905	San Bernardino County
6578	Fee-for-Service	1548596885	1548596885	1	1	DREW DE PAZ, JESSICA PSYD	1/15/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
6599	Fee-for-Service	1104827922	1104827922	1	1	DICKINSON, WADE A MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62554	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	HEALTH MEDICAL GRP INC	3152 N MILLBROOK AVE	STE B	FRESNO	CA	93703	1459	10	06019	36.779166	-119.7634925	Fresno County
6610	Fee-for-Service	1235624321	1235624321	1	1	DE LA VARA, DALLAS J MD	9/4/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	175169	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
6614	Fee-for-Service	1477502904	1477502904	1	1	DEMITZ, CHARLES G MD	5/31/1984	207L00000X	NA	Other	026	PHYSICIANS	34599	05	Anesthesiology	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
6617	Fee-for-Service	1639200694	1639200694	1	2	DIDI HIRSCH PSYCHIATRIC SERV	6/5/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	323 N PRAIRIE AVE	150, 155, 290, 315, 325,	INGLEWOOD	CA	90301	4502	19	06037	33.966333	-118.3439975	Los Angeles County
6640	Fee-for-Service	1851333686	1851333686	1	1	DANA-FARBER CANCER INSTITUTE	12/21/2022	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	450 BROOKLINE AVE	None	BOSTON	MA	02215	5418	00	None	42.33808422	-71.10808576	Suffolk County
6753	Fee-for-Service	1154457091	1154457091	1	1	DIRBAS, FREDERICK M MD	4/30/1992	208600000X	NA	General Surgery	026	PHYSICIANS	58935	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
6759	Fee-for-Service	1750488003	1750488003	1	1	DRASIN, TODD E MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77286	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6771	Fee-for-Service	1164629663	1164629663	1	1	DAYNE, MARGARET N	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	636 CRESTGLEN RD	None	GLENDORA	CA	91741	2178	19	06037	34.14915312	-117.8558391	Los Angeles County
6774	Fee-for-Service	1962835983	1962835983	1	1	DUNNIGAN, SARA R PSYD	9/10/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
6806	Fee-for-Service	1083927552	1083927552	1	1	DE ST MAURICE, ANNABELLE M	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149993	40	Pediatrics	0	In state provider	MD	10833 LE CONTE AV	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
6846	Fee-for-Service	1255817821	1255817821	1	1	DI BELLA, MARTINA MD	9/20/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158633	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
6876	Fee-for-Service	1649295114	1649295114	1	1	DELAPENA, ALBERT MD	1/31/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	26114	18	Ophthalmology	0	In state provider	None	2446 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
6947	Fee-for-Service	1013972231	1013972231	1	1	DEL ROSSO, LOURDES M MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	74082	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
6949	Fee-for-Service	1326007253	1326007253	1	1	DE PERALTA-VENTURINA,MARIZA	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	69166	22	Pathology (M.D. only)	0	In state provider	MD	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
6976	Fee-for-Service	1710192489	1710192489	1	1	DARSHIL SHAH	2/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13677 W MCDOWELL RD	None	GOODYEAR	AZ	85395	2635	00	None	33.461982	-112.3535475	Maricopa County
6997	Fee-for-Service	1588154116	1588154116	1	1	DULCE VILLA	1/25/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	66147 S AGUA DULCE DR	None	DESERT HOT SPRING	CA	92240	8111	33	06065	33.94353771	-116.5075695	Riverside County
7033	Fee-for-Service	1861616369	1861616369	1	1	DAVIS, LAYLA I LCSW	7/11/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
7046	Fee-for-Service	1003801457	1003801457	1	1	DICICCO, VICTORIA F PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5190 GOVERNOR DR	STE 108	SAN DIEGO	CA	92122	2848	37	06073	32.85681284	-117.1855521	San Diego County
7072	Fee-for-Service	1124638697	1124638697	1	1	DE LA CRUZ, CINDY M NP	12/14/2020	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1212 S MAIN ST	None	SALINAS	CA	93901	2260	27	06053	36.65759539	-121.6594973	Monterey County
7084	Fee-for-Service	1578628699	1578628699	1	1	DHAR, NAVEEN MD INC	10/1/2000	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 614	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
7128	Fee-for-Service	1568173037	1568173037	1	1	DR. STACY PIPES-JOYNER, LICE	1/4/2023	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NSED CLINICAL SOCIAL INC	6809 INDIANA AVE	130 B-11	RIVERSIDE	CA	92506	4221	33	06065	33.94312844	-117.3918196	Riverside County
7139	Fee-for-Service	1437379765	1437379765	1	1	DECCAN PACIFIC MEDICAL	2/22/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP, APC	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1758	01	06001	37.55887933	-121.9797796	Alameda County
7163	Fee-for-Service	1295731057	1295731057	1	1	DE LA STAR PHARMACY INC	8/1/2002	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1839	19	06037	34.17449827	-118.3274146	Los Angeles County
7239	Fee-for-Service	1326007253	1326007253	1	1	DE PERALTA-VENTURINA,MARIZA	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	69166	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	MD	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
7273	Fee-for-Service	1316081409	1316081409	1	1	DANG, HIEP DINH DO INC	2/21/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7610	08	Family Practice	0	In state provider	None	14160 BROOKHURST ST	None	GARDEN GROVE	CA	92843	4657	30	06059	33.757002	-117.9548115	Orange County
7284	Fee-for-Service	1417365545	1417365545	1	1	DORNIKA MEDICAL INC	5/5/2015	193400000X	NA	Other	026	PHYSICIANS	76326	01	General Practice	0	In state provider	None	2121 S SAN PEDRO ST	UNIT E	LOS ANGELES	CA	90011	1160	19	06037	34.02515231	-118.2590546	Los Angeles County
7319	Fee-for-Service	1760455075	1760455075	1	1	DICKSON, RICHARD L MD	9/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	2	Out of state provider	None	530 BOGACHIEL WAY	None	FORKS	WA	98331	9120	00	None	47.946141	-124.3931915	Clallam County
7371	Fee-for-Service	1578628699	1578628699	1	1	DHAR, NAVEEN MD INC	10/1/2000	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 614	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
7394	Fee-for-Service	1255416400	1255416400	1	1	DIAGNOSTIC PATH MED GRP	6/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
7420	Fee-for-Service	1386799377	1386799377	1	1	DEETHS, TONY M MD	1/1/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20695	30	Radiology	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
7426	Fee-for-Service	1437379765	1437379765	1	1	DECCAN PACIFIC MEDICAL	2/22/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, APC	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1758	01	06001	37.55887933	-121.9797796	Alameda County
7439	Fee-for-Service	1679651434	1679651434	1	1	DUGHMAN, SAMI S MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	35556	20	Orthopedic Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
7450	Fee-for-Service	1437133741	1437133741	1	1	DOCTOR, VISHAL S MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84162	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1207 FAIRCHILD COURT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
7453	Fee-for-Service	1821009812	1821009812	1	1	DEIRMENJIAN, JOHN MD APC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77009	36	Psychiatry	0	In state provider	None	4510 E PACIFIC COAST HWY	STE 120	LONG BEACH	CA	90804	6939	19	06037	33.78815204	-118.1400821	Los Angeles County
7461	Fee-for-Service	1396216719	1396216719	1	1	DEEFLAT LLC	2/1/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	2580 HIGHWAY 95	STE 106	BULLHEAD CITY	AZ	86442	7324	00	None	34.2909	-114.1249005	La Paz County
7475	Fee-for-Service	1609132034	1609132034	1	1	DORWART, ELIZABETH A DO	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12998	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
7555	Fee-for-Service	1548319494	1548319494	1	1	DEVELOPMENTAL CLIENT	10/4/1992	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE/COVEY QUAIL HOUSE	13802 COVEY QUAIL LN	None	MORENO VALLEY	CA	92553	3870	33	06065	33.91994454	-117.2311107	Riverside County
7621	Fee-for-Service	1306942073	1306942073	1	1	DRESSNER, MARK D MD	6/1/1998	207QA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	49222	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
7642	Fee-for-Service	1841436706	1841436706	1	1	DINENBERG, ROBERT E MD	4/27/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	80408	01	General Practice	0	In state provider	None	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	37	06073	32.77677653	-117.1592911	San Diego County
7652	Fee-for-Service	1477715829	1477715829	1	1	DR. ZACHARY VEST	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W 16TH AVE	None	DENVER	CO	80204	1335	00	None	39.74280302	-105.0412741	City and County of Denver
7706	Fee-for-Service	1386799377	1386799377	1	1	DEETHS, TONY M MD	1/1/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20695	42	Nuclear Medicine	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
7715	Fee-for-Service	1437379765	1437379765	1	1	DECCAN PACIFIC MEDICAL	2/22/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	GROUP, APC	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1758	01	06001	37.55887933	-121.9797796	Alameda County
7737	Fee-for-Service	1215469721	1215469721	1	1	DAVID HEWSON	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
7742	Fee-for-Service	1821009812	1821009812	1	1	DEIRMENJIAN, JOHN MD APC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77009	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4510 E PACIFIC COAST HWY	STE 120	LONG BEACH	CA	90804	6939	19	06037	33.78815204	-118.1400821	Los Angeles County
7757	Fee-for-Service	1336189091	1336189091	1	1	DRAKE, DEBRA L MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144613	08	Family Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
7764	Fee-for-Service	1174834055	1174834055	1	1	DOWNING, STEPHANIE R MD	2/26/2021	2086S0102X	NA	General Surgery	026	PHYSICIANS	127403	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
7772	Fee-for-Service	1801963020	1801963020	1	2	DELGADO, ELIANA D MD	7/1/2004	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1759 SWEETWOOD DR	None	DALY CITY	CA	94015	2012	41	06081	37.68858176	-122.4790329	San Mateo County
7786	Fee-for-Service	1306810031	1306810031	2	1	DE LA MERCED, JOEL R MD	10/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50414	40	Pediatrics	0	In state provider	None	3110 CHINO AVE	STE 250	CHINO HILLS	CA	91709	3518	36	06071	34.01077341	-117.738406	San Bernardino County
7801	Fee-for-Service	1215304944	1215304944	1	1	DOMKE, CHRISTOPHER PSYD	8/2/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
7845	Fee-for-Service	1043506728	1043506728	1	1	DAI, QIYUAN MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127877	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
7859	Fee-for-Service	1700143799	1700143799	1	1	DANG, JULIUS MD	11/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136581	01	General Practice	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
7908	Fee-for-Service	1306942073	1306942073	1	1	DRESSNER, MARK D MD	6/1/1998	207QA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	49222	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
7982	Fee-for-Service	1861490674	1861490674	1	1	DIMITROVA, ALBENA V MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86862	41	Internal Medicine	0	In state provider	None	780 E WASHINGTON BLVD	STE 202	CRESCENT CITY	CA	95531	8397	08	06015	41.775246	-124.194447	Del Norte County
8003	Fee-for-Service	1396759346	1396759346	1	1	DAVIS, KAREN J MD	8/31/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45723	08	Family Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
8093	Fee-for-Service	1104057157	1104057157	2	1	DR AMIR LEBASCHI A PROFESSIO	3/20/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	INSTITUTE	2220 E FRUIT STREET	STE 214	SANTA ANA	CA	92701	4459	30	06059	33.75277851	-117.8354745	Orange County
8103	Fee-for-Service	1558352351	1558352351	1	1	DANESCU, ADRIAN G MD	5/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83107	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
8114	Fee-for-Service	1073557757	1073557757	2	1	DEL RIO, MICHAEL J MD	9/12/2013	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50089	33	Thoracic Surgery	0	In state provider	None	28062 BAXTER RD	None	MURRIETA	CA	92562	5987	33	06065	33.61350847	-117.1691225	Riverside County
8123	Fee-for-Service	1407130727	1407130727	2	1	DENTAL SURGERY CENTERS OF	6/1/2019	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	AMERICA	1418 E MAIN ST	STE 110	SANTA MARIA	CA	93454	4833	42	06083	34.95286855	-120.4137315	Santa Barbara County
8126	Fee-for-Service	1235436023	1235436023	1	1	DO, JANET T MD	3/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113849	40	Pediatrics	0	In state provider	None	1045 ATLANTIC AVE	SUITE 605	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
8157	Fee-for-Service	1588074090	1588074090	1	1	DASIG, NATASHA V DO	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14679	36	Psychiatry	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
8214	Fee-for-Service	1760463830	1760463830	1	1	DAVIS, BRIAN A MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85393	25	Physical Medicine and Rehabilitation	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
8229	Fee-for-Service	1962089763	1962089763	1	1	DACASIN, RAFFIE V NP	11/2/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1920 TIENDA DR	STE 102	LODI	CA	95242	3930	39	06077	38.11678155	-121.2957005	San Joaquin County
8265	Fee-for-Service	1760593248	1760593248	1	1	DE HAAS, DAVID D MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	52573	08	Family Practice	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
8271	Fee-for-Service	1902808793	1902808793	1	1	DAVID MOODY	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 N THIRD AVE	None	SANDPOINT	ID	83864	1507	00	None	48.27786153	-116.5503511	Bonner County
8280	Fee-for-Service	1932281698	1932281698	1	1	DE LA TORRE, ANA PSYD	2/12/2025	225400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
8295	Fee-for-Service	1396141230	1396141230	1	1	DESAI, ARCHIS D MD	6/26/2018	207R00000X	NA	Other	026	PHYSICIANS	144563	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
8348	Fee-for-Service	1205034287	1205034287	1	1	DANIEL, EMAD H	3/11/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	123454	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
8357	Fee-for-Service	1528582186	1528582186	1	1	DANIEL EUBANKS	2/13/2024	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
8381	Fee-for-Service	1487609194	1487609194	1	1	DELPERO, RICHARD D MD	7/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49635	05	Anesthesiology	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
8384	Fee-for-Service	1801497706	1801497706	1	1	DE JESUS, ANA MARIA C NP	3/11/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
8413	Fee-for-Service	1720577687	1720577687	1	1	DANG, MARVIN T DO	12/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23024	08	Family Practice	0	In state provider	None	6344 TOPANGA CANYON BLVD	2040, 2060	WOODLAND HILLS	CA	91367	2362	19	06037	34.18515	-118.605863	Los Angeles County
8436	Fee-for-Service	1366632416	1366632416	1	1	DENNIS, AMY C MD	11/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111627	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
8457	Fee-for-Service	1548412026	1548412026	1	2	DE LA MOTTE, GRANT A MD	8/3/2021	2084N0008X	NA	Neurology	026	PHYSICIANS	106740	13	Neurology (M.D. only)	0	In state provider	None	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
8464	Fee-for-Service	1689986507	1689986507	1	1	DOUGHERTY, ALEXIS L MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126933	07	Dermatology	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
8469	Fee-for-Service	1942650981	1942650981	1	1	DOLEZAL, KEVIN S MD	1/5/2018	390200000X	NA	Other	026	PHYSICIANS	151777	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
8550	Fee-for-Service	1760593248	1760593248	1	1	DE HAAS, DAVID D MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	52573	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
8580	Fee-for-Service	1841473154	1841473154	1	1	DONG, HOANG S MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97540	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
8589	Fee-for-Service	1770523052	1770523052	1	1	DUKE, HENRY H MD	3/17/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	97274	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
8608	Fee-for-Service	1467487181	1467487181	1	1	DIAMANT, ALLISON L MD	8/1/1994	207R00000X	NA	Other	026	PHYSICIANS	78863	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
8623	Fee-for-Service	1770136228	1770136228	1	1	DITTA, SONEELA LCSW	10/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
8643	Fee-for-Service	1407989700	1407989700	1	1	DUNBAUGH, CHRISTOPHER M MFT	8/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	84796	-	NOT APPLICABLE	0	In state provider	None	101 CIRBY HILLS DRIVE	None	ROSEVILLE	CA	95678	4360	31	06061	38.7303989	-121.2872592	Placer County
8654	Fee-for-Service	1992768360	1992768360	1	1	DALAL, LOVE N MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82875	10	Gastroenterology (M.D. only)	0	In state provider	None	1408 COMMERCIAL WAY	None	BAKERSFIELD	CA	93309	0407	15	06029	35.36688109	-119.0600049	Kern County
8660	Fee-for-Service	1952620965	1952620965	1	1	DOMBROWSKI, MEGAN S NP	7/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
8693	Fee-for-Service	1548525611	1548525611	1	1	DUDLEY, MATTHEW T MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131338	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
8727	Fee-for-Service	1225429418	1225429418	1	1	DOCTORS PREFERRED HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6422 BELLINGHAM AVE	SUITE 204	NORTH HOLLYWOOD	CA	91606	1417	19	06037	34.187391	-118.398713	Los Angeles County
8743	Fee-for-Service	1811207723	1811207723	1	1	DIZON, MAE L CNP	2/28/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
8747	Fee-for-Service	1831718584	1831718584	1	1	DOUGHERTY, MARGARET LMFT	8/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8810	Fee-for-Service	1609145358	1609145358	1	1	DISTEFANO, LAURA G LCSW	2/16/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	9722	-	NOT APPLICABLE	0	In state provider	None	1127 S 38TH ST	None	SAN DIEGO	CA	92113	3210	37	06073	32.694264	-117.112392	San Diego County
8834	Fee-for-Service	1124261110	1124261110	1	1	DIAZ, ROBERTO I MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112035	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
8835	Fee-for-Service	1346351665	1346351665	1	1	DAQUINO, STEPHEN M DO	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8442	01	General Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2343	37	06073	32.72663119	-117.1611714	San Diego County
8842	Fee-for-Service	1194188938	1194188938	1	1	DELGADILLO, JENNIFER LMFT	9/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8859	Fee-for-Service	1922081090	1922081090	1	1	DAVIS, CHAD A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PARKVIEW MEDICAL CENTER	400 W 16TH ST	None	PUEBLO	CO	81003	0000	00	None	38.28171999	-104.6119963	Pueblo County
8906	Fee-for-Service	1881847101	1881847101	1	1	DARK, ANTHONY D MD	10/7/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	136577	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
8946	Fee-for-Service	1255609699	1255609699	1	1	DIGNITY HEALTH	11/15/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	16337 EVERHART DR	None	WEED	CA	96094	9400	47	06093	41.52751926	-122.3637346	Siskiyou County
8954	Fee-for-Service	1841358348	1841358348	1	1	DYCKMAN, JOHN M PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	925 THE ALAMEDA	None	BERKELEY	CA	94707	2310	01	06001	37.89072074	-122.2769176	Alameda County
9016	Fee-for-Service	1225429418	1225429418	1	1	DOCTORS PREFERRED HOSPICE	3/12/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6422 BELLINGHAM AVE	SUITE 204	NORTH HOLLYWOOD	CA	91606	1417	19	06037	34.187391	-118.398713	Los Angeles County
9068	Fee-for-Service	1467675264	1467675264	1	1	DOUCETTE, MICHELLE N LMFT	8/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
9095	Fee-for-Service	1043389596	1043389596	1	1	DANG, GERARD MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90805	None	None	0	In state provider	None	2420 CAMINO RAMON	None	SAN RAMON	CA	94583	4385	07	06013	37.77229042	-121.9634581	Contra Costa County
9122	Fee-for-Service	1346351665	1346351665	1	1	DAQUINO, STEPHEN M DO	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8442	08	Family Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2343	37	06073	32.72663119	-117.1611714	San Diego County
9140	Fee-for-Service	1427363639	1427363639	1	1	DIAZ, TYLER M LMFT	6/11/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2350 W SHAW AVE	SUITE 116	FRESNO	CA	93711	3400	10	06019	36.80841045	-119.834577	Fresno County
9149	Fee-for-Service	1538665773	1538665773	1	1	DULL, ADRIANE J MD	4/4/2023	207R00000X	NA	Other	026	PHYSICIANS	173932	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
9163	Fee-for-Service	1134449671	1134449671	1	1	DAVISSON, RACHEL A MD	8/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
9203	Fee-for-Service	1902543069	1902543069	1	1	DE JUAN SILAB, GESILLE	6/16/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1628 S MONTE VERDE DR	None	BEAUMONT	CA	92223	8588	33	06065	33.95463811	-117.012725	Riverside County
9209	Fee-for-Service	1407520224	1407520224	1	1	DAYLIGHT PHARMACY INC	1/12/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14841 BURBANK BLVD	None	SHERMAN OAKS	CA	91411	3339	19	06037	34.17213647	-118.456596	Los Angeles County
9236	Fee-for-Service	1255609699	1255609699	1	1	DIGNITY HEALTH	11/15/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	16337 EVERHART DR	None	WEED	CA	96094	9400	47	06093	41.52751926	-122.3637346	Siskiyou County
9313	Fee-for-Service	1689230575	1689230575	1	1	DENTON, JOSIE C	1/25/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
9324	Fee-for-Service	1952646952	1952646952	1	1	DEISTIC HOME HEALTH CARE,	8/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	327 ARDEN AVENUE	SUITE 201	GLENDALE	CA	91203	1116	19	06037	34.15851787	-118.2592388	Los Angeles County
9335	Fee-for-Service	1104112325	1104112325	1	1	DUQUETTE, JOANNA M MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131546	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
9344	Fee-for-Service	1184698284	1184698284	1	1	DENKINGER, MARSHALL MD	12/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	340 PEAK ONE DRIVE	None	FRISCO	CO	80443	0738	00	None	39.57003029	-106.0781094	Summit County
9365	Fee-for-Service	1306859178	1306859178	1	1	DARBINIAN, SEVAK H MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	69044	33	Thoracic Surgery	0	In state provider	None	1310 W STEWART DT	STE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
9406	Fee-for-Service	1528090040	1528090040	1	2	DESCOTEAUX, STEVEN D MD	10/4/2021	207R00000X	NA	Other	026	PHYSICIANS	168953	None	None	0	In state provider	None	1130 CONROY LN	SUITE 150	ROSEVILLE	CA	95661	4154	31	06061	38.73792807	-121.2748427	Placer County
9411	Fee-for-Service	1114487139	1114487139	1	1	DONG, JESSICA P MD	6/6/2022	208M00000X	NA	Other	026	PHYSICIANS	177667	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9418	Fee-for-Service	1942075213	1942075213	1	1	DE AMARAL, JARRET PT	3/11/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
9441	Fee-for-Service	1366449969	1366449969	1	1	DWYER, RICHARD M MD	2/26/1982	174400000X	NA	Other	026	PHYSICIANS	31641	41	Internal Medicine	0	In state provider	None	2722 S DEEGAN DR	None	SANTA ANA	CA	92704	6042	30	06059	33.71048807	-117.9035705	Orange County
9495	Fee-for-Service	1902543069	1902543069	1	1	DE JUAN SILAB, GESILLE	6/16/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1628 S MONTE VERDE DR	None	BEAUMONT	CA	92223	8588	33	06065	33.95463811	-117.012725	Riverside County
9499	Fee-for-Service	1477920650	1477920650	1	1	DAVIS, WHITNEY E CRNA	7/28/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
9507	Fee-for-Service	1639109457	1639109457	1	1	DR.S.SCHINKE/DR.K.SEHGAL	8/16/1993	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	HEMATOLOGY ONCOLOGY CONS	301 N SAN JACINTO ST	None	HEMET	CA	92543	3119	33	06065	33.75162	-116.9586895	Riverside County
9524	Fee-for-Service	1255609699	1255609699	1	1	DIGNITY HEALTH	11/30/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	16337 EVERHART DR	None	WEED	CA	96094	9400	47	06093	41.52751926	-122.3637346	Siskiyou County
9525	Fee-for-Service	1306978192	1306978192	1	1	DUTT, ASHA R MD	2/28/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50415	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
9554	Fee-for-Service	1598183360	1598183360	1	1	DREYFUSS, ANDREA P MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143040	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
9566	Fee-for-Service	1598024382	1598024382	1	1	DEILMANN, MARTIN MD	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121021	41	Internal Medicine	0	In state provider	None	690 GUZZI LANE	STE C	SONORA	CA	95370	5292	55	06109	37.97649546	-120.3719077	Tuolumne County
9600	Fee-for-Service	1306039300	1306039300	1	3	DAHIYA, SHYAM L MD INC	12/1/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	20930 BONITA STREET	SUITE W	CARSON	CA	90746	3683	19	06037	33.83978813	-118.2592106	Los Angeles County
9730	Fee-for-Service	1053315424	1053315424	1	1	DEVICK, MARGARET MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 N HIAWATHA DR	None	CANTON	SD	57013	5800	00	None	43.304454	-96.5574135	Lincoln County
9746	Fee-for-Service	1740231752	1740231752	1	1	DEACONESS HEALTH SYSTEM LLC	6/5/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5501 N PORTLAND	None	OKLAHOMA CITY	OK	73112	2074	00	None	35.526339	-97.58344848	Oklahoma County
9747	Fee-for-Service	1437207461	1437207461	1	1	DAVIS-MALTBY, TIFFANY	10/11/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	90165	08	Family Practice	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
9800	Fee-for-Service	1518168079	1518168079	1	1	DUBINSKY, THEODORE J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
9826	Fee-for-Service	1326244955	1326244955	1	1	DUFFY, DAVID E PHD	7/13/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
9841	Fee-for-Service	1407074578	1407074578	1	1	DUONG, HAN V MD INC	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88951	41	Internal Medicine	0	In state provider	HAN VAN DUONG MD INC	8632 VALLEY BLVD	STE D	ROSEMEAD	CA	91770	1740	19	06037	34.08053148	-118.0812235	Los Angeles County
9845	Fee-for-Service	1225498165	1225498165	1	1	DENNY-BROWN, SINAN MD	12/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140474	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
9886	Fee-for-Service	1285892620	1285892620	1	1	DANG, TOAN T MD	5/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132367	13	Neurology (M.D. only)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
9889	Fee-for-Service	1306039300	1306039300	1	3	DAHIYA, SHYAM L MD INC	12/1/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	20930 BONITA STREET	SUITE W	CARSON	CA	90746	3683	19	06037	33.83978813	-118.2592106	Los Angeles County
9901	Fee-for-Service	1710914528	1710914528	1	1	DAVID HINCHMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST LUKE'S REGIONAL MD	520 S EAGLE RD	None	BOISE	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
9932	Fee-for-Service	1164751053	1164751053	1	1	DIGANGI, MERCIE J DO	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11036	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
9988	Fee-for-Service	1942743745	1942743745	1	1	DANNY'S HOME HEALTH CARE INC	3/6/2020	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	.	1832 SOSCOL	SUITE 115-116	NAPA	CA	94559	1350	28	06055	38.30817893	-122.285021	Napa County
10029	Fee-for-Service	1376886879	1376886879	1	1	DAO, LINH C T MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134609	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
10033	Fee-for-Service	1740231752	1740231752	1	1	DEACONESS HEALTH SYSTEM LLC	6/5/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5501 N PORTLAND	None	OKLAHOMA CITY	OK	73112	2074	00	None	35.526339	-97.58344848	Oklahoma County
10088	Fee-for-Service	1184936973	1184936973	1	1	DHANOTA, HARINDER S DO	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14723	20	Orthopedic Surgery	0	In state provider	None	470 PLUMAS BLVD	STE 200	YUBA CITY	CA	95991	5007	51	06101	39.13270038	-121.6141985	Sutter County
10107	Fee-for-Service	1184496580	1184496580	1	1	DE HARO, MICHELLE LMFT	3/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
10126	Fee-for-Service	1922542596	1922542596	1	1	DIESEL, KORTNEY E LMFT	1/3/2023	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
10220	Fee-for-Service	1720202237	1720202237	1	1	DANVILLE PHARMACY INC	5/17/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 SAN RAMON VALLEY BLV	STE 106	DANVILLE	CA	94526	4035	07	06013	37.80823414	-121.9922059	Contra Costa County
10304	Fee-for-Service	1902341936	1902341936	1	1	DURAN, CORION LMFT	10/27/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6777 N WILLOW AVE	None	FRESNO	CA	93710	5900	10	06019	36.83465436	-119.7311422	Fresno County
10349	Fee-for-Service	1487663019	1487663019	1	1	DORSEY, MORNA J MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55827	03	Allergy	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
10358	Fee-for-Service	1649053455	1649053455	1	1	DOLIENTE, CHRISTINEJOY NP	1/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	77 ROLLING OAKS DR	#201	THOUSAND OAKS	CA	91361	1018	56	06111	34.17577423	-118.8748925	Ventura County
10393	Fee-for-Service	1033213111	1033213111	1	1	DAVATGARZADEH, AROUSHA MD	7/21/2009	207R00000X	NA	Other	026	PHYSICIANS	92753	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
10418	Fee-for-Service	1407998412	1407998412	1	1	DRUZIN, MAURICE	10/31/1989	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31332	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
10436	Fee-for-Service	1063770188	1063770188	1	1	DOMINGUEZ-MUCCIACCIO, PRISCI	2/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LLA LMFT	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
10451	Fee-for-Service	1295805893	1295805893	1	1	DARIN D OTT D.O.	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 N MAIN ST	None	KANAB	UT	84741	3260	00	None	37.054485	-112.5286185	Kane County
10475	Fee-for-Service	1134649973	1134649973	1	1	DEBOER, CHARLES M MD	6/9/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	157451	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
10478	Fee-for-Service	1720164247	1720164247	1	1	DHILLON, NAVREET MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73438	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
10507	Fee-for-Service	1770229908	1770229908	1	1	D'CRUZ, JOSHUA PT	12/22/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
10570	Fee-for-Service	1114474350	1114474350	1	1	DARLING, SHANNA L	2/22/2022	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	07	06013	37.88758326	-122.1181419	Contra Costa County
10625	Fee-for-Service	1568416147	1568416147	1	2	DESERT ADVANCED IMAGING MEDI	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	81880 DOCTOR CARREON BLV	STE A102	INDIO	CA	92201	5583	33	06065	33.70742953	-116.23572	Riverside County
10638	Fee-for-Service	1487663019	1487663019	1	1	DORSEY, MORNA J MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55827	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
10680	Fee-for-Service	1639267644	1639267644	1	2	DAMIRCHI, C MD INC	4/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50298	01	General Practice	0	In state provider	None	355 E 21ST ST	SUITE F	SAN BERNARDINO	CA	92404	4851	36	06071	34.13404548	-117.2779515	San Bernardino County
10707	Fee-for-Service	1265440366	1265440366	1	1	DEMIRJIAN HRATCH, DPM	8/15/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1257 W SAN BERNARDINO RD	None	COVINA	CA	91722	3509	19	06037	34.08850782	-117.9158316	Los Angeles County
10720	Fee-for-Service	1346895208	1346895208	1	1	DIAZ, IMELDA	10/28/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1818 S DEMAREE ST	None	VISALIA	CA	93277	3936	54	06107	36.314298	-119.3313735	Tulare County
10754	Fee-for-Service	1407207152	1407207152	1	1	DORRICOTT, ALEXA R MD	6/13/2023	208600000X	NA	General Surgery	026	PHYSICIANS	-	None	None	1	Border provider	None	3196 S MARYLAND PKWAY	STE 101A	LAS VEGAS	NV	89109	2317	00	None	36.13194	-115.136873	Clark County
10767	Fee-for-Service	1578630414	1578630414	1	1	DRENTH, EDWARD MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32326	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
10800	Fee-for-Service	1457966582	1457966582	1	1	DIVINE HEALTH HOSPICE INC	5/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 111AB	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
10817	Fee-for-Service	1083267678	1083267678	1	1	DALE, AMBER LMFT	7/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
10853	Fee-for-Service	1831774603	1831774603	1	1	DAVIDSON BROOKDALE LLC	7/29/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1326 BROOKDALE DR	None	MERCED	CA	95340	2611	24	06047	37.32287725	-120.456323	Merced County
10911	Fee-for-Service	1205028016	1205028016	1	1	DANSBY, IRENE S MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106584	None	None	0	In state provider	None	9602 STOCKDALE HWY	None	BAKERSFIELD	CA	93311	3618	15	06029	35.35453351	-119.1091725	Kern County
10915	Fee-for-Service	1982645180	1982645180	1	1	DOLEZAL, KATHRYN L NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1425 WOODSIDE DR	None	SAN LUIS OBISPO	CA	93401	5936	40	06079	35.26556057	-120.6388715	San Luis Obispo County
10947	Fee-for-Service	1649351941	1649351941	1	1	DAVIES, DANTAE D MD	7/19/2023	174400000X	NA	Other	026	PHYSICIANS	28898	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
10998	Fee-for-Service	1780359091	1780359091	1	1	DANIELL, CHRISTINA L LCSW	4/4/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
11002	Fee-for-Service	1902514623	1902514623	1	1	DAYTON, MICHAEL PT	3/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
11006	Fee-for-Service	1346895208	1346895208	1	1	DIAZ, IMELDA	10/28/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1818 S DEMAREE ST	None	VISALIA	CA	93277	3936	54	06107	36.314298	-119.3313735	Tulare County
11014	Fee-for-Service	1801850102	1801850102	1	1	DAVIS, STEPHEN O MD INC	9/20/2007	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	30022	41	Internal Medicine	0	In state provider	None	6081 N 1ST ST	STE 102	FRESNO	CA	93710	5466	10	06019	36.824994	-119.7748845	Fresno County
11018	Fee-for-Service	1760691950	1760691950	1	1	DAVIS, CHRISTOPHER K MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100260	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
11029	Fee-for-Service	1912466715	1912466715	1	1	DOROGI, ALLISON H MD	9/9/2024	207L00000X	NA	Other	026	PHYSICIANS	185524	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
11057	Fee-for-Service	1134154701	1134154701	1	1	DE BARRAICUA, LOUIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80364	08	Family Practice	0	In state provider	MY FAMILY CLINIC	6560 GREENBACK LN	STE 200	CITRUS HEIGHTS	CA	95621	6227	34	06067	38.677716	-121.310793	Sacramento County
11087	Fee-for-Service	1457966582	1457966582	1	1	DIVINE HEALTH HOSPICE INC	5/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 111AB	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
11184	Fee-for-Service	1174595821	1174595821	1	1	DIMEN, LAUREN A MD	6/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76200	40	Pediatrics	0	In state provider	None	133 N ALTADENA DR	FL 2	PASADENA	CA	91107	7325	19	06037	34.14843	-118.0986385	Los Angeles County
11206	Fee-for-Service	1154470953	1154470953	1	1	DUKE FACILITIES INC	4/1/2004	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	238 VINCENTE WAY	None	STOCKTON	CA	95207	2923	39	06077	38.01472702	-121.3066363	San Joaquin County
11211	Fee-for-Service	1194701581	1194701581	1	1	DALE S SVENDSEN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST CHARLES MEDICAL	2500 NE NEFF ROAD	None	BEND	OR	97701	0000	00	None	44.067735	-121.268187	Deschutes County
11212	Fee-for-Service	1528067949	1528067949	1	1	DEBORA MCCLARY, M.D.	7/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3815 E BELL RD	STE 2200	PHOENIX	AZ	85032	2139	00	None	33.638571	-111.9990015	Maricopa County
11216	Fee-for-Service	1902433352	1902433352	1	1	DE COSTER, MIKA J MD	6/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177561	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
11259	Fee-for-Service	1902439425	1902439425	1	1	DIGNITY HEALTH CONNECTED LIV	3/27/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	200 MERCY OAKS DR	None	REDDING	CA	96003	8641	45	06089	40.61610977	-122.3286425	Shasta County
11266	Fee-for-Service	1932193257	1932193257	2	1	DIANI, CHRISTOPHER A LCSW	2/23/2015	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 GOUGH ST	STE 403	SAN FRANCISCO	CA	94102	5971	38	06075	37.77435191	-122.4224354	San Francisco County
11304	Fee-for-Service	1760691950	1760691950	1	1	DAVIS, CHRISTOPHER K MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100260	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
11356	Fee-for-Service	1073762928	1073762928	1	1	DAVID, STEVEN	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
11364	Fee-for-Service	1053351288	1053351288	1	1	DEGUZMAN, THOMAS PT	1/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 W VALLEY BLVD	SUITE 204	ALHAMBRA	CA	91803	3257	19	06037	34.07808133	-118.1319851	Los Angeles County
11365	Fee-for-Service	1326018987	1326018987	1	1	DHAWAN, SUNIL S	8/13/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	53340	07	Dermatology	0	In state provider	None	2557 MOWRY AVE	STE 25	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
11431	Fee-for-Service	1356431043	1356431043	1	1	DIGESTIVE HLTH CONSULTAN	8/8/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2701 W ALAMEDA AVE	STE 206	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
11438	Fee-for-Service	1821002874	1821002874	1	1	DAVIS, BEVERLY MD	9/1/1995	207R00000X	NA	Other	026	PHYSICIANS	31558	41	Internal Medicine	0	In state provider	None	1045 ATLANTIC AVE	STE 508	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
11444	Fee-for-Service	1235660234	1235660234	1	1	DOBRY, ALLISON S CRNA	10/12/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	158809	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
11458	Fee-for-Service	1215404512	1215404512	1	1	DEFENBAUGH, NETA M NP	5/4/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
11528	Fee-for-Service	1013063957	1013063957	1	1	DANAN, EDMEE M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	43309	36	Psychiatry	0	In state provider	None	130 S MAIN ST	STE 212	SEBASTOPOL	CA	95472	4241	49	06097	38.40161324	-122.8239553	Sonoma County
11557	Fee-for-Service	1497101323	1497101323	1	2	DOLBEER ST MEDICAL SERVICES	7/6/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3300 RENNER DRIVE	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
11569	Fee-for-Service	1760408868	1760408868	1	1	DESCHLER, THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CARLE CLINIC ASSOC.	602 W UNIVERSITY AVENUE	None	URBANA	IL	61801	0000	00	None	40.11648632	-88.21509105	Champaign County
11619	Fee-for-Service	1144768318	1144768318	1	1	DEKOVEN, STANLEY E LMFT	5/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	530 11TH ST	None	RAMONA	CA	92065	3914	37	06073	33.03876595	-116.868302	San Diego County
11633	Fee-for-Service	1831651892	1831651892	1	1	DAY, WHITNEY A CRNA	1/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
11649	Fee-for-Service	MSS00025F	None	1	1	DIGNITY HEALTH CONNECTED	3/1/1999	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	LIVING	200 MERCY OAKS DRIVE	None	REDDING	CA	96003	8641	45	06089	40.61610977	-122.3286425	Shasta County
11704	Fee-for-Service	1700297066	1700297066	1	1	DADGAR, POOJA A MD	5/13/2024	208M00000X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
11714	Fee-for-Service	1629058441	1629058441	1	1	DANG, MINH MD	3/8/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	61331	None	None	0	In state provider	None	632 W 11TH ST	STE 219	TRACY	CA	95376	3861	39	06077	37.73965648	-121.4352045	San Joaquin County
11782	Fee-for-Service	1083226963	1083226963	1	1	DYNASTY HOSPICE INC	2/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	STE 207A	VAN NUYS	CA	91411	4132	19	06037	34.18663255	-118.452402	Los Angeles County
11809	Fee-for-Service	1417978289	1417978289	1	1	DAVIN, THOMAS D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	810 EAST 27TH ST	None	MINNEAPOLIS	MN	55407	0000	00	None	44.95374448	-93.26145339	Hennepin County
11818	Fee-for-Service	1194245241	1194245241	1	2	D&M MEDICAL SUPPLY, LLC	10/17/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	11405 FIRESTONE BLVD	H	NORWALK	CA	90650	2872	19	06037	33.91695834	-118.0895557	Los Angeles County
11830	Fee-for-Service	1487738555	1487738555	1	1	DIBBLE, LAURIE A MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	66324	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1580 VALENCIA ST	STE 809	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
11840	Fee-for-Service	1568510444	1568510444	1	1	DOAN, THIEN T MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	35579	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
11893	Fee-for-Service	1346260288	1346260288	1	1	DUGGAN, SHANNON L MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
11899	Fee-for-Service	1437369303	1437369303	1	1	DO, THONG H	7/7/2010	207R00000X	NA	Other	026	PHYSICIANS	100983	45	Nephrology (Renal-Kidney)	0	In state provider	None	3300 E SOUTH ST	STE 100	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
11905	Fee-for-Service	1407134687	1407134687	1	1	DATE, ANJALI A MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146942	30	Radiology	0	In state provider	None	2202 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5706	19	06037	34.03277088	-118.4813792	Los Angeles County
11921	Fee-for-Service	1821176736	1821176736	1	1	DIXON,CHRISTOPHER R MD	11/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	35929	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
11922	Fee-for-Service	1710178256	1710178256	1	1	DOKIMOS PHARMACY INC	4/22/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DOKIMOS NEVADA CITY PMCY	737 ZION ST	None	NEVADA CITY	CA	95959	2920	29	06057	39.25326438	-121.0260487	Nevada County
11927	Fee-for-Service	1407909690	1407909690	1	1	DRAZNER, SEAN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	339 HICKS ST	None	BROOKLYN	NY	11201	5509	00	None	40.69109568	-73.99773401	Kings County
11955	Fee-for-Service	1588152797	1588152797	1	1	DE LEON, LIZETT B CRNA	2/8/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
11979	Fee-for-Service	1376605360	1376605360	1	1	DENNY, LISA M LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
11980	Fee-for-Service	1326247644	1326247644	1	1	DEGAETANO, NOAH P MD	6/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	108691	36	Psychiatry	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
11996	Fee-for-Service	1730215633	1730215633	1	1	DAVIES, LAURA C MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	66459	26	Psychiatry (child)	0	In state provider	None	2266 UNION ST	None	SAN FRANCISCO	CA	94123	3902	38	06075	37.79697166	-122.4366001	San Francisco County
12011	Fee-for-Service	1265851513	1265851513	1	1	DAMICO KHALID, RITA M DO	6/22/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	15594	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
12051	Fee-for-Service	1003070814	1003070814	1	1	DURRANI, NANTARA MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107752	None	None	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
12071	Fee-for-Service	1083226963	1083226963	1	1	DYNASTY HOSPICE INC	2/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	STE 207A	VAN NUYS	CA	91411	4132	19	06037	34.18663255	-118.452402	Los Angeles County
12076	Fee-for-Service	1396770251	1396770251	1	1	DELEON-TALLMAN, MARIA T MD	3/17/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67277	None	None	0	In state provider	None	160 GLEN COVE MARINA	103	VALLEJO	CA	94591	7290	48	06095	38.07062486	-122.2124251	Solano County
12164	Fee-for-Service	1962972497	1962972497	1	1	DUONG, BETTY INC	6/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16152 BEACH BLVD	STE 265	HUNTINGTON BEACH	CA	92647	3806	30	06059	33.72889962	-117.9891397	Orange County
12188	Fee-for-Service	1437369303	1437369303	1	1	DO, THONG H	7/7/2010	207R00000X	NA	Other	026	PHYSICIANS	100983	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 100	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
12234	Fee-for-Service	1710190251	1710190251	1	1	DR B KAMKAR OD A	5/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL OPTOMETRY	1104 E COLORADO ST	None	GLENDALE	CA	91205	1309	19	06037	34.14262548	-118.2414555	Los Angeles County
12270	Fee-for-Service	1326247644	1326247644	1	1	DEGAETANO, NOAH P MD	6/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	108691	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
12365	Fee-for-Service	1740268481	1740268481	1	1	DANIEL A LANGER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3702 TIMBERLINE RD #A	None	FORT COLLINS	CO	80525	0000	00	None	40.5364436	-105.0391947	Larimer County
12382	Fee-for-Service	1750452264	1750452264	1	1	DELGADO, ROBERT L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
12403	Fee-for-Service	1699711267	1699711267	1	1	DI STANTE, ALEXANDER G	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60555	02	General Surgery	0	In state provider	None	3536 MENDOCINO AVE	STE 250	SANTA ROSA	CA	95403	3612	49	06097	38.473326	-122.725935	Sonoma County
12423	Fee-for-Service	1831726686	1831726686	1	1	DINH, TU C MD	9/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	190034	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
12440	Fee-for-Service	1114107877	1114107877	1	1	DAUDEL, JODY L MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	95421	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	100 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
12479	Fee-for-Service	1124190517	1124190517	1	1	DEVAS GERARD	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BROOKLYN	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
12515	Fee-for-Service	1992728075	1992728075	1	1	DOYLE, CARLA	10/8/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	19526 HILLSDALE DR	STE A	SONORA	CA	95370	9234	55	06109	37.97725615	-120.3246589	Tuolumne County
12517	Fee-for-Service	1629212535	1629212535	1	1	DYE, JUSTIN A MD	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	107923	14	Neurological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
12528	Fee-for-Service	1972904274	1972904274	1	1	DEKROON, SHAYNA J	10/14/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
12532	Fee-for-Service	1407158611	1407158611	1	1	DE LA TORRE VILLEGAS, LORENA	5/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
12562	Fee-for-Service	1699030577	1699030577	1	1	DAY, KEVIN MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145607	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12571	Fee-for-Service	1063490092	1063490092	1	1	DESPAIN, TREVYN L	5/7/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3908 10TH STREET	None	RIVERSIDE	CA	92501	3522	33	06065	33.98117228	-117.3785355	Riverside County
12583	Fee-for-Service	1699916122	1699916122	1	1	DUTTA, NABONITA	10/20/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
12593	Fee-for-Service	1750717880	1750717880	1	1	DE SANTIAGO, JESSICA L PSYD	4/14/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10165 FOOTHILL BLVD	#3	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
12598	Fee-for-Service	1801859459	1801859459	1	2	DO, DAVID A MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	78639	-	NOT APPLICABLE	0	In state provider	None	90 HIGHLAND AVENUE	BLDG J	SAN MARTIN	CA	95046	9504	43	06085	37.07384188	-121.6058583	Santa Clara County
12600	Fee-for-Service	1699423335	1699423335	1	1	DEUZ, NICK D NP	2/1/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
12633	Fee-for-Service	1326062225	1326062225	1	1	DRUMMOND, HENRY R PHD	6/17/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3711 LONG BEACH BLD	1016B	LONG BEACH	CA	92701	7417	19	06037	33.824583	-118.1893785	Los Angeles County
12661	Fee-for-Service	1790170355	1790170355	1	1	DING, JULIA H MD	10/18/2020	208VP0000X	NA	Other	026	PHYSICIANS	160474	05	Anesthesiology	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
12677	Fee-for-Service	1699495846	1699495846	1	1	DANIEL T ESKANDER MD PC	1/3/2023	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	681 S PARKER ST STE 150	None	ORANGE	CA	92868	4761	30	06059	33.77702403	-117.8595862	Orange County
12678	Fee-for-Service	1710907209	1710907209	1	1	DAJNOWICZ, ANTHONY M MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60395	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
12694	Fee-for-Service	1699711267	1699711267	1	1	DI STANTE, ALEXANDER G	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60555	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3536 MENDOCINO AVE	STE 250	SANTA ROSA	CA	95403	3612	49	06097	38.473326	-122.725935	Sonoma County
12700	Fee-for-Service	1851984132	1851984132	1	1	DITO, SUZANNE LMFT	9/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	307 S. B ST.	None	SAN MATEO	CA	94401	4053	41	06081	37.56539871	-122.3222584	San Mateo County
12723	Fee-for-Service	1770740862	1770740862	1	1	DOOSTAN, ARVIN MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116161	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
12733	Fee-for-Service	1396047361	1396047361	1	1	DAMIANI, STEPHEN M DO INC	10/28/2011	207RE0101X	NA	Endocrinology	026	PHYSICIANS	7410	41	Internal Medicine	0	In state provider	None	18092 WIKA RD	STE 110	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
12819	Fee-for-Service	1689740912	1689740912	1	1	DUONG, DAT Q MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77545	41	Internal Medicine	0	In state provider	None	14221 EUCLID ST	STE H	GARDEN GROVE	CA	92843	4991	30	06059	33.757191	-117.937638	Orange County
12863	Fee-for-Service	1730662834	1730662834	1	1	DNA HOME HEALTH SERVICES INC	12/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18425 BURBANK BLVD	STE 417	TARZANA	CA	91356	2806	19	06037	34.17226853	-118.5348151	Los Angeles County
12872	Fee-for-Service	1205802097	1205802097	1	1	DRAGER, SANDRA L MD	5/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120919	None	None	0	In state provider	None	800 EAST WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8358	08	06015	41.77272521	-124.1940494	Del Norte County
12875	Fee-for-Service	1790419315	1790419315	1	1	DOOLAN, JANINE	2/1/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
12883	Fee-for-Service	1902076292	1902076292	1	1	DUNNE, WILLIAM MD	2/14/2024	207R00000X	NA	Other	026	PHYSICIANS	60416	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
12885	Fee-for-Service	1184824955	1184824955	1	1	DIXON, KIMBERLY D MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115516	40	Pediatrics	0	In state provider	None	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	15	06029	35.3655	-118.985202	Kern County
12891	Fee-for-Service	1912954173	1912954173	1	1	DOCHERTY, STEPHEN D DO	3/1/1993	207P00000X	NA	Other	026	PHYSICIANS	5085	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
12907	Fee-for-Service	1336348853	1336348853	1	1	DIVINE HEALTHCARE SERVICES,I	8/27/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	405 W MANCHESTER BLVD	SUITE A	INGLEWOOD	CA	90301	1196	19	06037	33.96175122	-118.3621356	Los Angeles County
12916	Fee-for-Service	1053590737	1053590737	1	1	DENNIS DEL PAINE MD INC	1/3/2019	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	None	5309 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3516	39	06077	38.00514461	-121.293465	San Joaquin County
12993	Fee-for-Service	1144989161	1144989161	1	1	DIVINE PROVIDENCE HOME	3/6/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE	22151 VENTURA BLVD	SUITE 200A	WOODLAND HILLS	CA	91364	1666	19	06037	34.16870042	-118.6099445	Los Angeles County
12999	Fee-for-Service	1043487770	1043487770	1	1	DESHPANDE, DEEPTI R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N. CAMPELL	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
13021	Fee-for-Service	1396047361	1396047361	1	1	DAMIANI, STEPHEN M DO INC	10/28/2011	207RE0101X	NA	Endocrinology	026	PHYSICIANS	7410	67	Endocrinology	0	In state provider	None	18092 WIKA RD	STE 110	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
13087	Fee-for-Service	1497971790	1497971790	1	1	DEUGARTE, DANIEL A MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70300	85	Surgery-Pediatric	0	In state provider	None	200 MEDICAL PLAZA	STE 526	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
13096	Fee-for-Service	1366492944	1366492944	1	1	DAMANJEET,CHUGH MD	6/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21601 76 AVE W	None	EDMONDS	WA	98026	0000	00	None	47.803239	-122.335652	Snohomish County
13115	Fee-for-Service	1992871826	1992871826	1	1	DINH, LINH V OD	10/28/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10161 BOLSA AVE	STE 104C	WESTMINSTER	CA	92683	6779	30	06059	33.74508538	-117.9521356	Orange County
13163	Fee-for-Service	1821627720	1821627720	1	1	DIETRICH, ROSE A NP	6/22/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	444 PLUMAS BLVD	None	YUBA CITY	CA	95991	5071	51	06101	39.13178911	-121.6141048	Sutter County
13204	Fee-for-Service	1053590737	1053590737	1	1	DENNIS DEL PAINE MD INC	1/3/2019	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	5309 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3516	39	06077	38.00514461	-121.293465	San Joaquin County
13206	Fee-for-Service	1376859405	1376859405	1	1	DUPONT, PATRICIA L LCSW	7/14/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
13236	Fee-for-Service	1316972425	1316972425	1	1	DHANDA, PAULA R MD	4/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62526	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5685 MAIN ST	None	KELSEYVILLE	CA	95451	8945	17	06033	38.97222647	-122.8301393	Lake County
13245	Fee-for-Service	1679754956	1679754956	1	1	DEROSA, VINCENT P MD	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84898	10	Gastroenterology (M.D. only)	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
13258	Fee-for-Service	1922019322	1922019322	1	1	DHALIWAL, AMARJIT S MD	12/30/1998	207RH0003X	NA	Oncology	026	PHYSICIANS	49314	68	Hematology	0	In state provider	None	2161 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51254293	-120.8353135	Stanislaus County
13297	Fee-for-Service	1134433394	1134433394	1	1	DAMES, KILA T LMFT	4/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	212C	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
13303	Fee-for-Service	1609953124	1609953124	1	1	DABBY, SHARON N MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97908	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
13317	Fee-for-Service	1285809772	1285809772	1	1	DICK, DALLAS M MD	3/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125825	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
13329	Fee-for-Service	1689762585	1689762585	1	1	DEDACE, HADJI A T	3/5/2019	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2222 W BURBANK BLVD	SUITE 101	BURBANK	CA	91506	1280	19	06037	34.1795859	-118.3353987	Los Angeles County
13352	Fee-for-Service	1932186632	1932186632	1	1	DUNCAN, JOHN A III MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	62701	14	Neurological Surgery	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
13374	Fee-for-Service	1306964515	1306964515	1	1	DUNCAN, KENNETH A LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
13394	Fee-for-Service	1376997866	1376997866	1	1	DHILLON, AMANDEEP S MD	9/1/2019	208M00000X	NA	Other	026	PHYSICIANS	159743	41	Internal Medicine	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
13415	Fee-for-Service	1194328989	1194328989	1	1	DIVINE INTERVENTION HOSPICE,	5/27/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	44008 10TH ST W	STE A	LANCASTER	CA	93534	4231	19	06037	34.682508	-118.147952	Los Angeles County
13477	Fee-for-Service	1932239837	1932239837	1	4	DZEBOLO, NICHOLAS N MD	7/21/2012	2085N0904X	NA	Other	026	PHYSICIANS	36396	30	Radiology	0	In state provider	None	1030 S GLENDALE AVENUE	SUITE 200	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
13495	Fee-for-Service	1487914123	1487914123	1	2	DR DORYS P VARGAS OPTOMETRIS	1/9/2023	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3085 S ARCHIBALD AVE	SUITE A	ONTARIO	CA	91761	9005	36	06071	34.017894	-117.592695	San Bernardino County
13503	Fee-for-Service	1225528466	1225528466	1	3	DUONG, KHANH T MD	2/13/2024	207R00000X	NA	Other	026	PHYSICIANS	174153	None	None	0	In state provider	CE	767 S SUNSET AVE	5	WEST COVINA	CA	91790	3546	19	06037	34.0672602	-117.9400049	Los Angeles County
13515	Fee-for-Service	1780721944	1780721944	1	1	DR J SOLOMON MOORE OD	6/1/2001	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	AND ASSOCIATES INC	14434 HAMLIN ST	STE I	VAN NUYS	CA	91401	1461	19	06037	34.18863848	-118.447749	Los Angeles County
13534	Fee-for-Service	1114283405	1114283405	1	1	DOSSEN JONES, JANIS W MD	11/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111312	05	Anesthesiology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
13536	Fee-for-Service	1932105723	1932105723	1	1	DORNBRAND, LAURIE MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	33377	38	Geriatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
13545	Fee-for-Service	1922019322	1922019322	1	1	DHALIWAL, AMARJIT S MD	12/30/1998	207RH0003X	NA	Oncology	026	PHYSICIANS	49314	78	Neoplastic Diseases/Oncology	0	In state provider	None	2161 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51254293	-120.8353135	Stanislaus County
13548	Fee-for-Service	1538588397	1538588397	1	1	DUNAMIS INC GROUP HOME	6/3/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1302 EAST DAKOTA AVENUE	A1	FRESNO	CA	93704	4441	10	06019	36.78674555	-119.7950805	Fresno County
13549	Fee-for-Service	1063679850	1063679850	1	1	DAVIES, JONATHAN L MD	11/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
13566	Fee-for-Service	1962875450	1962875450	1	1	DPR RX INC	8/4/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3340 W BALL RD	STE P	ANAHEIM	CA	92804	3729	30	06059	33.81726795	-118.0068541	Orange County
13590	Fee-for-Service	1407042252	1407042252	1	1	DUMITRU ROTARU M.D.	1/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6801 ROGERS AVE	None	FORT SMITH	AR	72903	4067	00	None	35.356923	-94.3577505	Sebastian County
13611	Fee-for-Service	1205416427	1205416427	1	1	DHALIWAL, SEEPAJ MD	3/14/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
13630	Fee-for-Service	1760646152	1760646152	1	1	DUONG, HAI T MD	10/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103786	None	None	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
13707	Fee-for-Service	1194328989	1194328989	1	1	DIVINE INTERVENTION HOSPICE,	5/27/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	44008 10TH ST W	STE A	LANCASTER	CA	93534	4231	19	06037	34.682508	-118.147952	Los Angeles County
13715	Fee-for-Service	1497917702	1497917702	1	1	DANZER, ENRICO MD	5/18/2020	208600000X	NA	General Surgery	026	PHYSICIANS	151674	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
13756	Fee-for-Service	1508077884	1508077884	1	1	DAVID CONNOR	3/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
13767	Fee-for-Service	1932239837	1932239837	1	4	DZEBOLO, NICHOLAS N MD	7/21/2012	2085N0904X	NA	Other	026	PHYSICIANS	36396	42	Nuclear Medicine	0	In state provider	None	1030 S GLENDALE AVENUE	SUITE 200	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
13824	Fee-for-Service	1932105723	1932105723	1	1	DORNBRAND, LAURIE MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	33377	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
13833	Fee-for-Service	1871700823	1871700823	1	1	DE JONG, ANN MD	4/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118790	01	General Practice	0	In state provider	None	700 ALAMO PINTADO ROAD	None	SOLVANG	CA	93463	2220	42	06083	34.60203	-120.1262085	Santa Barbara County
13876	Fee-for-Service	1629207188	1629207188	1	1	DANIEL SEITZ MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
13881	Fee-for-Service	1578683827	1578683827	1	1	DITTO, MARSHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4321 W 16TH AVE	None	DENVER	CO	80204	1209	00	None	39.74279364	-105.043192	City and County of Denver
13885	Fee-for-Service	1932239837	1932239837	1	5	DZEBOLO, NICHOLAS N MD	6/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36396	None	None	0	In state provider	None	1100 RIDGESIDE DR	None	MONTEREY PARK	CA	91754	3731	19	06037	34.05006908	-118.1430507	Los Angeles County
13895	Fee-for-Service	1194044198	1194044198	1	1	DUONG, LINDA Y LMFT	10/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
13901	Fee-for-Service	1164118709	1164118709	1	1	DUARTE, KATELYNN M NP	2/16/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
13912	Fee-for-Service	1568439081	1568439081	1	2	DESERT AIDS PROJECT	10/23/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1445 N SUNRISE WAY	103	PALM SPRINGS	CA	92262	3700	33	06065	33.842448	-116.5281995	Riverside County
13955	Fee-for-Service	1427071075	1427071075	1	1	DUGONI, WILLIAM E JR MD	3/14/1996	208600000X	NA	General Surgery	026	PHYSICIANS	57686	33	Thoracic Surgery	0	In state provider	None	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
14044	Fee-for-Service	1932239837	1932239837	1	3	DZEBOLO, NICHOLAS N MD	7/21/2012	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36396	30	Radiology	0	In state provider	None	301 N PRAIRIE AVE	STE 125	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
14092	Fee-for-Service	1942284831	1942284831	1	1	DE MORAES, ALEXANDRE MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66851	01	General Practice	0	In state provider	None	2630 BRESLAUER WAY	None	REDDING	CA	96001	4246	45	06089	40.54961438	-122.3806835	Shasta County
14151	Fee-for-Service	1851833214	1851833214	1	1	DEGRASSE, MARSII NP	5/5/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
14169	Fee-for-Service	1942279914	1942279914	1	1	DECAYETTE, JACQUELINE MD	10/1/2002	207L00000X	NA	Other	026	PHYSICIANS	43343	05	Anesthesiology	0	In state provider	JACQUELINE I MD	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
14171	Fee-for-Service	1801803630	1801803630	1	1	DR. DANIEL VARGO M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNVI OF UTAH SURGICAL	50 NORTH MEDICAL DRIVE	None	SALT LAKE CITY	UT	84132	0100	00	None	40.77197161	-111.8352608	Salt Lake County
14202	Fee-for-Service	1871071167	1871071167	1	1	DHILLON, NAVNEET MD	6/4/2024	207P00000X	NA	Other	026	PHYSICIANS	186264	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
14214	Fee-for-Service	1417390071	1417390071	1	1	DANG, HUONG N MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135491	01	General Practice	0	In state provider	None	20101 LAKE CHABOT RD	3RD FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
14228	Fee-for-Service	1598105132	1598105132	1	1	DE LA TORRE, ASIA R MD	4/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133853	01	General Practice	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
14241	Fee-for-Service	1417452228	1417452228	1	1	DE SOUZA, KATYA I MD	9/20/2022	207P00000X	NA	Other	026	PHYSICIANS	176050	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
14243	Fee-for-Service	1427071075	1427071075	1	1	DUGONI, WILLIAM E JR MD	3/14/1996	208600000X	NA	General Surgery	026	PHYSICIANS	57686	02	General Surgery	0	In state provider	None	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
14269	Fee-for-Service	1033306592	1033306592	1	1	DABEL, PASCAL MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131011	45	Nephrology (Renal-Kidney)	0	In state provider	None	11550 INDIAN HILLS ROAD	STE 371	MISSION HILLS	CA	91345	1252	19	06037	34.28024575	-118.4588775	Los Angeles County
14278	Fee-for-Service	1013292358	1013292358	1	1	DOTE, TIFFANY W MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113828	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
14303	Fee-for-Service	1881602993	1881602993	1	1	DO, MATTHEW M DPM	9/19/1992	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13310 EUCLID ST	None	GARDEN GROVE	CA	92843	2514	30	06059	33.76953	-117.937703	Orange County
14313	Fee-for-Service	1215977723	1215977723	1	2	DATNGUYEN MD INC	8/8/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	292 EUCLID AVE	SUITE 210	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
14325	Fee-for-Service	1639342165	1639342165	1	1	DE ST JEOR, MAKAYLAH	5/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
14330	Fee-for-Service	1932239837	1932239837	1	3	DZEBOLO, NICHOLAS N MD	7/21/2012	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36396	42	Nuclear Medicine	0	In state provider	None	301 N PRAIRIE AVE	STE 125	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
14340	Fee-for-Service	1144610825	1144610825	1	1	DROLET, RENEE C MD	2/14/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157460	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
14341	Fee-for-Service	1861480667	1861480667	1	1	DAHMOUSH, LAILA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLN	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
14348	Fee-for-Service	1720175862	1720175862	1	1	DAVIS , JENNIFER L MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	101027	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
14410	Fee-for-Service	1972677821	1972677821	1	1	DE SILVA, ANIL M MD	7/31/1991	207L00000X	NA	Other	026	PHYSICIANS	72153	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	# 648	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
14415	Fee-for-Service	1164057550	1164057550	1	1	DALANGIN, FRANCESCA PT	9/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	401 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6387	43	06085	37.36777579	-122.0276404	Santa Clara County
14468	Fee-for-Service	1972611762	1972611762	1	1	DIKIO, NICOLAS MD	10/6/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40344	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
14488	Fee-for-Service	1770659336	1770659336	1	1	DIGNITY HEALTH	6/1/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
14492	Fee-for-Service	1982661591	1982661591	1	1	DORIA-MEDINA, CATHY L MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77694	67	Endocrinology	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
14505	Fee-for-Service	1003343799	1003343799	1	1	DE SILVA, SEVWANDI G MD	1/16/2022	207R00000X	NA	Other	026	PHYSICIANS	163828	None	None	0	In state provider	None	350 TERRACINA	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
14541	Fee-for-Service	1679936850	1679936850	1	1	DALAL, SUNIT MD	2/5/2020	390200000X	NA	Other	026	PHYSICIANS	159459	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
14542	Fee-for-Service	1205965647	1205965647	1	1	DUONG, VIET Q MD	8/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108496	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2636	19	06037	33.93112671	-118.2035532	Los Angeles County
14552	Fee-for-Service	1033306592	1033306592	1	1	DABEL, PASCAL MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131011	41	Internal Medicine	0	In state provider	None	11550 INDIAN HILLS ROAD	STE 371	MISSION HILLS	CA	91345	1252	19	06037	34.28024575	-118.4588775	Los Angeles County
14553	Fee-for-Service	1568817450	1568817450	1	1	DUNN, COLIN P MD	9/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	186661	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
14567	Fee-for-Service	1730162637	1730162637	2	1	DHOKIA, ASHOK J	3/18/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1902 G ST	None	BAKERSFIELD	CA	93301	4325	15	06029	35.37638257	-119.0222725	Kern County
14592	Fee-for-Service	1124254214	1124254214	1	1	DESAI, AMISHA D MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114926	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
14610	Fee-for-Service	1760736805	1760736805	1	1	DEUTINGER, ARON PSYD	5/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
14614	Fee-for-Service	1376706515	1376706515	1	1	DIAMOND, HILARY LMFT	1/9/2025	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
14638	Fee-for-Service	1497741037	1497741037	1	1	DESAI, SANDIP R. MD	12/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4780 SWEETWATER BLVD	STE 150	SUGAR LAND	TX	77479	3165	00	None	29.58535437	-95.63137434	Fort Bend County
14660	Fee-for-Service	1275613374	1275613374	1	1	DELAMAZA, LUIS MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35127	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
14682	Fee-for-Service	1417277385	1417277385	1	1	DAVIS, MOLLY B MD	7/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118681	08	Family Practice	0	In state provider	None	3201 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7374	34	06067	38.58561	-121.2838875	Sacramento County
14711	Fee-for-Service	1316978554	1316978554	1	1	DEAK, PAMELA WERTZ MD	12/31/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54653	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
14720	Fee-for-Service	1932272614	1932272614	1	1	DANG, PHONG T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78903	05	Anesthesiology	0	In state provider	None	12832 GARDEN GROVE BLVD	STE 230	GARDEN GROVE	CA	92843	2033	30	06059	33.77433247	-117.908712	Orange County
14721	Fee-for-Service	1942719703	1942719703	1	1	DR CHRISTINA HOPSON INC	12/23/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	2800 BENEDICT DRIVE	None	SAN LEANDRO	CA	94568	2923	01	06001	37.71593435	-122.131151	Alameda County
14729	Fee-for-Service	1003636499	1003636499	1	1	DENICOLA, SARAH ROSE DOULA	11/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
14737	Fee-for-Service	1902280969	1902280969	1	2	DONALDSON, STACY L LMFT	10/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9033 BASELINE RD	SUITE A	RANCHO CUCAMONGA	CA	91730	1255	36	06071	34.12151248	-117.6080805	San Bernardino County
14754	Fee-for-Service	1346403987	1346403987	1	1	DURAWA, CASSIE L MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
14756	Fee-for-Service	1932239837	1932239837	1	1	DZEBOLO, NICHOLAS N MD	7/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36396	02	General Surgery	0	In state provider	None	404 W 9TH ST	None	SAN BERNARDINO	CA	92410	1014	36	06071	34.1158173	-117.2920389	San Bernardino County
14781	Fee-for-Service	1114698982	1114698982	1	1	DIVINE BIRTHRIGHT, LLC DBA D	11/29/2023	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
14801	Fee-for-Service	1003270216	1003270216	1	1	DEVRIES, JONATHAN E DO	9/29/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	19155	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
14804	Fee-for-Service	1124501994	1124501994	1	1	DEAMER, KATHRYN E PT	7/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
14833	Fee-for-Service	1649297540	1649297540	1	1	DIANA, JOHN N MD	7/5/2006	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	87859	20	Orthopedic Surgery	0	In state provider	None	1100 TRANCAS ST	STE 250	NAPA	CA	94558	2908	28	06055	38.32316569	-122.2981938	Napa County
14881	Fee-for-Service	1871869420	1871869420	1	1	DUAN, KEVIN I MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129144	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
14926	Fee-for-Service	1386611861	1386611861	1	1	DAVIDSON, SCOTT MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	166247	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
14929	Fee-for-Service	1457362691	1457362691	1	1	DEHLENDORF, CHRISTINE E	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87230	08	Family Practice	0	In state provider	MD	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
14980	Fee-for-Service	1164560413	1164560413	1	1	DAVID F. YOUNG MD	9/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1309 NE 6TH ST	None	GRANTS PASS	OR	97526	1252	00	None	42.452001	-123.3225325	Josephine County
15004	Fee-for-Service	1376528489	1376528489	1	2	DEYHIMY, DAVID	2/19/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82776	-	NOT APPLICABLE	0	In state provider	None	4049 MILLER WAY	None	SACRAMENTO	CA	95817	1332	34	06067	38.556639	-121.4604765	Sacramento County
15027	Fee-for-Service	1841502531	1841502531	1	1	DONG, QUAN LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
15031	Fee-for-Service	1194032169	1194032169	1	1	DR MURRAY TAUBMAN	6/18/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	AN OPTOMETRIC CORP	12568 VALLEY VIEW ST	None	GARDEN GROVE	CA	92845	2006	30	06059	33.78049752	-118.0307808	Orange County
15053	Fee-for-Service	1831622034	1831622034	1	1	DEMUTH, PETER MD	6/30/2020	207R00000X	NA	Other	026	PHYSICIANS	159319	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
15058	Fee-for-Service	1760426415	1760426415	1	1	DHAWAN, VIJAY M MD	2/28/1984	207R00000X	NA	Other	026	PHYSICIANS	32299	41	Internal Medicine	0	In state provider	None	3404 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02458936	-118.1406483	Los Angeles County
15062	Fee-for-Service	1275824799	1275824799	1	1	DANG, TAM T MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
15096	Fee-for-Service	1144247990	1144247990	1	1	DE SA, MARGARET MARY MD	10/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51411	40	Pediatrics	0	In state provider	None	1000 S ANAHEIM BLVD	STE 201	ANAHEIM	CA	92805	5803	30	06059	33.82054594	-117.9088937	Orange County
15150	Fee-for-Service	1093701161	1093701161	1	1	DIANA V MARIN, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 SW 62ND AVE	None	MIAMI	FL	33155	3009	00	None	25.74141026	-80.29501628	Miami-Dade County
15205	Fee-for-Service	1447322250	1447322250	1	1	DORFMAN, LIYA MD	1/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82483	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
15217	Fee-for-Service	1912165259	1912165259	1	1	DHOLAKIYA, PRIYAL P MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	108860	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3301 C STREET	SUITE 500	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
15283	Fee-for-Service	1033298187	1033298187	1	1	DUROUSSEAU, SHARON E MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72083	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
15333	Fee-for-Service	1205858917	1205858917	1	1	DOUGHERTY, DAVID C MD	7/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47681	41	Internal Medicine	0	In state provider	BAKERSFIELD INTERNAL MED	3900 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1458	15	06029	35.395731	-119.0081545	Kern County
15341	Fee-for-Service	1932341963	1932341963	1	1	DASU, VANI T DO	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12890	05	Anesthesiology	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
15346	Fee-for-Service	1760426415	1760426415	1	1	DHAWAN, VIJAY M MD	2/28/1984	207R00000X	NA	Other	026	PHYSICIANS	32299	01	General Practice	0	In state provider	None	3404 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02458936	-118.1406483	Los Angeles County
15357	Fee-for-Service	1235386533	1235386533	1	1	DESAI PATRAWALA, URVISHA PT	11/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
15474	Fee-for-Service	1023438405	1023438405	1	1	DENG, CATHY MD	10/24/2024	207L00000X	NA	Other	026	PHYSICIANS	160305	05	Anesthesiology	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
15478	Fee-for-Service	1336672187	1336672187	1	1	DE AZAMBUJA, KATHERINE M MD	8/9/2021	390200000X	NA	Other	026	PHYSICIANS	159349	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
15483	Fee-for-Service	1407855620	1407855620	1	1	DUHANEY HOME HEALTH CARE	7/29/2008	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	6060 W MANCHESTER AVE	SUITE 312	LOS ANGELES	CA	90045	4267	19	06037	33.95976851	-118.390734	Los Angeles County
15493	Fee-for-Service	1326507625	1326507625	1	1	DEBBANEH, PETER MD	2/17/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	181880	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
15513	Fee-for-Service	1407214638	1407214638	1	1	DAVIS, ELENA	1/19/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
15605	Fee-for-Service	1396748158	1396748158	1	1	DIXIT, RAJIV K MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40735	01	General Practice	0	In state provider	ARTHRITIS & RHEUMATOLOGY	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
15608	Fee-for-Service	1851303259	1851303259	1	1	DAB, SUSAN B MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45583	40	Pediatrics	0	In state provider	None	3490 CALIFORNIA STREET	SUITE 200	SAN FRANCISCO	CA	94118	1892	38	06075	37.78668333	-122.4514243	San Francisco County
15613	Fee-for-Service	1063138238	1063138238	1	1	DONG, SYDNIE CRNA	11/18/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
15621	Fee-for-Service	1346201696	1346201696	1	1	DOAN, BAN D MD	4/4/2015	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43454	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15663 BROOKHURST ST	None	WESTMINSTER	CA	92683	7556	30	06059	33.73513398	-117.9547979	Orange County
15652	Fee-for-Service	1114066974	1114066974	1	1	DUNCAN, MAX B DO	1/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	5164	13	Neurology (M.D. only)	0	In state provider	None	1350 S ELISEO DRIVE	STE 220	GREENBRAE	CA	94904	2133	21	06041	37.94490653	-122.537021	Marin County
15682	Fee-for-Service	1093071227	1093071227	1	1	DUNCAN, ELIZABETH K LPCC	8/18/2023	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
15718	Fee-for-Service	1245523992	1245523992	1	1	DRAG, LAUREN L PHD	7/24/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15765	Fee-for-Service	1194356279	1194356279	1	1	DR. REGINE SMET, O.D., INC	3/1/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2901 LOS FELIZ BLVD	None	LOS ANGELES	CA	90039	1502	19	06037	34.129008	-118.263933	Los Angeles County
15775	Fee-for-Service	1568728657	1568728657	1	1	DALY, SUN C MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111255	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
15776	Fee-for-Service	1821558586	1821558586	1	1	DURAN, CELINA MD	1/15/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
15777	Fee-for-Service	1629017355	1629017355	1	1	DOHERTY, MELISSA	6/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	0000	00	None	44.08199228	-123.0283538	Lane County
15820	Fee-for-Service	1407240336	1407240336	1	1	DOYLE, ZOE MD	6/23/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144258	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
15821	Fee-for-Service	1750642138	1750642138	1	1	DABBS, DANIELLE N DO INC	9/17/2014	2086S0127X	NA	General Surgery	026	PHYSICIANS	8807	02	General Surgery	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
15832	Fee-for-Service	1457396178	1457396178	1	1	DERMATOLOGY & LASER	9/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	CENTER OF SAN DIEGO	319 F ST	STE 102	CHULA VISTA	CA	91910	2666	37	06073	32.64113029	-117.0808109	San Diego County
15840	Fee-for-Service	1437219581	1437219581	1	1	DAY, I-KAWEI MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	43558	41	Internal Medicine	0	In state provider	None	10410 LOWER AZUSA RD	STE 103	EL MONTE	CA	91731	1277	19	06037	34.09185146	-118.0407774	Los Angeles County
15852	Fee-for-Service	1245312420	1245312420	1	1	DIRE,CHRISTOPHER A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4011 TALBOT RD	STE 500	RENTON	WA	98055	0000	00	None	47.44331246	-122.2117632	King County
15862	Fee-for-Service	1942622097	1942622097	1	1	DANESHMAND, SHERVIN MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133307	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
15890	Fee-for-Service	1396748158	1396748158	1	1	DIXIT, RAJIV K MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	40735	83	Rheumatology	0	In state provider	ARTHRITIS & RHEUMATOLOGY	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
15924	Fee-for-Service	1174819361	1174819361	1	1	DOSHI, NEIL R MD	4/19/2022	208M00000X	NA	Other	026	PHYSICIANS	132830	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
15932	Fee-for-Service	1821406984	1821406984	1	1	DALIESIO, MARIO LMFT	8/10/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7700 IRVINE CENTER DR	STE 800	IRVINE	CA	92618	3047	30	06059	33.65876225	-117.7500004	Orange County
15933	Fee-for-Service	1255445300	1255445300	1	1	DELA CRUZ, RHODORA C	7/1/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50532	40	Pediatrics	0	In state provider	PEDIATRIC CLINIC	2147 MOWRY AVE	STE A2	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
15934	Fee-for-Service	1013169390	1013169390	1	1	DEUTSCH, NANCY D	4/15/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1238 CYPRESS AVE	None	SAN DIEGO	CA	92103	4426	37	06073	32.7443808	-117.1525505	San Diego County
15974	Fee-for-Service	1023406675	1023406675	1	1	DEVINECOOTER, SARAH A NP	4/3/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
16039	Fee-for-Service	1932503091	1932503091	1	1	DIPRIMA, THOMAS J	4/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
16040	Fee-for-Service	1134115710	1134115710	1	1	DOWDS, GORDON W MD	5/31/1985	207RP1001X	NA	Pulmonology	026	PHYSICIANS	40197	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7320 WOODLAKE AVE	STE 290	WEST HILLS	CA	91307	1490	19	06037	34.20245266	-118.6321273	Los Angeles County
16128	Fee-for-Service	1437219581	1437219581	1	1	DAY, I-KAWEI MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	43558	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10410 LOWER AZUSA RD	STE 103	EL MONTE	CA	91731	1277	19	06037	34.09185146	-118.0407774	Los Angeles County
16132	Fee-for-Service	1346542479	1346542479	1	1	DEMETRAL, LINDSEY C DO	5/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11912	40	Pediatrics	0	In state provider	None	2828 FRESNO ST	203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
16135	Fee-for-Service	1962740894	1962740894	1	1	DEGUZMAN, DOROTHY V CRNA	3/1/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
16152	Fee-for-Service	1730399551	1730399551	1	1	DODD, ANNA L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
16189	Fee-for-Service	1053577676	1053577676	1	1	DORGAN, BRYON J DO	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13021	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2773 HARRIS ST	SUITE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
16196	Fee-for-Service	1376121012	1376121012	1	1	DIAMOND CARE TRANSPORT INC.	3/1/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	437 N PALORA AVE	None	YUBA CITY	CA	95991	4711	51	06101	39.12817886	-121.6333158	Sutter County
16200	Fee-for-Service	1871937045	1871937045	1	1	DANIELS, BRIANNE H DO	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14055	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
16201	Fee-for-Service	1568416147	1568416147	1	8	DESERT ADVANCED IMAGING MEDI	9/18/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	35800 BOB HOPE DRIVE	STE 150A	RANCHO MIRAGE	CA	92270	1722	33	06065	33.790527	-116.4058645	Riverside County
16235	Fee-for-Service	1740253061	1740253061	1	1	DR.OCTAVIO VIDAL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5656 S POWER RD	None	GILBERT	AZ	85295	8487	00	None	33.31386	-111.6877185	Maricopa County
16294	Fee-for-Service	1790043289	1790043289	2	1	DEVERA, RUTHANN L MD	12/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	119879	None	None	0	In state provider	None	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
16324	Fee-for-Service	1295710747	1295710747	1	1	DUQUE, JOHN J MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	48442	10	Gastroenterology (M.D. only)	0	In state provider	None	480 4TH AVE	STE 316	CHULA VISTA	CA	91910	4403	37	06073	32.63411298	-117.0816772	San Diego County
16371	Fee-for-Service	1154501054	1154501054	1	1	DE MONS, MARSHAWN PT	9/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
16408	Fee-for-Service	1740790427	1740790427	1	1	DEVINE, KELLY A LCSW	5/23/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 FOLSOM BLVD.	STE 1400	SACRAMENTO	CA	91816	5219	34	06067	38.568393	-121.4658585	Sacramento County
16447	Fee-for-Service	1891873451	1891873451	1	1	DEMAS, BARBARA E MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	39814	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
16476	Fee-for-Service	1346297108	1346297108	1	1	DOWLATI, BIJAN MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77413	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
16477	Fee-for-Service	1053577676	1053577676	1	1	DORGAN, BRYON J DO	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13021	41	Internal Medicine	0	In state provider	None	2773 HARRIS ST	SUITE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
16489	Fee-for-Service	1508815473	1508815473	1	1	DESERT ANESTHESIA	3/14/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CONSULTANTS LP	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
16502	Fee-for-Service	1881078988	1881078988	1	1	DESGREY, SANDRA A CNP	12/4/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2791 AGOURA RD	None	THOUSAND OAKS	CA	91361	3101	56	06111	34.15068671	-118.8255597	Ventura County
16524	Fee-for-Service	1740619063	1740619063	1	1	DANIELS, CANDICE M CNP	3/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	812 S GRAND AVE	None	LOS ANGELES	CA	90017	4610	19	06037	34.04543884	-118.2582805	Los Angeles County
16549	Fee-for-Service	1326654815	1326654815	1	1	DANG, LINH NP	8/26/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
16597	Fee-for-Service	1538302062	1538302062	1	1	DAVIS, NICHOLAS A MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158983	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
16612	Fee-for-Service	1871751628	1871751628	1	1	DIETRICH, JENNIFER L MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139371	05	Anesthesiology	0	In state provider	None	450 STANYAN STREET	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
16615	Fee-for-Service	1295710747	1295710747	1	1	DUQUE, JOHN J MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	48442	41	Internal Medicine	0	In state provider	None	480 4TH AVE	STE 316	CHULA VISTA	CA	91910	4403	37	06073	32.63411298	-117.0816772	San Diego County
16686	Fee-for-Service	1265848519	1265848519	1	1	DUONG, TAMMY MD	4/19/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	130609	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
16700	Fee-for-Service	1104891068	1104891068	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	TULARE DIALYSIS	545 E TULARE AVE	None	TULARE	CA	93274	4220	54	06107	36.20876896	-119.3411002	Tulare County
16723	Fee-for-Service	1841265261	1841265261	1	1	DICHTER, GEORGE MD	6/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	40039	41	Internal Medicine	0	In state provider	None	2876 SYCAMORE DR	STE 101	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
16730	Fee-for-Service	1932360062	1932360062	1	1	DENNIS, JOLANTA M MD	2/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	113913	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
16807	Fee-for-Service	1013329051	1013329051	1	1	DAYALO, FERDINAND D NP	8/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	694817	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
16852	Fee-for-Service	1790170702	1790170702	1	1	DE VRIES, CHRISTIAAN R MD	7/21/2020	207R00000X	NA	Other	026	PHYSICIANS	150125	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
16857	Fee-for-Service	1144241647	1144241647	1	1	DANNY K WORWOOD	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	75 N 2260 W	None	HURRICANE	UT	84737	2034	00	None	37.17774517	-113.3295348	Washington County
16868	Fee-for-Service	1255108692	1255108692	1	1	DOBALIAN, TATUM A CRNA	3/13/2024	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
16886	Fee-for-Service	1538302062	1538302062	1	1	DAVIS, NICHOLAS A MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	158983	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
16900	Fee-for-Service	1295710747	1295710747	1	1	DUQUE, JOHN J MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	48442	66	Emergency Medicine (Urgent Care)	0	In state provider	None	480 4TH AVE	STE 316	CHULA VISTA	CA	91910	4403	37	06073	32.63411298	-117.0816772	San Diego County
16944	Fee-for-Service	1881273381	1881273381	1	1	DAULAT, SHILPA MD	1/7/2025	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
16947	Fee-for-Service	1164817946	1164817946	1	1	DIMAYA, ROLAND M	12/27/2022	207P00000X	NA	Other	026	PHYSICIANS	19913	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
16964	Fee-for-Service	1609940113	1609940113	1	1	DAVID DAEWHAN KIM, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6777 W MAPLE RD	None	W BLOOMFIELD	MI	48322	3013	00	None	42.53823	-83.406843	Oakland County
16969	Fee-for-Service	1699155150	1699155150	1	1	DILLARD, KIRA L MD	4/13/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	162015	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA # B200	None	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
16974	Fee-for-Service	1609862424	1609862424	1	1	DARREN E WHITCOMB MD	5/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 MEDICAL CENTER BLVD	None	MARRERO	LA	70072	3147	00	None	29.89168678	-90.09584835	Jefferson Parish
16996	Fee-for-Service	1497334072	1497334072	1	1	DUNKLE, ASHLEY MD	3/13/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182074	08	Family Practice	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
17002	Fee-for-Service	1104159383	1104159383	1	1	DEZFOLI, SEPER MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113069	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
17043	Fee-for-Service	1407044589	1407044589	1	1	DR JOAN SY MEDICAL CORP	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	6587	None	None	0	In state provider	None	23521 PASEO DE VALENCIA	STE 311	LAGUNA HILLS	CA	92653	3107	30	06059	33.61113028	-117.7126684	Orange County
17080	Fee-for-Service	1700223294	1700223294	1	1	DE LA CRUZ, CARLA M MD	7/22/2021	207L00000X	NA	Other	026	PHYSICIANS	172563	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
17126	Fee-for-Service	1700216611	1700216611	1	1	DANIELS, GREGORY R CRNA	3/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
17138	Fee-for-Service	1790170702	1790170702	1	1	DE VRIES, CHRISTIAAN R MD	7/21/2020	207R00000X	NA	Other	026	PHYSICIANS	150125	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
17160	Fee-for-Service	1013908227	1013908227	1	1	DUNCAN, TIMOTHY B MD	4/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87083	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
17164	Fee-for-Service	1679632392	1679632392	1	1	DOURTE, SUZANNE L OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5225 CANYON CREST DR	STE 13	RIVERSIDE	CA	92507	6301	33	06065	33.95618617	-117.3293404	Riverside County
17185	Fee-for-Service	1548289275	1548289275	1	1	DAVID W DAVISON MD	3/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	406 S GARY AVE	None	MONAHANS	TX	79756	4799	00	None	31.59358104	-102.8844069	Ward County
17209	Fee-for-Service	1851587182	1851587182	1	1	DIMMLER, MIRIAM R PHD	4/18/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
17211	Fee-for-Service	1992165708	1992165708	1	1	DUNLOP, DARCIE D LMFT	6/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26413 JEFFERSON AVE.	SUITE E	MURRIETA	CA	92562	4727	33	06065	33.53475568	-117.1791945	Riverside County
17216	Fee-for-Service	1083988844	1083988844	1	1	DICKINSON, JOSEPH D DPM	9/17/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
17223	Fee-for-Service	1588788830	1588788830	1	1	DAY, SHELLEY MD	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99063	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
17251	Fee-for-Service	1205199924	1205199924	1	1	DEMBITSKY, NICHOLAS P L MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144538	41	Internal Medicine	0	In state provider	None	300 FIR ST	None	SAN DIEGO	CA	92101	2327	37	06073	32.72513447	-117.1616355	San Diego County
17291	Fee-for-Service	1447598396	1447598396	1	1	DILLON, KEITH O MD INC	11/2/2006	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75356	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1510 E MAIN ST	STE 104	SANTA MARIA	CA	93454	4826	42	06083	34.95282793	-120.4100798	Santa Barbara County
17296	Fee-for-Service	1548409709	1548409709	1	1	DEWILDE, KATHRYN C	3/5/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
17311	Fee-for-Service	1730365248	1730365248	1	1	DIONISIO, CATHERINE F PHD	1/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
17325	Fee-for-Service	1124387998	1124387998	1	1	DUOMO PHARMACY INC	9/25/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12157 VICTORY BLVD	#A	NORTH HOLLYWOOD	CA	91606	3204	19	06037	34.18669745	-118.3985415	Los Angeles County
17372	Fee-for-Service	1861912438	1861912438	1	1	DANIEL, MICHAEL M DPM	9/1/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	240 E 13TH STREET	None	MERCED	CA	95341	6234	24	06047	37.2929228	-120.4743925	Merced County
17417	Fee-for-Service	1710908223	1710908223	1	1	DO, JOHN-KHOA DO	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8905	41	Internal Medicine	0	In state provider	None	65 N MADISON AVE	STE 200	PASADENA	CA	91101	2035	19	06037	34.14705803	-118.1384317	Los Angeles County
17520	Fee-for-Service	1982645180	1982645180	1	2	DOLEZAL, KATHRYN L NP	12/4/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	488996	-	NOT APPLICABLE	0	In state provider	None	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4513	40	06079	35.27488974	-120.6468257	San Luis Obispo County
17530	Fee-for-Service	1326397936	1326397936	1	1	DIPAOLO, LAURA H MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127058	01	General Practice	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
17547	Fee-for-Service	1144265521	1144265521	1	1	DREES, CORNELIA N MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
17604	Fee-for-Service	1073591889	1073591889	1	1	DANIEL GILDAY MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	505 S 336TH ST	SUITE 600	FEDERAL WAY	WA	98003	0000	00	None	47.30005468	-122.3272224	King County
17670	Fee-for-Service	1730261488	1730261488	2	1	DASARI, PADMA MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	48000	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
17671	Fee-for-Service	1326010331	1326010331	1	1	DANIEL E. BROOKS, M.D.	6/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
17679	Fee-for-Service	1518971464	1518971464	1	1	DE LA PENA EYE CLINIC, A MED	8/1/1996	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	A MEDICAL GROUP, INC	2715 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
17701	Fee-for-Service	1619593860	1619593860	1	1	DAUD, SALAR MD	8/28/2023	207R00000X	NA	Other	026	PHYSICIANS	182908	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
17735	Fee-for-Service	1508905449	1508905449	1	1	DAVARPANAH, NICOLE N MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94886	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	8589	30	06059	33.62421676	-117.9309656	Orange County
17759	Fee-for-Service	1134742703	1134742703	1	1	DESERT PHYSICIANS MEDICAL GR	12/19/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
17783	Fee-for-Service	1740539980	1740539980	1	1	DIDI HIRSCH PSYCHIATRIC SERV	3/1/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICE	11643 GLENOAKS BLVD	None	PACOIMA	CA	91331	1050	19	06037	34.28133474	-118.4198166	Los Angeles County
17789	Fee-for-Service	1396857462	1396857462	1	1	DOHEMANN, JESSE H MD	1/21/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	72917	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	STE 423	SAN FRANCISCO	CA	94115	2380	38	06075	37.7904826	-122.4324477	San Francisco County
17806	Fee-for-Service	1912449430	1912449430	1	1	DETWILER PSYCHOLOGY APC	10/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	471 E TAHQUITZ CANYON WA	219	PALM SPRINGS	CA	92262	6620	33	06065	33.8230047	-116.543381	Riverside County
17815	Fee-for-Service	1861569279	1861569279	1	1	DREW AND RASKIN MD INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	PARTNERSHIP	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
17927	Fee-for-Service	1841202520	1841202520	1	1	DEATSCH, RICHARD B MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	50088	02	General Surgery	0	In state provider	None	612 W DUARTE RD	STE 602	ARCADIA	CA	91007	9241	19	06037	34.12647805	-118.051994	Los Angeles County
17961	Fee-for-Service	1992202626	1992202626	1	1	DUONG, DENNIS MD	10/1/2021	207R00000X	NA	Other	026	PHYSICIANS	17864	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
17966	Fee-for-Service	1518971464	1518971464	1	1	DE LA PENA EYE CLINIC, A MED	8/1/1996	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL GROUP, INC	2715 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
17975	Fee-for-Service	1134647233	1134647233	1	1	DAVILA-CARRANZA, NESTOR S	10/25/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	1660 E ROSEVILLE PKWY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
17986	Fee-for-Service	1740441898	1740441898	1	1	DANIEL LERNER MD	3/2/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 NE NEFF RD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
18024	Fee-for-Service	1639111966	1639111966	1	1	DEFRIEZ, STEPHEN D DO	7/20/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	21373	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
18037	Fee-for-Service	1972147494	1972147494	1	1	DEFENDER LLC	10/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3500 FOLSOM BLVD	None	SACRAMENTO	CA	95816	6615	34	06067	38.566188	-121.4625645	Sacramento County
18050	Fee-for-Service	1417111303	1417111303	1	1	DESAI, MONALI Y MD	1/23/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	137770	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	150 CATHERINE LANE	STE F	GRASS VALLEY	CA	95945	5719	29	06057	39.22894557	-121.0489578	Nevada County
18064	Fee-for-Service	1205918851	1205918851	1	1	DHIRAJ KUMAR KOTWAL	1/14/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 MEDICAL CTR DR	None	MCKINNEY	TX	75069	1650	00	None	33.15995321	-96.63541695	Collin County
18067	Fee-for-Service	1417649013	1417649013	1	1	DADE, ETHLENE E CNP	8/17/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17083 MAIN ST	None	HESPERIA	CA	92345	6075	36	06071	34.41986247	-117.2905272	San Bernardino County
18101	Fee-for-Service	1851840417	1851840417	1	1	DELOZIER, ELIZABETH R	11/27/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18241	Fee-for-Service	1538111216	1538111216	1	1	DUCKWILER, GARY R MD	1/31/1991	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52580	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
18252	Fee-for-Service	1568416147	1568416147	1	9	DESERT ADVANCED IMAGING MEDI	12/8/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	72-605 HWY 111	STE A-1	PALM DESERT	CA	92260	3392	33	06065	33.7215393	-116.3792025	Riverside County
18258	Fee-for-Service	1588827034	1588827034	1	1	DOTY, DONALD JR CPO	2/29/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1828 E CESAR E CHAVEZ AV	#A12	LOS ANGELES	CA	90033	2400	19	06037	34.05023174	-118.2154927	Los Angeles County
18263	Fee-for-Service	1326123068	1326123068	1	1	DEVOOGD, RUTH NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
18280	Fee-for-Service	1902575442	1902575442	1	1	DRESSMAN, JENNIFER PT	12/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
18303	Fee-for-Service	1346384898	1346384898	1	1	DIETZ, ADAM G R MD	8/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105159	20	Orthopedic Surgery	0	In state provider	None	25775 MCBEAN PARKWAY	None	VALENCIA	CA	91355	0000	19	06037	34.40042013	-118.5511416	Los Angeles County
18338	Fee-for-Service	1992053581	1992053581	1	1	DOLATSHAHI, MARYAM MD	10/10/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	140286	08	Family Practice	0	In state provider	None	1071 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	1103	43	06085	37.2509447	-121.8743507	Santa Clara County
18339	Fee-for-Service	1700835451	1700835451	1	1	DIAZ, GERVACIO D III MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69801	41	Internal Medicine	0	In state provider	None	2013 COFFEE RD	None	MODESTO	CA	95355	2405	50	06099	37.673127	-120.975776	Stanislaus County
18348	Fee-for-Service	1336377829	1336377829	1	1	DENICOLA, MATTHEW M MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115650	22	Pathology (M.D. only)	0	In state provider	None	400 PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
18355	Fee-for-Service	1174113534	1174113534	1	3	DIAGNOSTIC PATHOLOGY LABORAT	3/3/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORY SERVICES, INC.	11815 EDUCATION ST	None	AUBURN	CA	95602	2410	31	06061	38.94431878	-121.1009419	Placer County
18375	Fee-for-Service	1679762702	1679762702	1	2	DEVORE, GREGGORY R MD	1/30/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5525 ETIWANDA AVE	STE 313	TARZANA	CA	91356	6127	19	06037	34.17046451	-118.5308463	Los Angeles County
18387	Fee-for-Service	1679762702	1679762702	1	5	DEVORE, GREGGORY R MD	8/19/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	A MEDICAL CORPORATION	44215 15TH ST WEST	STE 112	LANCASTER	CA	93534	5503	19	06037	34.68666415	-118.1568572	Los Angeles County
18393	Fee-for-Service	1154324036	1154324036	1	1	DETWILER, JOHN H MD	7/1/1976	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23336	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	210 S JUNIPER ST	STE 103	ESCONDIDO	CA	92025	4230	37	06073	33.12179893	-117.0778404	San Diego County
18406	Fee-for-Service	1750477162	1750477162	1	1	DE LOS SANTOS, HANNAH MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65270	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
18432	Fee-for-Service	1518147230	1518147230	1	1	DONOGHUE, NANCY MFT	10/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	31758	-	NOT APPLICABLE	0	In state provider	None	1100 SPORTFISHER DRIVE	None	OCEANSIDE	CA	92054	2550	37	06073	33.20107607	-117.3773312	San Diego County
18460	Fee-for-Service	1558453712	1558453712	1	1	DEBLASIO, DOMINICK J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
18475	Fee-for-Service	1518996974	1518996974	1	1	DIXON, SAMUEL P MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	45816	01	General Practice	0	In state provider	None	4500 W 116TH ST	None	HAWTHORNE	CA	90250	2209	19	06037	33.92906042	-118.3548882	Los Angeles County
18489	Fee-for-Service	1497809586	1497809586	1	1	DUNN, WESLEY M MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84295	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
18499	Fee-for-Service	1801885322	1801885322	1	1	DABHIA, GURINDER K MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDRENS WAY	MC5003	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
18581	Fee-for-Service	1558701292	1558701292	1	1	DICKERSON, CHARLES E JR CRNA	8/8/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
18586	Fee-for-Service	1962454652	1962454652	1	1	DIEP, DANIEL T MD	4/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91505	08	Family Practice	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
18593	Fee-for-Service	1609975689	1609975689	1	1	DAWSON, ARTHUR D MD	8/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	21398	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
18696	Fee-for-Service	1750477162	1750477162	1	1	DE LOS SANTOS, HANNAH MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65270	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
18702	Fee-for-Service	1710411954	1710411954	1	1	DHALIWAL, AKASHDEEP K DO	7/26/2021	207R00000X	NA	Other	026	PHYSICIANS	18901	None	None	0	In state provider	None	15248 ELEVENTH ST	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
18725	Fee-for-Service	1568967248	1568967248	1	1	DELGADO, JESSICA M PT	10/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
18758	Fee-for-Service	1750663043	1750663043	1	1	DIREEN, CATHERINE LMFT	4/20/2023	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
18764	Fee-for-Service	1518996974	1518996974	1	1	DIXON, SAMUEL P MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	45816	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4500 W 116TH ST	None	HAWTHORNE	CA	90250	2209	19	06037	33.92906042	-118.3548882	Los Angeles County
18819	Fee-for-Service	1710585633	1710585633	1	1	DAT N DUONG DO MEDICAL CORP	9/17/2021	193200000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	14361 BEACH BLVD	STE 203	WESTMINSTER	CA	92683	4568	30	06059	33.75337421	-117.9897243	Orange County
18822	Fee-for-Service	1033157003	1033157003	1	1	DENNIS, FREDERICK T MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37860	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
18823	Fee-for-Service	1326018821	1326018821	1	1	DESHPANDE, ABHIJIT G MD	3/5/2021	207RS0012X	NA	Other	026	PHYSICIANS	143486	None	None	0	In state provider	None	34 MARK WEST SPRINGS RD	3RD FLOOR	SANTA ROSA	CA	95403	1436	49	06097	38.49639719	-122.7501553	Sonoma County
18853	Fee-for-Service	1154474302	1154474302	1	1	DAKOTA MEDICAL INC	9/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	409 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2916	19	06037	34.15985309	-118.2619302	Los Angeles County
18855	Fee-for-Service	1871507111	1871507111	1	1	DUPONT, TIMOTHY J MD	12/31/1984	207L00000X	NA	Other	026	PHYSICIANS	49782	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
18864	Fee-for-Service	1831728740	1831728740	1	1	DAVARI, PARAN MD	2/24/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	190216	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
18865	Fee-for-Service	1003859661	1003859661	1	1	DOAN, ALEXANDER D MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	62476	41	Internal Medicine	0	In state provider	None	105 N BASCOM AVE	STE 103	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
18879	Fee-for-Service	1316365935	1316365935	1	1	DUBIN, BRIAN L MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	141120	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
18901	Fee-for-Service	1528587383	1528587383	1	1	DOBROWSKY, VALERIA P LCSW	7/21/2023	390200000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
18923	Fee-for-Service	1780060699	1780060699	1	1	DESAI, DIMPI NITIN MD	6/22/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	179196	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18924	Fee-for-Service	1326064973	1326064973	1	1	DR. SERGIO R COLLADO M.D.	8/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4403 HARRISON BLVD	STE 3490	OGDEN	UT	84403	3271	00	None	41.18328	-111.9536955	Weber County
18934	Fee-for-Service	1912958539	1912958539	1	1	DEMOSS, MARY L OD	1/1/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	32245 MISSION TRL	STE D4	LAKE ELSINORE	CA	92530	4528	33	06065	33.65526061	-117.2976756	Riverside County
18961	Fee-for-Service	1609246461	1609246461	1	1	DIGNITY HEALTH	8/31/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2126 SOLANO STREET	None	CORNING	CA	96021	2713	52	06103	39.92806326	-122.1959638	Tehama County
18967	Fee-for-Service	1942379987	1942379987	1	1	DAUWALDER, TIMOTHY J DO	12/1/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	7875	-	NOT APPLICABLE	0	In state provider	None	916 N MOUNTAIN AVE	SUITE A	UPLAND	CA	91786	3658	36	06071	34.105419	-117.670193	San Bernardino County
18968	Fee-for-Service	1962580118	1962580118	1	1	DUNN,MICHAEL MD	1/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	URGENT CARE EXPRESS	415 N VAL VISTA DR	STE 101	MESA	AZ	85213	0000	00	None	33.42312	-111.7525455	Maricopa County
19008	Fee-for-Service	1699027581	1699027581	1	1	DIXON, DARLA E PSYD	7/27/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4781 GETTYSBURG	STE 108	FRESNO	CA	93726	1814	10	06019	36.80131952	-119.737098	Fresno County
19019	Fee-for-Service	1194885418	1194885418	1	1	DANIELS PHARMACY	10/13/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	943 GENEVA AVE	None	SAN FRANCISCO	CA	94112	3402	38	06075	37.71616793	-122.440444	San Francisco County
19029	Fee-for-Service	1356023154	1356023154	1	1	DIVINE MAMA DOULA PROJECT LL	8/25/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
19030	Fee-for-Service	1861601148	1861601148	1	1	DURIAN, BRADFORD	2/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	39146	-	NOT APPLICABLE	0	In state provider	None	222 W VALERIO ST	REAR BUILDING	SANTA BARBARA	CA	93101	2930	42	06083	34.42532284	-119.7137898	Santa Barbara County
19105	Fee-for-Service	1730528571	1730528571	1	1	DE GUZMAN, GERALD G	10/4/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
19113	Fee-for-Service	1295830974	1295830974	1	1	DR MAHADEV MD INC	6/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45109	40	Pediatrics	0	In state provider	INC	125 S CHAPARRAL CT	STE 102	ANAHEIM	CA	92808	2263	30	06059	33.86510213	-117.7446181	Orange County
19123	Fee-for-Service	1447208921	1447208921	1	1	DE MEO, MARK J MD	2/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	12988	22	Pathology (M.D. only)	0	In state provider	None	1049 4TH ST	None	SANTA ROSA	CA	95404	4303	49	06097	38.444508	-122.7060495	Sonoma County
19148	Fee-for-Service	1447821467	1447821467	1	1	DIAMOND RIDGE POST ACUTE	7/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	2351 LOVERIDGE	None	PITTSBURG	CA	94565	5117	07	06013	38.00579658	-121.8716881	Contra Costa County
19151	Fee-for-Service	1003859661	1003859661	1	1	DOAN, ALEXANDER D MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	62476	45	Nephrology (Renal-Kidney)	0	In state provider	None	105 N BASCOM AVE	STE 103	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
19152	Fee-for-Service	1851496095	1851496095	1	1	DINHLUU, DIEMKHANH M OD	8/8/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2103 E GONZALES RD	None	LOS ANGELES	CA	93030	3757	19	06037	34.2189506	-119.151337	Ventura County
19167	Fee-for-Service	1538377874	1538377874	1	1	DAVILA, DIEGO MD	2/7/2019	174400000X	NA	Other	026	PHYSICIANS	69207	42	Nuclear Medicine	0	In state provider	None	14445 OLIVE VIEW DR	2D-115	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
19214	Fee-for-Service	1598705469	1598705469	1	1	DIXON, KATHERINE M MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	34302	26	Psychiatry (child)	0	In state provider	None	8939 LA MESA BLVD	None	LA MESA	CA	91941	4057	37	06073	32.77474557	-117.0045237	San Diego County
19226	Fee-for-Service	1972943520	1972943520	1	1	DALY, MICHAEL C MD	8/5/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	174754	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
19230	Fee-for-Service	1992779102	1992779102	1	1	DOUGLAS J MARTINI MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 SE CARY PKWY	STE 100	CARY	NC	27518	7413	00	None	35.742015	-78.7624335	Wake County
19231	Fee-for-Service	1740601459	1740601459	1	1	DUPLESSIS, GERMEEN LCSW	8/17/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
19250	Fee-for-Service	1609246461	1609246461	1	1	DIGNITY HEALTH	8/31/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2126 SOLANO STREET	None	CORNING	CA	96021	2713	52	06103	39.92806326	-122.1959638	Tehama County
19278	Fee-for-Service	1770563041	1770563041	1	1	DELEN, FRANCISCUS M MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	77507	66	Emergency Medicine (Urgent Care)	0	In state provider	None	CASTRO & DUBOCE ST	N HOSPITAL TOWER # 133	SAN FRANCISCO	CA	94115	0000	38	06075	37.769049	-122.43582	San Francisco County
19307	Fee-for-Service	1023271574	1023271574	1	1	DOTY, EVE CPO	2/29/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1828 E CESAR E CHAVEZ AV	#A12	LOS ANGELES	CA	90033	2400	19	06037	34.05023174	-118.2154927	Los Angeles County
19350	Fee-for-Service	1770514531	1770514531	1	1	DHARMARAJAN, DEEPA MD	1/24/2022	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	173834	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
19389	Fee-for-Service	1932620028	1932620028	1	1	DA COSTA, REGINA L LFMT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90121	-	NOT APPLICABLE	0	In state provider	None	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90503	1727	19	06037	33.8188341	-118.1923297	Los Angeles County
19402	Fee-for-Service	1568416147	1568416147	1	6	DESERT ADVANCED IMAGING MEDI	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	2601 E TAHQUITZ CANYON W	None	PALM SPRINGS	CA	92262	7015	33	06065	33.82306152	-116.517609	Riverside County
19412	Fee-for-Service	1457413601	1457413601	1	1	DI PIAZZA, JILL M	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
19456	Fee-for-Service	1538377874	1538377874	1	1	DAVILA, DIEGO MD	2/7/2019	174400000X	NA	Other	026	PHYSICIANS	69207	30	Radiology	0	In state provider	None	14445 OLIVE VIEW DR	2D-115	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
19457	Fee-for-Service	1235417411	1235417411	1	1	DANG, THI B MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122538	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
19485	Fee-for-Service	1508243213	1508243213	1	1	DANG, THUY-LINH C LMFT	1/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 BRISTOL ST	G-101	COSTA MESA	CA	92626	7912	30	06059	33.67689875	-117.8872016	Orange County
19554	Fee-for-Service	1497146120	1497146120	1	1	DASHTAEI, AYDA DO	7/2/2020	208600000X	NA	General Surgery	026	PHYSICIANS	18093	None	None	0	In state provider	None	18310 US HWY 18	STE 100	APPLE VALLEY	CA	92307	2206	36	06071	34.54034956	-117.2645069	San Bernardino County
19565	Fee-for-Service	1770563041	1770563041	1	1	DELEN, FRANCISCUS M MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	77507	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	CASTRO & DUBOCE ST	N HOSPITAL TOWER # 133	SAN FRANCISCO	CA	94115	0000	38	06075	37.769049	-122.43582	San Francisco County
19583	Fee-for-Service	1356340970	1356340970	1	1	DONALD R KLEIN	6/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3900 CAPITOL MALL DR SW	None	OLYMPIA	WA	98502	8654	00	None	47.04174423	-122.9516179	Thurston County
19668	Fee-for-Service	1073661955	1073661955	1	1	DAMIANI, SANDRA C MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85489	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
19674	Fee-for-Service	1639638869	1639638869	1	1	DONG, TOBIAS X MD	6/16/2022	207R00000X	NA	Other	026	PHYSICIANS	178767	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19688	Fee-for-Service	1003036765	1003036765	1	1	DAVIES, JOHN R MS RPT	1/4/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4220 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	3511	30	06059	33.8029437	-118.059982	Orange County
19713	Fee-for-Service	1164928495	1164928495	1	1	DING, LIANG MD	3/22/2022	207ZP0102X	NA	Other	026	PHYSICIANS	175322	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
19759	Fee-for-Service	1336358977	1336358977	1	1	DOUGLAS, DANIELLE J MD	5/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89796	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5500 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3016	37	06073	32.7793549	-117.0091108	San Diego County
19774	Fee-for-Service	1740583210	1740583210	1	1	DORANELI SALAS	11/4/2010	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8986 TERRACORVO CIRCLE	None	STOCKTON	CA	95212	3831	39	06077	38.03008852	-121.2636136	San Joaquin County
19801	Fee-for-Service	1922217678	1922217678	1	1	DEMATTOS, NATASHA V MD	12/18/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	88166	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON STREET	SUITE 2400	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
19858	Fee-for-Service	1770563041	1770563041	1	1	DELEN, FRANCISCUS M MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	77507	41	Internal Medicine	0	In state provider	None	CASTRO & DUBOCE ST	N HOSPITAL TOWER # 133	SAN FRANCISCO	CA	94115	0000	38	06075	37.769049	-122.43582	San Francisco County
19892	Fee-for-Service	1699861484	1699861484	1	1	DESAI, ROOPAL V MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77875	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
19904	Fee-for-Service	1275611048	1275611048	1	1	DUTTA, SUPARNA MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75951	25	Physical Medicine and Rehabilitation	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
19923	Fee-for-Service	1144989385	1144989385	1	1	DR. JIMMY PHAN MEDICAL CORPO	1/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	425 DIAMOND DRIVE	SUITE 103	LAKE ELSINORE	CA	92530	9288	33	06065	33.65802263	-117.3002985	Riverside County
19951	Fee-for-Service	1538184072	1538184072	1	1	DAS, TAPASH K MD	1/27/2023	207R00000X	NA	Other	026	PHYSICIANS	54956	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
19971	Fee-for-Service	1134110091	1134110091	1	1	DELEO, VINCENT A MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	50794	07	Dermatology	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
19977	Fee-for-Service	1376634113	1376634113	1	1	DEL MUNDO, AMOR S MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50531	26	Psychiatry (child)	0	In state provider	None	180 S PROSPECT AVE	STE 140B	TUSTIN	CA	92780	3698	30	06059	33.74439669	-117.8224841	Orange County
20003	Fee-for-Service	1487914123	1487914123	1	1	DR DORYS P VARGAS OPTOMETRIS	6/29/2018	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIST INC	1800 N PERRIS BLVD	None	PERRIS	CA	92571	7201	33	06065	33.806115	-117.229473	Riverside County
20064	Fee-for-Service	1740583210	1740583210	1	1	DORANELI SALAS	11/4/2010	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8986 TERRACORVO CIRCLE	None	STOCKTON	CA	95212	3831	39	06077	38.03008852	-121.2636136	San Joaquin County
20088	Fee-for-Service	1609867738	1609867738	1	1	DESILVA WENDY E DO	9/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6436	08	Family Practice	0	In state provider	None	112 HARVARD AVE	STE 284	CLAREMONT	CA	91711	4716	19	06037	34.09483308	-117.7163218	Los Angeles County
20143	Fee-for-Service	1609904085	1609904085	1	1	DAI, JING MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88518	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
20191	Fee-for-Service	1811207483	1811207483	1	1	DERBOGHOSSIANS, SHAHIN MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42661	34	Urology and Urological Surgery	0	In state provider	INC	116 S LOUISE ST	SUITE A	GLENDALE	CA	91205	1025	19	06037	34.14557547	-118.2526054	Los Angeles County
20202	Fee-for-Service	1457902439	1457902439	1	1	DUARTE, GEORGE E LMFT	10/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
20240	Fee-for-Service	1578749396	1578749396	1	1	DYCAICO, CATHERINE MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	60867	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
20264	Fee-for-Service	1376634113	1376634113	1	1	DEL MUNDO, AMOR S MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50531	36	Psychiatry	0	In state provider	None	180 S PROSPECT AVE	STE 140B	TUSTIN	CA	92780	3698	30	06059	33.74439669	-117.8224841	Orange County
20321	Fee-for-Service	1689856635	1689856635	1	1	DHARAWAT, AMITA R MD	2/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121022	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3009	56	06111	34.27623479	-119.2520218	Ventura County
20347	Fee-for-Service	1124132543	1124132543	1	1	DANN, JOHN J III MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	41331	02	General Surgery	0	In state provider	None	895 MORAGA RD	STE 7	LAFAYETTE	CA	94549	5039	07	06013	37.88677178	-122.1180216	Contra Costa County
20362	Fee-for-Service	1568552651	1568552651	1	1	DANIELS, MARK W MD	5/1/2000	2080P0205X	NA	Endocrinology	026	PHYSICIANS	63018	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
20398	Fee-for-Service	1053955070	1053955070	1	1	DESERT WIND HOSPICE INC	7/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14359 AMARGOSA RD	STE O	VICTORVILLE	CA	92392	2385	36	06071	34.51176581	-117.3301466	San Bernardino County
20408	Fee-for-Service	1376006429	1376006429	1	1	DANG-ORITA, NANCY MD	11/15/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	177956	77	Infectious Disease	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
20490	Fee-for-Service	1013677624	1013677624	1	1	DALILAH RESTREPO MD, A MEDIC	1/19/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	AL CORPORATION	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
20495	Fee-for-Service	1336675628	1336675628	1	1	DUSTIN YBARRA	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
20515	Fee-for-Service	1548331440	1548331440	1	1	DEBOER, MARK T MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59873	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20554	Fee-for-Service	1154439131	1154439131	1	1	DUK, ANTHONY D MD	7/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	80755	36	Psychiatry	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
20566	Fee-for-Service	1124679766	1124679766	1	1	DAVIDSON, HENRY J MD	11/6/2019	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
20582	Fee-for-Service	1477522589	1477522589	1	1	DUDYALA, VIJAYA MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79466	41	Internal Medicine	0	In state provider	None	33077 ALVARADO-NILES RD	None	UNION CITY	CA	94587	3109	01	06001	37.59324793	-122.0436351	Alameda County
20599	Fee-for-Service	1629041595	1629041595	1	1	DYSON, JOHN W MD	1/25/2001	207L00000X	NA	Other	026	PHYSICIANS	85994	05	Anesthesiology	0	In state provider	None	110 BUTTE ST	None	REDDING	CA	96001	0000	45	06089	40.58473922	-122.3892543	Shasta County
20625	Fee-for-Service	1134888290	1134888290	1	1	DELICARE HEALTH SERVICES	2/10/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	31416 CHEMIN CHEVALIER	None	TEMECULA	CA	92591	5910	33	06065	33.52247796	-117.1059373	Riverside County
20631	Fee-for-Service	1295006658	1295006658	1	1	DANA BARANSKI	3/22/2012	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13720 PALOMINO CREEK DR	None	CORONA	CA	92883	8958	33	06065	33.72712669	-117.4210159	Riverside County
20636	Fee-for-Service	1518277987	1518277987	1	1	DELSEN, MARYAM LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
20640	Fee-for-Service	1699795237	1699795237	1	1	DE LA CRUZ, LOURDES A MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	42190	40	Pediatrics	0	In state provider	None	3724 LONE TREE WAY	None	ANTIOCH	CA	94509	6018	07	06013	37.98362677	-121.8058276	Contra Costa County
20666	Fee-for-Service	1639545304	1639545304	2	1	DORADO PHARMACY INC	7/31/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13003 VAN NUYS BLVD	STE E	PACOIMA	CA	91331	8324	19	06037	34.27013384	-118.4166087	Los Angeles County
20671	Fee-for-Service	1760402887	1760402887	1	1	DELGADO, ANA R CNMW	9/10/2002	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20678	Fee-for-Service	1386630622	1386630622	1	1	DR. KUMAR SAMPATH	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHRIST HOSPITAL	4440 WEST 95TH STREET	None	OAK LAWN	IL	64053	2600	00	None	41.722344	-87.732567	Cook County
20685	Fee-for-Service	1053955070	1053955070	1	1	DESERT WIND HOSPICE INC	7/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14359 AMARGOSA RD	STE O	VICTORVILLE	CA	92392	2385	36	06071	34.51176581	-117.3301466	San Bernardino County
20686	Fee-for-Service	1669552006	1669552006	2	1	DISTEFANO, MICHAEL C MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
20695	Fee-for-Service	1376006429	1376006429	1	1	DANG-ORITA, NANCY MD	11/15/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	177956	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
20722	Fee-for-Service	1508486903	1508486903	1	1	DOSHI, NIRMITA R MD	7/3/2023	390200000X	NA	Other	026	PHYSICIANS	186588	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
20803	Fee-for-Service	1548331440	1548331440	1	1	DEBOER, MARK T MD	8/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59873	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20809	Fee-for-Service	1427306554	1427306554	1	1	DAVIDBADAL, CC LCSW	8/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 CARNEGIE DR	STE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.06796019	-117.2749922	San Bernardino County
20843	Fee-for-Service	1720516768	1720516768	1	1	DAVIS-LOBBAN, KORINNE E LMFT	10/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E. CARNEGIE DRIVE	SUITE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
20895	Fee-for-Service	1215960737	1215960737	1	1	DOW, DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3015 NE LOOP 286	None	PARIS	TX	75460	3433	00	None	33.67421469	-95.52145081	Lamar County
20909	Fee-for-Service	1922116037	1922116037	2	1	DIGNITY COMMUNITY CARE	7/1/2019	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
20919	Fee-for-Service	1295006658	1295006658	1	1	DANA BARANSKI	3/22/2012	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13720 PALOMINO CREEK DR	None	CORONA	CA	92883	8958	33	06065	33.72712669	-117.4210159	Riverside County
20920	Fee-for-Service	1992232953	1992232953	1	1	DIVINE ANGELS HOSPICE	11/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4712 BROOKS ST	None	MONTCLAIR	CA	91763	4707	36	06071	34.0615587	-117.7021591	San Bernardino County
20976	Fee-for-Service	1669552006	1669552006	2	1	DISTEFANO, MICHAEL C MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
20997	Fee-for-Service	1174540520	1174540520	1	1	DE-PAZ, JORDAN MD	7/22/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	82325	08	Family Practice	0	In state provider	None	115 HOSPITAL DR	None	UKIAH	CA	95482	4591	23	06045	39.15095011	-123.2032368	Mendocino County
21062	Fee-for-Service	1154613545	1154613545	1	1	DUGUAY, JOEL CCC-A	8/5/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	500 PROFESSIONAL CENTER	STE 511	NOVATO	CA	94947	4361	21	06041	38.09574302	-122.5780834	Marin County
21066	Fee-for-Service	1982680781	1982680781	1	1	DE GUZMAN, NELSON C MD	8/17/2021	207R00000X	NA	Other	026	PHYSICIANS	73959	None	None	0	In state provider	None	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	04	06007	39.750084	-121.7934327	Butte County
21101	Fee-for-Service	1568646735	1568646735	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	170 ALAMEDA DE LAS	PULGAS	REDWOOD CITY	CA	94062	2751	41	06081	37.48095011	-122.2532536	San Mateo County
21115	Fee-for-Service	1144965534	1144965534	1	2	DOKKA TRANSPORTATION LLC	7/11/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2667 CAMINO DEL RIO S	214-93	SAN DIEGO	CA	92108	3707	37	06073	32.76977026	-117.135564	San Diego County
21122	Fee-for-Service	1588968697	1588968697	1	1	DR. DEBORA SEDAGHAT OBGYN, I	7/27/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	NC.	11100 WARNER AVE	106	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
21125	Fee-for-Service	1285925883	1285925883	1	1	DOCTOR, NIRAJ S MD	12/5/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	123667	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2110 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	15	06029	35.37344851	-119.0261655	Kern County
21136	Fee-for-Service	1760872188	1760872188	1	1	DANG, KIM ANN V MD	4/1/2021	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	159626	None	None	0	In state provider	None	8851 CENTER DR	STE 500	LA MESA	CA	91942	3033	37	06073	32.78189749	-117.0075062	San Diego County
21160	Fee-for-Service	1376875088	1376875088	1	1	DANSBY, LEVI R MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110459	None	None	0	In state provider	None	9602 STOCKDALE HWY	None	BAKERSFIELD	CA	93311	3618	15	06029	35.35453351	-119.1091725	Kern County
21165	Fee-for-Service	1679685218	1679685218	1	1	DANG, KEVIN MD INC	7/1/2002	207L00000X	NA	Other	026	PHYSICIANS	70939	05	Anesthesiology	0	In state provider	None	2601 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
21167	Fee-for-Service	1518036029	1518036029	1	1	DABANIAN, LISA J MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8285	30	Radiology	0	In state provider	None	1700 MT VERNON AVE	ROOM 1241	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
21202	Fee-for-Service	1922116037	1922116037	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
21205	Fee-for-Service	1992232953	1992232953	1	1	DIVINE ANGELS HOSPICE	11/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4712 BROOKS ST	None	MONTCLAIR	CA	91763	4707	36	06071	34.0615587	-117.7021591	San Bernardino County
21283	Fee-for-Service	1174540520	1174540520	1	1	DE-PAZ, JORDAN MD	7/22/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	82325	15	Obstetrics (D.O. only)	0	In state provider	None	115 HOSPITAL DR	None	UKIAH	CA	95482	4591	23	06045	39.15095011	-123.2032368	Mendocino County
21311	Fee-for-Service	1821683806	1821683806	1	1	DELGADO, JOANNE S NP	9/14/2022	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27625 JEFFERSON AVE	STE. 101	TEMECULA	CA	92590	2619	33	06065	33.51653601	-117.1610206	Riverside County
21323	Fee-for-Service	1134256365	1134256365	1	1	DANIELS, ANTHONY G LMFT	1/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 MT DIABLO BLVD	404	WALNUT CREEK	CA	94596	4852	07	06013	37.89867436	-122.0569334	Contra Costa County
21358	Fee-for-Service	1417483868	1417483868	1	1	DHILLON, SAMEEP S MD	10/28/2022	208VP0014X	NA	Other	026	PHYSICIANS	161019	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
21389	Fee-for-Service	1568646735	1568646735	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	170 ALAMEDA DE LAS	PULGAS	REDWOOD CITY	CA	94062	2751	41	06081	37.48095011	-122.2532536	San Mateo County
21413	Fee-for-Service	1558323709	1558323709	1	1	DVA RENAL HEALTHCARE INC	7/22/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	2530 ANTHEM VILLAGE DR	None	HENDERSON	NV	89052	5548	00	None	35.97963622	-115.0984793	Clark County
21473	Fee-for-Service	1174660385	1174660385	1	2	DELOATCH, CANDYCE J MD	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125972	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
21487	Fee-for-Service	1922116037	1922116037	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
21563	Fee-for-Service	1831809813	1831809813	1	1	DURAN, VANESSA OT	9/18/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
21588	Fee-for-Service	1982622916	1982622916	1	1	DUALAN, GEORGE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30357	08	Family Practice	0	In state provider	None	376 W BADILLO ST	None	COVINA	CA	91723	1827	19	06037	34.0862457	-117.8963259	Los Angeles County
21647	Fee-for-Service	1851536353	1851536353	1	1	DEVERS, CECIL	11/6/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
21657	Fee-for-Service	1972628659	1972628659	1	1	DOURGARIAN,AMY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	665 WINTER ST	None	SALEM	OR	97301	3919	00	None	44.933211	-123.0355125	Marion County
21662	Fee-for-Service	1285742312	1285742312	1	1	DOMINIC, SUSAN R MD	7/31/1989	207R00000X	NA	Other	026	PHYSICIANS	68190	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
21665	Fee-for-Service	1124605746	1124605746	1	1	DESHPANDE, ANUSHA S DO	8/7/2024	208M00000X	NA	Other	026	PHYSICIANS	21354	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
21677	Fee-for-Service	1508334632	1508334632	1	1	DUARTE, ERICKA G LCSW	2/19/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2141 N HARBOR BLVD	STE 25000	FULLERTON	CA	92835	3830	30	06059	33.89443025	-117.9288328	Orange County
21684	Fee-for-Service	1437755899	1437755899	1	1	DABNEY, NATASHA NICOLE	8/9/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3561 YACHT DRIVE	None	DISCOVERY BAY	CA	94505	1745	07	06013	37.88985006	-121.6254165	Contra Costa County
21686	Fee-for-Service	1750381885	1750381885	1	1	DONTHI, RAJESH R MD	3/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128215	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
21774	Fee-for-Service	1194245241	1194245241	1	1	D&M MEDICAL SUPPLY, LLC	10/17/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	11405 FIRESTONE BLVD	None	NORWALK	CA	90650	2872	19	06037	33.91695834	-118.0895557	Los Angeles County
21814	Fee-for-Service	1871645234	1871645234	1	1	DANG, THAI L DO	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7458	18	Ophthalmology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
21831	Fee-for-Service	1215490362	1215490362	1	1	DE SILVA, SADIE R MD	6/24/2022	208M00000X	NA	Other	026	PHYSICIANS	178333	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
21848	Fee-for-Service	1134288079	1134288079	1	1	DORHOFER, DIANA M PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DRIVE	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
21855	Fee-for-Service	1104261262	1104261262	1	1	DAWSON, ADAM G DO	6/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
21894	Fee-for-Service	1922454768	1922454768	1	1	DAI, ZHI PENG DO	3/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17205	08	Family Practice	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
21908	Fee-for-Service	1376857128	1376857128	1	1	DHERE, RIJUTA A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
21935	Fee-for-Service	1497289862	1497289862	1	1	DINDOFFER, DAVID MD	7/8/2021	390200000X	NA	Other	026	PHYSICIANS	162748	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
21936	Fee-for-Service	1154490647	1154490647	1	1	DAMRELL, XI Z MD	7/3/2018	207P00000X	NA	Other	026	PHYSICIANS	146396	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
21959	Fee-for-Service	1679157309	1679157309	1	1	DIAMOND STAR HOME HEALTH CAR	9/15/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE B107	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
21966	Fee-for-Service	1396852380	1396852380	1	1	DANIEL DENT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
21970	Fee-for-Service	1568416147	1568416147	1	1	DESERT ADVANCED IMAGING MEDI	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	72855 FRED WARING DR	None	PALM DESERT	CA	92260	9367	33	06065	33.72858055	-116.3943135	Riverside County
21971	Fee-for-Service	1437755899	1437755899	1	1	DABNEY, NATASHA NICOLE	8/9/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3561 YACHT DRIVE	None	DISCOVERY BAY	CA	94505	1745	07	06013	37.88985006	-121.6254165	Contra Costa County
21976	Fee-for-Service	1295815090	1295815090	1	1	DIAZ, JOHN F MD	4/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91692	24	Plastic Surgery	0	In state provider	None	4910 VAN NUYS BLVD	STE 306	SHERMAN OAKS	CA	91403	1715	19	06037	34.15979697	-118.4486826	Los Angeles County
21978	Fee-for-Service	1134152572	1134152572	1	1	DUNBAR, RICHARD D MD	5/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	20666	30	Radiology	0	In state provider	None	25455 BARTON RD	STE 107B	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
21985	Fee-for-Service	1184656290	1184656290	1	1	DETWILER, SUSAN P MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	75321	22	Pathology (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
22025	Fee-for-Service	1942628045	1942628045	1	1	DOUILLARD, JELENA MD	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142207	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
22061	Fee-for-Service	1669538336	1669538336	1	1	DETTMAN, KAREN A	10/17/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
22095	Fee-for-Service	1568990232	1568990232	1	1	DRAKE, LUKE C MD	7/19/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	177202	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
22148	Fee-for-Service	1821288903	1821288903	1	1	DE CLARO, ANNA MARIA O MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100396	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
22218	Fee-for-Service	1306132063	1306132063	1	1	DOAN, HIEU N	4/18/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	848 E GARVEY AVE	STE B	MONTEREY PARK	CA	91755	3064	19	06037	34.06247991	-118.1103709	Los Angeles County
22243	Fee-for-Service	1669568457	1669568457	1	1	DEE, DEREK T MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65423	20	Orthopedic Surgery	0	In state provider	None	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
22283	Fee-for-Service	1245345297	1245345297	2	1	DDE RX INC	8/15/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18491 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2805	19	06037	33.98831212	-117.9021288	Los Angeles County
22296	Fee-for-Service	1568535615	1568535615	1	1	DATTA, JYOTI S MD INC	12/31/1979	174400000X	NA	Other	026	PHYSICIANS	33096	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1045 ATLANTIC AVE	STE 616	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
22336	Fee-for-Service	1619977527	1619977527	1	1	DILLON, CYNTHIA REYNOLDS	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	79019	08	Family Practice	0	In state provider	CYNTHIA REYNOLDS DILLON	1355 EAST ST	STE 110	REDDING	CA	96001	0801	45	06089	40.58628506	-122.3887911	Shasta County
22368	Fee-for-Service	1710916283	1710916283	1	1	DAVIS, MARC AARON MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84114	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
22408	Fee-for-Service	1508893744	1508893744	1	1	DANCIGER, HARVEY R DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	74000 COUNTRY CLUB DR	STE A2	PALM DESERT	CA	92260	1677	33	06065	33.75805952	-116.373249	Riverside County
22412	Fee-for-Service	1467715748	1467715748	1	1	DESHPANDE, KAVITA P MD	2/8/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154882	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
22413	Fee-for-Service	1376528489	1376528489	1	1	DEYHIMY, DAVID MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82776	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
22419	Fee-for-Service	1912055906	1912055906	1	1	DALE, TRACY MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69955	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
22425	Fee-for-Service	1639526833	1639526833	1	1	DC GIRON HEALTHCARE SERVICES	4/26/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3170 CROW CANYON PL	SUITE 130	SAN RAMON	CA	94583	1347	07	06013	37.77547298	-121.9719797	Contra Costa County
22458	Fee-for-Service	1225055916	1225055916	1	1	DIMAGIBA, LALAINE G MD	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51599	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
22554	Fee-for-Service	1093408775	1093408775	1	1	DIAZ, VANESSA	9/3/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2102 BUSINESS CENTER DR	STE 250	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
22563	Fee-for-Service	1326031477	1326031477	1	1	DRESCHER, ROBIN J OD	11/2/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
22582	Fee-for-Service	1922102441	1922102441	1	1	DUKHOVNY, IRINA MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52476	13	Neurology (M.D. only)	0	In state provider	None	5300 GEARY BLVD	STE 200	SAN FRANCISCO	CA	94121	2355	38	06075	37.78055056	-122.4764152	San Francisco County
22597	Fee-for-Service	1255459129	1255459129	1	1	DESSER, EVELYN M CNP	6/1/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10889 WELLWORTH AVE	None	LOS ANGELES	CA	90024	4918	19	06037	34.05707768	-118.4424488	Los Angeles County
22611	Fee-for-Service	1326090762	1326090762	1	1	DR MICHAEL PASS	2/20/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	890 OAK ST SE	None	SALEM	OR	97301	3905	00	None	44.932887	-123.0341175	Marion County
22619	Fee-for-Service	1295716785	1295716785	1	1	DURKIN, ROBERT C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1319 PUNAHOU ST	None	HONOLULU	HI	96849	0001	00	None	21.30030321	-157.8342762	Honolulu County
22627	Fee-for-Service	1477014611	1477014611	1	1	DECAMPS, SCARLETT M	7/31/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	181452	67	Endocrinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
22641	Fee-for-Service	1851450597	1851450597	1	1	DESCALZI, JAVIER F MD	10/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81270	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
22675	Fee-for-Service	1558324640	1558324640	1	1	DREWEK, RUPALI MD	12/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
22697	Fee-for-Service	1366856841	1366856841	1	1	DANA COPELAND REDDY	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115598	41	Internal Medicine	0	In state provider	RHEUMATOLOGY PC	272 CHURCH AVE	STE 1	CHULA VISTA	CA	91910	2718	37	06073	32.64244569	-117.0792461	San Diego County
22725	Fee-for-Service	1962806430	1962806430	1	1	DEO, KIM CHI LCSW	10/3/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
22750	Fee-for-Service	1720074081	1720074081	1	1	DAVIS, JAMES R. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E PECAN ST	None	ALTUS	OK	73521	6141	00	None	34.63529809	-99.31892165	Jackson County
22834	Fee-for-Service	1811494495	1811494495	1	1	DAY, ELISABETH L MD	8/9/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165696	None	None	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
22890	Fee-for-Service	1154958569	1154958569	1	1	DOCTOR, DANIELLE A MD	7/27/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185319	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
22891	Fee-for-Service	1447224365	1447224365	1	1	DVA HEALTHCARE RENAL	4/23/1993	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	5354 CLAREMONT AVE	None	OAKLAND	CA	94618	1035	01	06001	37.84053631	-122.2594196	Alameda County
22938	Fee-for-Service	1467475251	1467475251	1	1	DURRANI, TIMUR S MD	7/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92882	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3111 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5829	19	06037	33.97284681	-118.2119367	Los Angeles County
22961	Fee-for-Service	1083898050	1083898050	1	1	DAYANIM, SARA MD	6/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103844	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12-411 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
22971	Fee-for-Service	1366643090	1366643090	1	1	DATTA, SHRUTI MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134349	41	Internal Medicine	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
22985	Fee-for-Service	1366856841	1366856841	1	1	DANA COPELAND REDDY	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115598	83	Rheumatology	0	In state provider	RHEUMATOLOGY PC	272 CHURCH AVE	STE 1	CHULA VISTA	CA	91910	2718	37	06073	32.64244569	-117.0792461	San Diego County
22995	Fee-for-Service	1053774364	1053774364	1	1	DELGROSSO, STEPHEN	7/12/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	132334	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93, WARD 95 3RD FL	SAN FRANCISCO	CA	94110	3185	38	06075	37.75548534	-122.4065362	San Francisco County
22997	Fee-for-Service	1306266473	1306266473	1	1	DUA, MOHIT PHD	11/10/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
23066	Fee-for-Service	1205261070	1205261070	1	1	DIVINE CARE HOSPICE INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7177 BROCKTON AVE	SUITE 224	RIVERSIDE	CA	92506	2633	33	06065	33.94289496	-117.3943941	Riverside County
23076	Fee-for-Service	1770715575	1770715575	1	1	DOKUKIN, ANDREI N	1/27/2011	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	110631	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
23128	Fee-for-Service	1932884517	1932884517	1	1	DOSHIER, TARA P LCSW	10/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
23149	Fee-for-Service	1609459031	1609459031	1	1	DARCIE DUNLOP, LMFT	5/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41197 GOLDEN GATE CIR	STE 201	MURRIETA	CA	92562	1422	33	06065	33.53652808	-117.1759195	Riverside County
23160	Fee-for-Service	1861414203	1861414203	1	1	DUFFY, DAVID S MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71879	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
23170	Fee-for-Service	1174113534	1174113534	1	6	DIAGNOSTIC PATHOLOGY LABORAT	3/3/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORY SERVICES, INC.	100 MISSION BLVD	None	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
23199	Fee-for-Service	1811459704	1811459704	1	1	DUKE, TAYLOR MD	9/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180819	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
23248	Fee-for-Service	1215914239	1215914239	1	1	DICKINSON, MARK T MD	9/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67587	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	SUITE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
23249	Fee-for-Service	1508808544	1508808544	1	1	DAVILA, A MD	6/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
23256	Fee-for-Service	1568509669	1568509669	1	1	DYNAMICS ORTHOTICS AND	7/1/1993	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PROSTHETICS	1830 W OLYMPIC BLVD	STE 123	LOS ANGELES	CA	90006	3734	19	06037	34.05055886	-118.2773468	Los Angeles County
23257	Fee-for-Service	1457514358	1457514358	1	1	DELANEY, STEPHEN J PHD	8/4/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94569	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
23270	Fee-for-Service	1356610406	1356610406	1	1	DAVOREN, KATHERINE G MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148919	41	Internal Medicine	0	In state provider	None	8700 BEVELRY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
23301	Fee-for-Service	1063299733	1063299733	1	1	DRYDEN GARDENS INC	10/11/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	610 W DRYDEN STREET	None	GLENDALE	CA	91202	2831	19	06037	34.16078076	-118.2684386	Los Angeles County
23328	Fee-for-Service	1326112848	1326112848	2	1	DILDAX CORPORATION	6/27/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16900 BELLFLOWER BLVD	None	BELLFLOWER	CA	90706	5904	19	06037	33.881058	-118.1252535	Los Angeles County
23354	Fee-for-Service	1205261070	1205261070	1	1	DIVINE CARE HOSPICE INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7177 BROCKTON AVE	SUITE 224	RIVERSIDE	CA	92506	2633	33	06065	33.94289496	-117.3943941	Riverside County
23417	Fee-for-Service	1811375280	1811375280	1	1	DASOVICH, GRACE M MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	149508	40	Pediatrics	0	In state provider	None	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	19	06037	34.137603	-118.101464	Los Angeles County
23435	Fee-for-Service	1174708135	1174708135	1	1	DEBOER, EMILY M MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
23459	Fee-for-Service	1750038345	1750038345	1	1	DHALIWAL, JAISLEEN NP	1/20/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	50	06099	37.662489	-120.957588	Stanislaus County
23510	Fee-for-Service	1811026552	1811026552	1	1	DENTONE, STEPHEN OD	1/24/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
23546	Fee-for-Service	1528141058	1528141058	1	1	DUNLOP, SUSAN P	1/31/1994	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
23577	Fee-for-Service	1356577399	1356577399	1	1	DESA, POOJA P	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136203	None	None	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
23581	Fee-for-Service	1467488635	1467488635	1	1	DE LA PAZ, ROBERT MD	10/22/2020	2085N0700X	NA	MRI Provider	026	PHYSICIANS	53198	None	None	0	In state provider	None	225 W HOSPITALITY LN	102	SAN BERNARDINO	CA	92408	3244	36	06071	34.06586109	-117.2884682	San Bernardino County
23595	Fee-for-Service	1558657387	1558657387	1	1	DONNELLY, JUDD T	12/28/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
23615	Fee-for-Service	1902148505	1902148505	1	1	DWORKIS, DANIEL MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147389	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
23628	Fee-for-Service	1992191803	1992191803	1	1	DIXON, BRITTANY MD	1/31/2019	207P00000X	NA	Other	026	PHYSICIANS	149958	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
23632	Fee-for-Service	1558641852	1558641852	1	1	DERBOGHOSSIANS, ARMEN MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108977	34	Urology and Urological Surgery	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
23654	Fee-for-Service	1962714741	1962714741	1	1	DUNN, DAVID LPCC	1/26/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
23714	Fee-for-Service	1487611703	1487611703	1	1	DEL REAL, JANET E LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
23720	Fee-for-Service	1174708135	1174708135	1	1	DEBOER, EMILY M MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
23779	Fee-for-Service	1699129064	1699129064	1	1	DONALDSON, JARED MD	1/18/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171113	None	None	0	In state provider	None	3953 W STETSON AVE	None	HEMET	CA	92545	9687	33	06065	33.72930152	-117.012681	Riverside County
23820	Fee-for-Service	1154824712	1154824712	1	1	DIGNITY HOME HEALTH CARE	9/22/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	333 N SANTA ANITA AVE	SUITE 2	ARCADIA	CA	91006	2855	19	06037	34.14447	-118.031608	Los Angeles County
23828	Fee-for-Service	1144225426	1144225426	1	3	DESERT TRAUMA SURGEONS INC	1/1/2022	163W00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP INC	3630 E. IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
23833	Fee-for-Service	1780090571	1780090571	1	1	DETIERRA, CAROLYN LMFT	7/20/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
23836	Fee-for-Service	1396704672	1396704672	1	1	DUONG, RICHARD L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50544	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
23840	Fee-for-Service	1891547311	1891547311	1	1	DOULADILIGENCE	5/3/2024	251E00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
23843	Fee-for-Service	1487173118	1487173118	1	1	DADDINO, BRITTANY N NP	3/26/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
23844	Fee-for-Service	1396760427	1396760427	1	1	DORIN, ADAM F MD	8/6/2013	207L00000X	NA	Other	026	PHYSICIANS	86440	05	Anesthesiology	0	In state provider	None	2101 NORTH WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
23877	Fee-for-Service	1659589869	1659589869	1	1	DALTON AVENUE HOMES, INC	12/10/2001	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15918 S DALTON AVE	None	GARDENA	CA	90247	3908	19	06037	33.88603416	-118.3032034	Los Angeles County
23887	Fee-for-Service	1902198997	1902198997	1	1	DURAND, QUINN C PSYD	6/18/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
23905	Fee-for-Service	1750320800	1750320800	1	1	DOUGLAS R MYERS OD INC	2/23/1994	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 COHASSET RD	STE 24	CHICO	CA	95926	2260	04	06007	39.75142109	-121.8506286	Butte County
23925	Fee-for-Service	1043321789	1043321789	1	1	DAVIES, YINKA K MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72135	40	Pediatrics	0	In state provider	None	9281 OFFICE PARK CIR	STE 120	ELK GROVE	CA	95758	8069	34	06067	38.418264	-121.39641	Sacramento County
23937	Fee-for-Service	1003376575	1003376575	1	1	DING, BELICIA K MD	12/13/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	178583	38	Geriatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23940	Fee-for-Service	1437753274	1437753274	1	1	DE MESA, MA KRISTEL CNP	4/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4829 CLAIREMONT DR	None	SAN DIEGO	CA	92117	2706	37	06073	32.83175462	-117.2052088	San Diego County
23943	Fee-for-Service	1013418649	1013418649	1	1	D'MORIAS, SAMANTHA R LMFT	10/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	735 STATE STREET	SUITE 532	SANTA BARBARA	CA	93101	5555	42	06083	34.41942344	-119.6991527	Santa Barbara County
23972	Fee-for-Service	1114926490	1114926490	1	1	DAVIDSON, JEROME G MD	5/28/1987	207RH0000X	NA	Hematology	026	PHYSICIANS	22489	78	Neoplastic Diseases/Oncology	0	In state provider	None	18533 ROSCOE BLVD	STE 233	NORTHRIDGE	CA	91324	4632	19	06037	34.22075552	-118.5373395	Los Angeles County
24035	Fee-for-Service	1780390922	1780390922	1	1	DAVID DEL BELLO MD INC	4/26/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	None	950 S ARROYO PKWY FL 3	None	PASADENA	CA	91105	3932	19	06037	34.12942212	-118.1471619	Los Angeles County
24056	Fee-for-Service	1629205174	1629205174	1	1	DENTICO-OLIN, MARC MD	1/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143794	01	General Practice	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
24095	Fee-for-Service	1346072261	1346072261	1	1	DE GUZMAN, JONINA	8/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 W ARROW HWY	130	SAN DIMAS	CA	91773	2330	19	06037	34.10677054	-117.8331379	Los Angeles County
24099	Fee-for-Service	1528403789	1528403789	1	1	DUANMU, YOUYOU MD	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156268	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
24116	Fee-for-Service	1467876714	1467876714	1	1	DOAN, MICHELLE M PHD	8/5/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
24117	Fee-for-Service	1144225426	1144225426	1	3	DESERT TRAUMA SURGEONS INC	1/1/2022	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	3630 E. IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
24178	Fee-for-Service	1174113534	1174113534	1	1	DIAGNOSTIC PATHOLOGY LABORAT	3/3/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORY SERVICES, INC.	ONE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3034	48	06095	38.76553806	-121.2497067	Placer County
24180	Fee-for-Service	1609119353	1609119353	1	1	DOMINGUEZ, MATTHEW L MD	6/14/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	171908	-	NOT APPLICABLE	0	In state provider	None	3525 PRESLEY AVE	None	RIVERSIDE	CA	92507	4453	33	06065	33.978609	-117.3469995	Riverside County
24217	Fee-for-Service	1043321789	1043321789	1	1	DAVIES, YINKA K MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72135	10	Gastroenterology (M.D. only)	0	In state provider	None	9281 OFFICE PARK CIR	STE 120	ELK GROVE	CA	95758	8069	34	06067	38.418264	-121.39641	Sacramento County
24259	Fee-for-Service	1114926490	1114926490	1	1	DAVIDSON, JEROME G MD	5/28/1987	207RH0000X	NA	Hematology	026	PHYSICIANS	22489	41	Internal Medicine	0	In state provider	None	18533 ROSCOE BLVD	STE 233	NORTHRIDGE	CA	91324	4632	19	06037	34.22075552	-118.5373395	Los Angeles County
24284	Fee-for-Service	1043797400	1043797400	1	1	DOI, TRITIA K RRT	9/24/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
24302	Fee-for-Service	1518527993	1518527993	1	1	DANNA, KATHLEENA	10/3/2024	207RR0500X	NA	Other	026	PHYSICIANS	19946	83	Rheumatology	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
24304	Fee-for-Service	1649400086	1649400086	1	1	DAVID, JACOB A MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115154	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
24310	Fee-for-Service	1043368210	1043368210	1	1	DOS SANTOS, LYN M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50666	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
24352	Fee-for-Service	1215411830	1215411830	1	1	DIIULIO, HELEN S NP	12/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24370	Fee-for-Service	1801487756	1801487756	1	1	DR. MOVSESYAN THERAPY SERVIC	3/5/2021	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ES, INC	1201 S VICTORY BLVD	206	BURBANK	CA	91502	2552	19	06037	34.16527115	-118.3059384	Los Angeles County
24406	Fee-for-Service	1144225426	1144225426	1	3	DESERT TRAUMA SURGEONS INC	1/1/2022	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	3630 E. IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
24408	Fee-for-Service	1962899047	1962899047	1	1	DOANE, KATHERINE F MD	8/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
24478	Fee-for-Service	1760041321	1760041321	1	1	DONNER, DAVID W MD	10/1/2022	207P00000X	NA	Other	026	PHYSICIANS	181008	None	None	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
24486	Fee-for-Service	1871612929	1871612929	1	1	DARDASHTI, HONEY B LMFT	7/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48897	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
24528	Fee-for-Service	1134191752	1134191752	1	1	DONAYRE, CARLOS E MD	6/4/1986	2086S0129X	NA	General Surgery	026	PHYSICIANS	55336	None	None	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
24529	Fee-for-Service	1295946010	1295946010	1	1	DE JESUS, JOSEPH MD	1/6/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1444 FLORIDA AVE	STE 101	MODESTO	CA	95350	4400	50	06099	37.66487562	-120.9961927	Stanislaus County
24547	Fee-for-Service	1114926490	1114926490	1	1	DAVIDSON, JEROME G MD	5/28/1987	207RH0000X	NA	Hematology	026	PHYSICIANS	22489	68	Hematology	0	In state provider	None	18533 ROSCOE BLVD	STE 233	NORTHRIDGE	CA	91324	4632	19	06037	34.22075552	-118.5373395	Los Angeles County
24576	Fee-for-Service	1073594560	1073594560	1	1	DAVIDSON, LOREN T	8/19/2008	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
24599	Fee-for-Service	1043368210	1043368210	1	1	DOS SANTOS, LYN M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50666	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
24604	Fee-for-Service	1881608123	1881608123	1	1	DIVELEY, KENT MD	5/31/1992	207L00000X	NA	Other	026	PHYSICIANS	42452	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
24609	Fee-for-Service	1326000944	1326000944	1	1	DUPRE, MARCEL MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CEP PORTLAND	10123 SE MARKET STREET	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
24621	Fee-for-Service	1073663431	1073663431	1	1	DAMERON'S LINACIA PHARMA	8/27/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	420 W ACACIA ST	None	STOCKTON	CA	95203	2441	39	06077	37.96135715	-121.2996632	San Joaquin County
24640	Fee-for-Service	1104831882	1104831882	1	1	DARIA PACHECO NP	2/2/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	3742	00	None	33.480864	-112.0795155	Maricopa County
24751	Fee-for-Service	1023610854	1023610854	1	1	DIAB, JESSICA PT	8/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
24755	Fee-for-Service	1760001911	1760001911	1	1	DEL ROSARIO, MUTYA MITHI D M	9/18/2023	207R00000X	NA	Other	026	PHYSICIANS	187833	None	None	0	In state provider	D	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
24761	Fee-for-Service	1255727871	1255727871	1	1	DESAI, RUJUL R	11/8/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	170128	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
24835	Fee-for-Service	1215967658	1215967658	1	1	DALLAS, JAMES R OD	12/5/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1356 E MAIN ST	STE A	BARSTOW	CA	92311	3220	36	06071	34.89481556	-117.0051968	San Bernardino County
24864	Fee-for-Service	1073594560	1073594560	1	1	DAVIDSON, LOREN T	8/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84391	36	Psychiatry	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
24872	Fee-for-Service	1538245410	1538245410	1	1	DESTINO, LAUREN A MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103066	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
24885	Fee-for-Service	1497191225	1497191225	1	1	DE LA PORTILLA, ELIZABETH A	12/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13885	41	Internal Medicine	0	In state provider	DO	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
24924	Fee-for-Service	1952313520	1952313520	1	1	DRAZIN, NOAM Z MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66067	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
24943	Fee-for-Service	1780980367	1780980367	1	1	DENTSPLY IH INC	4/30/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	880 APOLLO STREET	STE 200	EL SEGUNDO	CA	90245	4723	19	06037	33.90287114	-118.3864395	Los Angeles County
24946	Fee-for-Service	1407425531	1407425531	1	1	DANIEL FLINN, D.O., INC	4/18/2022	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	40949 WINCHESTER RD	None	TEMECULA	CA	92591	6031	33	06065	33.52574268	-117.1589811	Riverside County
25002	Fee-for-Service	1396057360	1396057360	1	1	DEBOYES, TELIA N MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120986	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVENUE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
25030	Fee-for-Service	1386711380	1386711380	1	1	DER, DENNIS E MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76727	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
25031	Fee-for-Service	1831485424	1831485424	1	1	DR IGA LENTOWICZ	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 JOHNSON FERRY RD	None	ATLANTA	GA	30342	1606	00	None	33.90791732	-84.3540509	Fulton County
25064	Fee-for-Service	1437259892	1437259892	2	1	DOMINIQUE H SCHIFFER	2/3/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
25077	Fee-for-Service	1740264506	1740264506	1	1	DEROSE, ALBERT L MD	9/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	STE 13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
25088	Fee-for-Service	1629720578	1629720578	1	1	DAVIS, GEIA S NP	7/25/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
25133	Fee-for-Service	1992111744	1992111744	1	1	DODGE, JACOB A MD	10/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146550	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
25194	Fee-for-Service	1861461147	1861461147	1	1	DI SIMONE, CHRISTOPHER MD	6/14/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	74788	None	None	0	In state provider	None	9800 BRIMHALL RD	None	BAKERSFIELD	CA	93312	2784	15	06029	35.3688055	-119.1114495	Kern County
25202	Fee-for-Service	1063551885	1063551885	1	2	DUONG, DUC H MD INC	4/26/2005	207T00000X	NA	General Surgery	026	PHYSICIANS	84028	14	Neurological Surgery	0	In state provider	None	8043 2ND STREET	SUITE 105	DOWNEY	CA	90241	3621	19	06037	33.94296553	-118.1360957	Los Angeles County
25227	Fee-for-Service	1588748768	1588748768	1	1	DU MONT PEASLEE FM	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	34778	08	Family Practice	0	In state provider	None	313 KENDAL ST	None	VACAVILLE	CA	95688	3960	48	06095	38.35754372	-121.9893443	Solano County
25229	Fee-for-Service	1063193092	1063193092	1	1	DABA, HANNAH AKOH	2/9/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12672 ATHERTON DR	None	MORENO VALLEY	CA	92555	2524	33	06065	33.93668792	-117.2071738	Riverside County
25240	Fee-for-Service	1205288396	1205288396	1	1	DON, MICHELLE D MD	11/18/2019	207ZP0102X	NA	Other	026	PHYSICIANS	145915	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25281	Fee-for-Service	1790704419	1790704419	1	1	DUVOISIN, ROBERT M MD	12/23/1992	207P00000X	NA	Other	026	PHYSICIANS	6249	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
25297	Fee-for-Service	1629158761	1629158761	1	1	DOWNING, TIMOTHY H MD	8/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79060	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
25322	Fee-for-Service	1851889562	1851889562	1	1	DENG, JIE MD	6/21/2023	2085R0001X	NA	Other	026	PHYSICIANS	163557	None	None	0	In state provider	None	200 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
25357	Fee-for-Service	1518063676	1518063676	1	1	DAYRIT, MELVIN N MD	2/1/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45741	01	General Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
25387	Fee-for-Service	1407344146	1407344146	1	1	DOEGE, LAUREN E DO	10/6/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	20205	25	Physical Medicine and Rehabilitation	0	In state provider	None	117 BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
25418	Fee-for-Service	1528068459	1528068459	1	1	DUNCAN, DAVID R MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74891	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
25481	Fee-for-Service	1689247298	1689247298	1	1	DOERR, CATHERINE CCC-SLP	10/18/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	120	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
25491	Fee-for-Service	1063551885	1063551885	1	2	DUONG, DUC H MD INC	4/26/2005	207T00000X	NA	General Surgery	026	PHYSICIANS	84028	13	Neurology (M.D. only)	0	In state provider	None	8043 2ND STREET	SUITE 105	DOWNEY	CA	90241	3621	19	06037	33.94296553	-118.1360957	Los Angeles County
25516	Fee-for-Service	1063193092	1063193092	1	1	DABA, HANNAH AKOH	2/9/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12672 ATHERTON DR	None	MORENO VALLEY	CA	92555	2524	33	06065	33.93668792	-117.2071738	Riverside County
25546	Fee-for-Service	1073508511	1073508511	1	1	DALGLEISH, GERALD E MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	29090	22	Pathology (M.D. only)	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
25559	Fee-for-Service	1770507659	1770507659	1	1	DAO, TINA OD INC	7/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNTAIN VALLEY OPTOMETR	16027 BROOKHURST ST	STE E	FOUNTAIN VALLEY	CA	92708	1551	30	06059	33.729984	-117.954766	Orange County
25661	Fee-for-Service	1538144076	1538144076	1	1	DORAN, TIMOTHY J OD	6/10/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6405 DAY STREET	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
25665	Fee-for-Service	1134310477	1134310477	1	1	DEAN, DANINE J PSYD	8/13/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3831 HUGHES AVE	SUITE 708	CULVER CITY	CA	90232	6842	19	06037	34.02243278	-118.3981492	Los Angeles County
25668	Fee-for-Service	1659365765	1659365765	1	1	DAVIS,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
25677	Fee-for-Service	1932239837	1932239837	1	2	DZEBOLO, NICHOLAS N MD	7/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36396	42	Nuclear Medicine	0	In state provider	None	817 W BEVERLY BLVD	STE 103	MONTEBELLO	CA	90640	4264	19	06037	34.01735778	-118.1069216	Los Angeles County
25699	Fee-for-Service	1942664255	1942664255	1	1	DING, YI MD	8/7/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	150554	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
25701	Fee-for-Service	1184873762	1184873762	1	1	DANDAMUDI, VENKATA S MD	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138216	13	Neurology (M.D. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
25707	Fee-for-Service	1851596381	1851596381	1	1	DADFARIN, SHAHROUZ S MD	11/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95833	08	Family Practice	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
25709	Fee-for-Service	1811017320	1811017320	1	1	DABNER, SHASA T OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11001 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1413	19	06037	34.26991066	-118.4671653	Los Angeles County
25748	Fee-for-Service	1649414293	1649414293	1	1	DIVIN, CECILIA R MD	11/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113360	08	Family Practice	0	In state provider	None	3946 NORWOOD AVENUE	None	SACRAMENTO	CA	95838	3300	34	06067	38.639952	-121.456359	Sacramento County
25750	Fee-for-Service	1831382753	1831382753	1	1	DAUB, DOUGLAS M MD	8/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77230	08	Family Practice	0	In state provider	None	6280 JACKSON DR	STE 8	SAN DIEGO	CA	92119	3436	37	06073	32.79264272	-117.0182026	San Diego County
25769	Fee-for-Service	1770772121	1770772121	1	1	DOMINGUEZ, ROBERTO LMFT	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	77649	-	NOT APPLICABLE	0	In state provider	None	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
25796	Fee-for-Service	1588154116	1588154116	1	2	DULCE VILLA	1/25/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	66171 S AGUA DULCE DR	None	DESERT HOT SPRING	CA	92240	8111	33	06065	33.94353548	-116.507394	Riverside County
25812	Fee-for-Service	1699771022	1699771022	1	1	DRESS, DANIEL MD	12/7/2018	207R00000X	NA	Other	026	PHYSICIANS	157830	41	Internal Medicine	0	In state provider	None	25109 JEFFERSON AVE	SUITE 100	MURRIETA	CA	92562	8116	33	06065	33.55410071	-117.2028115	Riverside County
25832	Fee-for-Service	1073508511	1073508511	1	1	DALGLEISH, GERALD E MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	29090	01	General Practice	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
25939	Fee-for-Service	1891348173	1891348173	1	1	DEBORD, ARLENE B CCC-SLP	3/14/2023	2355S0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
25942	Fee-for-Service	1386718989	1386718989	1	1	DAYOAN, EDWARD S MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76088	41	Internal Medicine	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
25965	Fee-for-Service	1932239837	1932239837	1	2	DZEBOLO, NICHOLAS N MD	7/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36396	30	Radiology	0	In state provider	None	817 W BEVERLY BLVD	STE 103	MONTEBELLO	CA	90640	4264	19	06037	34.01735778	-118.1069216	Los Angeles County
25973	Fee-for-Service	1104142454	1104142454	1	1	DOUGLAS, AMY L MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118894	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1798 NORTH GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
25992	Fee-for-Service	1659994549	1659994549	1	1	DR MARGARET NGUYEN OPTOMETRI	9/12/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ST INC	9001 APOLLO WAY	None	DOWNEY	CA	90242	4033	19	06037	33.92303224	-118.1286645	Los Angeles County
25996	Fee-for-Service	1942326269	1942326269	1	1	DO, PAUL C MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107442	40	Pediatrics	0	In state provider	None	7060 N RECREATION AVENUE	STE 101	FRESNO	CA	93720	8022	10	06019	36.8388	-119.7404335	Fresno County
26025	Fee-for-Service	1033613732	1033613732	1	1	DORUELO, ASHLEY L MD	9/21/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178499	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
26125	Fee-for-Service	1750651485	1750651485	1	1	DIEP, DAVID D DO	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12549	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
26139	Fee-for-Service	1144839366	1144839366	1	1	DAVIDS, STEPHEN PT	10/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5061 SHASTA DAM BLVD	None	SHASTA LAKE	CA	96019	9422	45	06089	40.68027851	-122.3557875	Shasta County
26158	Fee-for-Service	1548000631	1548000631	1	1	DORR, XENNIA LMFT	7/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
26184	Fee-for-Service	1366597346	1366597346	1	1	DECICCO, VERONICA E PHD	3/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
26229	Fee-for-Service	1386718989	1386718989	1	1	DAYOAN, EDWARD S MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76088	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 STADIUM WAY	None	LOS ANGELES	CA	90026	2606	19	06037	34.07578277	-118.248587	Los Angeles County
26235	Fee-for-Service	1982982955	1982982955	1	1	DRABINA-DOMBROWSKI, VALERIE	6/7/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	M DO	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
26257	Fee-for-Service	1932239837	1932239837	1	2	DZEBOLO, NICHOLAS N MD	7/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	36396	08	Family Practice	0	In state provider	None	817 W BEVERLY BLVD	STE 103	MONTEBELLO	CA	90640	4264	19	06037	34.01735778	-118.1069216	Los Angeles County
26274	Fee-for-Service	1760651426	1760651426	1	1	DESAI, ANUJ B MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100624	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
26288	Fee-for-Service	1841804101	1841804101	1	1	DESERT VALLEY MEDICAL GROUP,	5/17/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	11883 AMETHYST RD	203	VICTORVILLE	CA	92392	9224	36	06071	34.466292	-117.3643015	San Bernardino County
26298	Fee-for-Service	1922767201	1922767201	1	1	DORSEY, MORGAN PT	3/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
26342	Fee-for-Service	1255371662	1255371662	1	1	DESAI, PREMAL J MD	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79668	34	Urology and Urological Surgery	0	In state provider	None	8631 W THIRD STREET	STE 715E	LOS ANGELES	CA	90048	5911	19	06037	34.07361928	-118.3803143	Los Angeles County
26399	Fee-for-Service	1114037645	1114037645	1	1	DOYLE, MARY L MD	7/1/2004	208000000X	NA	Pediatric Primary Care	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	636 W SIERRA MADRE BLVD	UNIT B	SIERRA MADRE	CA	91024	0901	19	06037	34.16177108	-118.0658384	Los Angeles County
26408	Fee-for-Service	1558769232	1558769232	1	1	DUNAMIS INC GROUP HOME	11/12/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5550 NORTH 1ST STREET	None	FRESNO	CA	93710	6201	10	06019	36.81809235	-119.7721799	Fresno County
26430	Fee-for-Service	1801864020	1801864020	1	1	DHINDSA, HARPREET S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64349	41	Internal Medicine	0	In state provider	None	4770 N CEDAR AVE	None	FRESNO	CA	93726	1065	10	06019	36.804717	-119.754103	Fresno County
26488	Fee-for-Service	1194188508	1194188508	1	1	DAIRO, ABIMBOLA O MD	6/18/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154363	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
26515	Fee-for-Service	1134193006	1134193006	1	1	DVA HEALTHCARE RENAL CARE	10/1/1996	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	60 G STREET	BLDG 5	LOS BANOS	CA	93635	3658	24	06047	37.06697572	-120.8553069	Merced County
26546	Fee-for-Service	1578726022	1578726022	1	2	DOTY, SPENCER A CPO	8/28/2018	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	855 N LARK ELLEN AVE	SUITE A	WEST COVINA	CA	91791	1099	19	06037	34.087707	-117.9166385	Los Angeles County
26562	Fee-for-Service	1114030491	1114030491	1	1	DANA SELTZER	5/14/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7797 W PARADISE LN	STE 130	PEORIA	AZ	85382	5011	00	None	33.634512	-112.2265035	Maricopa County
26564	Fee-for-Service	1083675730	1083675730	1	1	DR PAUL BORMES	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 FAIRMONT BLVD	None	RAPID CITY	SD	57701	7511	00	None	44.05858539	-103.2244711	Pennington County
26573	Fee-for-Service	1841804101	1841804101	1	1	DESERT VALLEY MEDICAL GROUP,	4/18/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	11883 AMETHYST RD	203	VICTORVILLE	CA	92392	9224	36	06071	34.466292	-117.3643015	San Bernardino County
26601	Fee-for-Service	1003862350	1003862350	1	1	DOHERTY, CAROLYN M MD	3/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61638	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 N PEPPER AVE	MOB SUITE 308 SURGERY	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
26624	Fee-for-Service	1912071523	1912071523	1	1	DILLON, AILEEN M MD	2/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42413	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
26650	Fee-for-Service	1568569226	1568569226	1	1	DANIEL MURO,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 ELIZABETH ST	None	CORP CHRISTI	TX	78404	2235	00	None	27.77746621	-97.39543569	Nueces County
26699	Fee-for-Service	1932287778	1932287778	1	1	DOWNS, THOMAS W MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	74834	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
26701	Fee-for-Service	1609819895	1609819895	1	1	DHALIWAL, HARJINDER S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82878	05	Anesthesiology	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
26717	Fee-for-Service	1639351125	1639351125	1	1	DANG, DAN V MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90388	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	173 N MORRISON AVE	STE C	SAN JOSE	CA	95216	2712	43	06085	37.33258801	-121.9084887	Santa Clara County
26720	Fee-for-Service	1801864020	1801864020	1	1	DHINDSA, HARPREET S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64349	45	Nephrology (Renal-Kidney)	0	In state provider	None	4770 N CEDAR AVE	None	FRESNO	CA	93726	1065	10	06019	36.804717	-119.754103	Fresno County
26741	Fee-for-Service	1982600318	1982600318	1	1	DAVIS, CURTIS L MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	39601	41	Internal Medicine	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
26765	Fee-for-Service	1003849480	1003849480	1	1	DIALYSIS CLINIC INC	11/1/1988	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1771 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7040	34	06067	38.563866	-121.46562	Sacramento County
26791	Fee-for-Service	1437239571	1437239571	1	1	DUEL, BARRY P MD	6/1/1998	208800000X	NA	Other	026	PHYSICIANS	84789	34	Urology and Urological Surgery	0	In state provider	None	101 CITY DR S	BLDG 10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
26836	Fee-for-Service	1770659336	1770659336	1	3	DIGNITY HEALTH	1/30/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	850 FAIR OAKS AVE	SUITE 120	ARROYO GRANDE	CA	93420	3929	40	06079	35.11274104	-120.588873	San Luis Obispo County
26874	Fee-for-Service	1811163371	1811163371	1	1	DEWLAND, THOMAS A MD	1/2/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	103667	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
26894	Fee-for-Service	1306873294	1306873294	1	1	DORIGO, OLIVER MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63220	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MED PLAZA STE 340	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
26907	Fee-for-Service	1609865294	1609865294	1	1	DESAI, MEGHNA R MD	1/29/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	102698	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
26911	Fee-for-Service	1477129245	1477129245	1	2	DIAZ, IRMA J	7/1/2022	342000000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3330 FLORIDA AVE	E	HEMET	CA	92544	4984	33	06065	33.74778549	-116.936046	Riverside County
26915	Fee-for-Service	1306860036	1306860036	1	1	DUBIN, ANNE MARIE MD	6/14/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81498	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
26919	Fee-for-Service	1215241351	1215241351	1	1	DOUD, TRICIA PHD	11/9/2010	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
26928	Fee-for-Service	1518573310	1518573310	1	1	DR. SEAN DOUGHERTY, DPM, INC	12/1/2020	261QP1100X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	.	1620 PENNSYLVANIA AVE	SUITE A	FAIRFIELD	CA	94533	3509	48	06095	38.2594713	-122.0498661	Solano County
26948	Fee-for-Service	1811938509	1811938509	1	1	DONNELLY, SANDRA	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	49068	None	None	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
26973	Fee-for-Service	1396061602	1396061602	1	1	DOAN, THUY A MD	8/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137073	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
26989	Fee-for-Service	1932287778	1932287778	1	1	DOWNS, THOMAS W MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	74834	30	Radiology	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
27032	Fee-for-Service	1790901338	1790901338	1	1	DEELY, ALANNA D	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
27086	Fee-for-Service	1194734731	1194734731	1	1	DIABLO NEPHROLOGY MEDICAL	10/12/1984	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	2222 EAST STREET	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
27105	Fee-for-Service	1518644673	1518644673	1	1	DAUGHENBAUGH, ROBIN A LCSW	11/20/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
27147	Fee-for-Service	1023035078	1023035078	1	1	DELIOUKINA, MARIA L MD	6/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65752	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
27149	Fee-for-Service	1538409750	1538409750	1	1	DEHART, SHERICE M LCSW	8/30/2021	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
27154	Fee-for-Service	1851314702	1851314702	1	1	DAMROSE, EDWARD J MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61521	04	Otology, Laryngology, Rhinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
27202	Fee-for-Service	1306860036	1306860036	1	1	DUBIN, ANNE MARIE MD	6/14/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81498	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
27234	Fee-for-Service	1235469172	1235469172	1	1	DESHMUKH, PRIYANKA M MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127595	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
27243	Fee-for-Service	1407902612	1407902612	1	1	DIAS, ROBERT A MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97143	13	Neurology (M.D. only)	0	In state provider	None	2030 SUTTER PLACE	None	DAVIS	CA	95616	6215	57	06113	38.56292466	-121.7715423	Yolo County
27258	Fee-for-Service	1487678520	1487678520	1	1	DESHPANDE, RENU L MD	2/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92825	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
27261	Fee-for-Service	1053586651	1053586651	1	1	DR. KELI M. KWOK M.D.	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
27316	Fee-for-Service	1629543947	1629543947	1	1	DREISEN, CHRISTINE M NP	5/14/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
27350	Fee-for-Service	1861534943	1861534943	1	1	DEAN, LEAH K LMFT	6/4/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
27377	Fee-for-Service	1578917936	1578917936	1	1	DIEGO, JOSE L MD	9/6/2023	208600000X	NA	General Surgery	026	PHYSICIANS	185841	None	None	0	In state provider	None	1317 OAKDALE ROAD	SUITE 100	MODESTO	CA	95355	3362	50	06099	37.662489	-120.957588	Stanislaus County
27391	Fee-for-Service	1578040283	1578040283	1	1	DAROL D JOSEFF MD INC	2/27/2019	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2428 CASTILLO STREET	SUITE C	SANTA BARBARA	CA	93105	5308	42	06083	34.43122758	-119.7251364	Santa Barbara County
27434	Fee-for-Service	1023035078	1023035078	1	1	DELIOUKINA, MARIA L MD	6/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65752	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
27439	Fee-for-Service	1386652196	1386652196	1	1	DAVIS, PAMELA M MD	2/28/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52081	None	None	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
27442	Fee-for-Service	1851314702	1851314702	1	1	DAMROSE, EDWARD J MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61521	84	Surgery-Head and Neck	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
27476	Fee-for-Service	1831203454	1831203454	1	1	DURBIN, MARGARET A MD	10/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50928	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
27495	Fee-for-Service	1770762619	1770762619	1	1	DANG, TRIEN T MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101753	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
27496	Fee-for-Service	1164457883	1164457883	1	1	DULAI, GARETH S MD	3/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	80828	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA STE 36	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
27541	Fee-for-Service	1992097851	1992097851	1	1	DONOHUE, RACHEL MD	2/22/2022	207ZP0102X	NA	Other	026	PHYSICIANS	176110	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
27547	Fee-for-Service	1598264491	1598264491	1	1	DR. BEI ZHANG OPTOMETRIST, I	8/29/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	NC	1104 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	3219	01	06001	37.695303	-121.9287465	Alameda County
27563	Fee-for-Service	1972953875	1972953875	1	1	DEBRA L WINEGARDEN PHD	4/21/2022	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	106 POLLASKY AVE	SUITE D	CLOVIS	CA	93612	1159	10	06019	36.828954	-119.7020255	Fresno County
27643	Fee-for-Service	1780996132	1780996132	1	1	DHAKAL, BIDUR MD	1/5/2021	207R00000X	NA	Other	026	PHYSICIANS	169889	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
27692	Fee-for-Service	1467483115	1467483115	1	1	DELAROCHA, HECTOR N MD	10/2/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	42466	40	Pediatrics	0	In state provider	None	3116 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02382271	-118.137273	Los Angeles County
27763	Fee-for-Service	1831203454	1831203454	1	1	DURBIN, MARGARET A MD	10/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50928	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
27765	Fee-for-Service	1235737271	1235737271	1	1	DULBERG, JEAN F LMFT	11/9/2020	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	540 WAGNON ROAD	None	SEBASTOPOL	CA	95472	9204	49	06097	38.38009604	-122.8913688	Sonoma County
27852	Fee-for-Service	1972953875	1972953875	1	1	DEBRA L WINEGARDEN PHD	4/21/2022	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	106 POLLASKY AVE	SUITE D	CLOVIS	CA	93612	1159	10	06019	36.828954	-119.7020255	Fresno County
27915	Fee-for-Service	1881890515	1881890515	1	1	DUBEN, ORA G	6/14/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
27987	Fee-for-Service	1184812851	1184812851	1	1	DELTA EYE MEDICAL GRP	7/1/1997	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2160 W GRANT LINE RD	STE 100	TRACY	CA	95377	7331	39	06077	37.75399922	-121.455877	San Joaquin County
28035	Fee-for-Service	1437180676	1437180676	1	1	DAVTYAN, HAKOB G MD	6/30/1984	208G00000X	NA	General Surgery	026	PHYSICIANS	54367	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
28044	Fee-for-Service	1346456399	1346456399	1	1	DOUGLAS, GEOFFREY P MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1707 W CHARLESTON BLVD	160	LAS VEGAS	NV	89102	2354	00	None	36.15879353	-115.1643015	Clark County
28091	Fee-for-Service	1437169695	1437169695	1	1	DOUTHWAITE, PENNY J MD	4/1/1984	207P00000X	NA	Other	026	PHYSICIANS	39615	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 S SUSANA RD	None	COMPTON	CA	90221	5418	19	06037	33.87386619	-118.2070981	Los Angeles County
28122	Fee-for-Service	1902677974	1902677974	1	1	DELMONTE, MARCO PAOLO	4/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3610 CENTRAL AVE	SUITE 500	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
28137	Fee-for-Service	1194845453	1194845453	1	1	DUDLEY, KANDI LMFT	2/26/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
28138	Fee-for-Service	1972953875	1972953875	1	1	DEBRA L WINEGARDEN PHD	4/21/2022	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	106 POLLASKY AVE	SUITE D	CLOVIS	CA	93612	1159	10	06019	36.828954	-119.7020255	Fresno County
28171	Fee-for-Service	1578650883	1578650883	1	1	DERDZINSKA, ANNA B MD	3/3/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42489	40	Pediatrics	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
28174	Fee-for-Service	1316045008	1316045008	1	1	DE GROOT, JOHN F MD	10/25/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	175228	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
28208	Fee-for-Service	1447727409	1447727409	1	1	DILLON, DAVID A CCC-SLP	10/2/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
28237	Fee-for-Service	1760972186	1760972186	1	1	DESHPANDE, KAIVALYA S	7/11/2023	207LP2900X	NA	Other	026	PHYSICIANS	179401	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
28288	Fee-for-Service	1700892759	1700892759	1	1	DIAZ, LUIS A MD	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	74041	40	Pediatrics	0	In state provider	None	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
28321	Fee-for-Service	1205815446	1205815446	1	1	DIPPEL, LENNIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4214 E SOUTHCROSS BLVD	None	SAN ANTONIO	TX	78222	3723	00	None	29.37474943	-98.41185093	Bexar County
28342	Fee-for-Service	1316156797	1316156797	1	1	DEHGHANI, HOSSEIN MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113434	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
28375	Fee-for-Service	1760806228	1760806228	1	1	DUVALL, CHRISTOPHER	12/16/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
28377	Fee-for-Service	1811217300	1811217300	1	1	DAS, VINITHA MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140836	03	Allergy	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
28427	Fee-for-Service	1962496885	1962496885	1	1	DENOUDEN, PAUL W MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66900	41	Internal Medicine	0	In state provider	None	6255 W SUNSET BLVD	# 2100	LOS ANGELES	CA	90028	7403	19	06037	34.09802749	-118.3255515	Los Angeles County
28432	Fee-for-Service	1366696395	1366696395	1	1	DHIMAN, NAVEEN K MD	6/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104998	08	Family Practice	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
28438	Fee-for-Service	1477808665	1477808665	1	1	DHP OF SIERRA NEVADA MEDICAL	8/10/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
28442	Fee-for-Service	1891731162	1891731162	1	1	DURAIRAJ, SADAYYAPA MD	1/1/1982	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	26651	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
28458	Fee-for-Service	1578650883	1578650883	1	1	DERDZINSKA, ANNA B MD	3/3/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42489	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
28500	Fee-for-Service	1700456993	1700456993	1	1	DURAN, TERESA G	8/3/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	833 KAHLSTROM AVE	None	TRINIDAD	CA	95570	9726	12	06023	41.03827708	-124.1123474	Humboldt County
28507	Fee-for-Service	1225127491	1225127491	1	1	DALY, MARIA F DO	12/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	5106	08	Family Practice	0	In state provider	None	150 GLEN COVE MARINA RD	STE 102	VALLEJO	CA	94591	7237	48	06095	38.07034035	-122.212283	Solano County
28516	Fee-for-Service	1063447134	1063447134	1	1	DANESH, SID A MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	39428	07	Dermatology	0	In state provider	None	316 E LAS TUNAS DR	STE 103	SAN GABRIEL	CA	91776	1535	19	06037	34.10314065	-118.096387	Los Angeles County
28538	Fee-for-Service	1447717574	1447717574	1	1	DIVINE ADULT DAY HEALTH CARE	11/18/2020	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	6650 VAN NUYS BLVD	None	VAN NUYS	CA	91405	4617	19	06037	34.19220072	-118.4487198	Los Angeles County
28551	Fee-for-Service	1053535377	1053535377	1	1	DAVIDSON, JOEL I MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89324	02	General Surgery	0	In state provider	None	863 N DOUGLAS STREET	#100	EL SEGUNDO	CA	90245	2801	19	06037	33.92830583	-118.3831669	Los Angeles County
28602	Fee-for-Service	1588860720	1588860720	1	1	DW MEDICAL SUPPLY INC	7/29/2008	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DW MEDICAL SUPPLY INC	1524 CENTINELA AVE	None	INGLEWOOD	CA	90302	1144	19	06037	33.97698788	-118.3662006	Los Angeles County
28605	Fee-for-Service	1669781597	1669781597	1	1	DELGADILLO, RENE MD	9/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125155	36	Psychiatry	0	In state provider	None	1090 THIRD STREET	STE 1	SOUTH LAKE TAHOE	CA	96150	3485	09	06017	38.91492536	-119.9966528	El Dorado County
28633	Fee-for-Service	1316156797	1316156797	1	1	DEHGHANI, HOSSEIN MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113434	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
28648	Fee-for-Service	1760647465	1760647465	1	1	DIETERICH, ALISA M NP	8/11/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
28653	Fee-for-Service	1821174178	1821174178	1	1	DAHMEN KEVIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 E BROADWAY AVE	None	BISMARCK	ND	58502	0997	00	None	46.807119	-100.7778375	Burleigh County
28660	Fee-for-Service	1902923766	1902923766	1	1	DR YANG'S FAMILY CARE	12/5/2006	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	10201 MISSION GORGE RD	STE H	SANTEE	CA	92071	3026	37	06073	32.83844552	-116.9759925	San Diego County
28732	Fee-for-Service	1508892977	1508892977	1	1	DITLOW, AARON D DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	990 W FREMONT AVE	STE W	SUNNYVALE	CA	94087	3065	43	06085	37.35204047	-122.0541002	Santa Clara County
28752	Fee-for-Service	1013164136	1013164136	1	1	DICKEY, MARIA I S DO	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12638	01	General Practice	0	In state provider	None	243 MARCH STREET	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
28760	Fee-for-Service	1134403207	1134403207	1	1	DAMORE, LORI A CRNA	4/25/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
28788	Fee-for-Service	1700456993	1700456993	1	1	DURAN, TERESA G	8/3/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	833 KAHLSTROM AVE	None	TRINIDAD	CA	95570	9726	12	06023	41.03827708	-124.1123474	Humboldt County
28796	Fee-for-Service	1922016294	1922016294	1	1	DINAKAR, HASSAN MD	12/4/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	51086	-	NOT APPLICABLE	0	In state provider	None	1400 EMELINE AVENUE	BUILDING K	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
28830	Fee-for-Service	1285950329	1285950329	1	1	DOBBERFUHL, AMY D MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133671	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
28844	Fee-for-Service	1528012945	1528012945	1	1	DOWRAD MEDICAL GROUP	12/31/1995	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	DOWNEY RADIOLOGY ASSOC	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
28854	Fee-for-Service	1588160055	1588160055	1	1	DINH, PERRY L DO	12/16/2022	207P00000X	NA	Other	026	PHYSICIANS	19480	None	None	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
28887	Fee-for-Service	1013972991	1013972991	1	1	DOLIN, NATALIA MD	10/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	143392	None	None	0	In state provider	None	495 BIRCH ST	B	CALEXICO	CA	92231	2374	13	06025	32.6794317	-115.4928454	Imperial County
28895	Fee-for-Service	1295877868	1295877868	1	1	DUONG, ANHDAO T OD	9/28/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
28946	Fee-for-Service	1851596936	1851596936	1	1	DR. AUBREY J. SLAUGHTER M.D.	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
28953	Fee-for-Service	1184646119	1184646119	1	1	DUONG, CALVIN M MD	5/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91752	41	Internal Medicine	0	In state provider	None	1300 E COOLEY DRIVE	None	COLTON	CA	92324	3905	36	06071	34.0544745	-117.306315	San Bernardino County
28957	Fee-for-Service	1750543187	1750543187	1	1	DAVIS, ROSE MARIE S	5/6/2010	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 N TUSTIN AVE	STE 1	SANTA ANA	CA	92705	3605	30	06059	33.752241	-117.8342255	Orange County
28960	Fee-for-Service	1679981229	1679981229	1	1	DIVYASWATHI CITLA SRIDHAR	7/10/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
28975	Fee-for-Service	1699719237	1699719237	1	1	DONNELLY, JOSEPH H MD	2/8/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86398	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
29047	Fee-for-Service	1609357649	1609357649	1	1	DIAZ, ELIZABETH LCSW	7/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
29080	Fee-for-Service	1538220298	1538220298	1	1	DANGE, RAJIV P MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97329	40	Pediatrics	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
29171	Fee-for-Service	1841271723	1841271723	1	1	DAVID LEE, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1423 N JEFFERSON AVE	None	SPRINGFIELD	MO	65802	1917	00	None	37.22492991	-93.28917587	Greene County
29177	Fee-for-Service	1457440992	1457440992	1	1	DEREBERY, MARY J MD	8/31/1985	207YX0602X	NA	ENT/Otolaryngology	026	PHYSICIANS	42073	04	Otology, Laryngology, Rhinology	0	In state provider	None	2122 W 3RD ST	None	LOS ANGELES	CA	90057	1902	19	06037	34.0630888	-118.2733329	Los Angeles County
29192	Fee-for-Service	1114233053	1114233053	1	1	DAYAL, RAKHI MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117784	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
29198	Fee-for-Service	1013473818	1013473818	1	1	DENG, CECILIA	7/22/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
29215	Fee-for-Service	1710094107	1710094107	1	1	DYDELL, KARIN M MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73350	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	STE 1002	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
29248	Fee-for-Service	1598702714	1598702714	1	1	DAVENPORT, ERIK MD	12/1/1998	207P00000X	NA	Other	026	PHYSICIANS	62215	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
29275	Fee-for-Service	1386722171	1386722171	1	1	DHILLON, MANIZA MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	71373	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
29330	Fee-for-Service	1548897119	1548897119	1	1	DASILVA, AUDREY MD	5/22/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182796	40	Pediatrics	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
29340	Fee-for-Service	1467610170	1467610170	1	1	DHILLON, RANVIR S MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141212	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
29375	Fee-for-Service	1699757583	1699757583	1	1	DROR, OZ H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72232	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
29382	Fee-for-Service	1902504806	1902504806	1	1	DYER BOCAGE, SEETA NP	8/4/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	36	06071	34.51210263	-117.3272335	San Bernardino County
29404	Fee-for-Service	1689769051	1689769051	1	1	DISAIA JOHN PHILIP MD	12/1/1997	2086S0122X	NA	General Surgery	026	PHYSICIANS	72451	24	Plastic Surgery	0	In state provider	None	101 CITY DR S	BLDG 10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
29433	Fee-for-Service	1033183397	1033183397	1	1	DVA HEALTHCARE RENAL	12/23/2003	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	7701 WHITE LN	STE D	BAKERSFIELD	CA	93309	0201	15	06029	35.31813154	-119.0889765	Kern County
29520	Fee-for-Service	1396796678	1396796678	1	1	DENG, DONNA Y MD	7/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72583	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
29539	Fee-for-Service	1326317314	1326317314	1	1	DREISBACH, KRYSTAL D LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
29552	Fee-for-Service	1124589163	1124589163	1	1	DUNN, DOMINIQUE CNP	3/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
29575	Fee-for-Service	1689835654	1689835654	1	1	DEEN, SERINA R MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120707	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
29589	Fee-for-Service	1730625476	1730625476	1	1	DIAZ, ROCIO LMFT	11/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
29615	Fee-for-Service	1073695367	1073695367	1	1	DARNELL, T ALLAN MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	61846	44	Public Health	0	In state provider	None	25455 BARTON RD	STE 106A	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
29618	Fee-for-Service	1942632534	1942632534	1	1	DIGNITY HEALTH	5/16/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	408 PINE ST	None	MOUNT SHASTA	CA	96067	2126	47	06093	41.31312726	-122.3154792	Siskiyou County
29649	Fee-for-Service	1023167434	1023167434	1	1	DECAPUA, JEROME M DC	11/30/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	C	39063 HIGHWAY 299	SUITE B	WILLOW CREEK	CA	95573	0540	12	06023	40.93918109	-123.6304436	Humboldt County
29664	Fee-for-Service	1376512848	1376512848	1	1	DEVEREAUX, C E MD	4/1/1999	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	75223	10	Gastroenterology (M.D. only)	0	In state provider	None	3923 WARING RD	STE A	OCEANSIDE	CA	92056	4499	37	06073	33.18776771	-117.2893136	San Diego County
29669	Fee-for-Service	1639686264	1639686264	1	1	DA YOU ACUPUNCTURE & HERBS,	6/26/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CTURE & HERBS, INC.	1550 THE ALAMEDA STE 130	None	SAN JOSE	CA	95126	2322	43	06085	37.33513357	-121.9160189	Santa Clara County
29672	Fee-for-Service	1851075907	1851075907	1	1	DEREK Q PHAN MD MEDICAL CORP	6/15/2023	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	ORATION	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
29762	Fee-for-Service	1841722592	1841722592	1	1	DAVIS, MICHELLE MD	10/6/2022	390200000X	NA	Other	026	PHYSICIANS	180690	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
29782	Fee-for-Service	1154006401	1154006401	1	1	D DHILLON AND D CHANDRA	1/19/2024	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1215 PLUMAS ST	SUITE 1300A	YUBA CITY	CA	95991	3400	51	06101	39.14709336	-121.6175316	Sutter County
29799	Fee-for-Service	1487728598	1487728598	1	1	DILLMANN, SUSANNE M PHD	7/30/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
29807	Fee-for-Service	1164503694	1164503694	1	1	DIABETIC EYE MEDICAL	2/1/1996	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CLINIC	431 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	1413	19	06037	33.9697001	-118.3440391	Los Angeles County
29820	Fee-for-Service	1891738142	1891738142	1	1	DAHLIN, CHRISTINE E MD INC	12/20/2011	207R00000X	NA	Other	026	PHYSICIANS	84455	None	None	0	In state provider	None	375 E ROLLING OAKS DR	SUITE 115	THOUSAND OAKS	CA	91361	1023	56	06111	34.17433197	-118.8706258	Ventura County
29828	Fee-for-Service	1932230562	1932230562	1	1	DAVIS, BOBBY J LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.09817553	-118.293237	Los Angeles County
29875	Fee-for-Service	1376770768	1376770768	1	1	DE SILVA, SAYUMI MD	6/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116754	40	Pediatrics	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
29903	Fee-for-Service	1619453735	1619453735	1	1	DE FALKENBERG, TERA L CCC-SL	7/13/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3578 MUSTANG DR	None	ONTARIO	CA	91761	9198	36	06071	34.007904	-117.5898195	San Bernardino County
29909	Fee-for-Service	1942632534	1942632534	1	1	DIGNITY HEALTH	9/15/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	408 PINE ST	None	MOUNT SHASTA	CA	96067	2126	47	06093	41.31312726	-122.3154792	Siskiyou County
29927	Fee-for-Service	1619170222	1619170222	1	1	DEISCH, JEREMY K MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117116	None	None	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
29973	Fee-for-Service	1164464319	1164464319	1	1	DAVIS, HOWARD Z MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	36969	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
30017	Fee-for-Service	1184935918	1184935918	1	1	DAMARJIAN, TINA G MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137519	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
30029	Fee-for-Service	1104161439	1104161439	1	1	DR DAVID HAHN	8/14/2013	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGIST PC	1252 BROADWAY	STE I	EL CAJON	CA	92021	4904	37	06073	32.80773453	-116.9381385	San Diego County
30154	Fee-for-Service	1376770768	1376770768	1	1	DE SILVA, SAYUMI MD	6/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116754	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
30195	Fee-for-Service	1942632534	1942632534	1	1	DIGNITY HEALTH	5/16/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	408 PINE ST	None	MOUNT SHASTA	CA	96067	2126	47	06093	41.31312726	-122.3154792	Siskiyou County
30227	Fee-for-Service	1003858697	1003858697	1	1	DITTMAR, KURT D MD	6/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75232	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
30315	Fee-for-Service	1366219180	1366219180	1	1	DANIEL JOHN, MIRIAM CRNA	5/12/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
30361	Fee-for-Service	1477565794	1477565794	1	1	DYE, SCOTT F MD	7/31/1986	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	38230	None	None	0	In state provider	None	45 CASTRO ST	STE 117	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
30378	Fee-for-Service	1700185980	1700185980	1	1	DEVENDRA, GANESH P MD	9/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125974	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
30420	Fee-for-Service	1538118385	1538118385	2	1	DANIEL, JEFFREY T MD	1/27/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	5330 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
30427	Fee-for-Service	1003940529	1003940529	1	1	DIAZ, VICTORIA F L	8/1/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
30486	Fee-for-Service	1336131176	1336131176	1	1	DR. PAUL KENNETH LERER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	525 CENTRAL AVE	STE C	WESTFIELD	NJ	07090	2545	00	None	40.64803882	-74.34087843	Union County
30505	Fee-for-Service	1316095656	1316095656	1	1	DUBEAU, JOSEPH A MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	60281	22	Pathology (M.D. only)	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
30541	Fee-for-Service	1245441997	1245441997	1	1	DESOUZA, KAVIT A MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146632	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	19341 BEAR VALLEY RD	SUITE 105	APPLE VALLEY	CA	92308	5152	36	06071	34.47101125	-117.2412548	San Bernardino County
30544	Fee-for-Service	1093074627	1093074627	1	1	DAHHAN, TAMARA G DO	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13140	83	Rheumatology	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
30556	Fee-for-Service	1528346103	1528346103	1	1	DONG, HUAWEI MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123090	41	Internal Medicine	0	In state provider	None	8700 BEVELRY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
30598	Fee-for-Service	1962839811	1962839811	1	1	DRG MYRIAD SOLUTIONS, INC	2/1/2019	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	11899 EDGEWOOD RD	SUITE B	AUBURN	CA	95603	3435	31	06061	38.92037518	-121.0827596	Placer County
30679	Fee-for-Service	1447339452	1447339452	1	1	DICUS, MICHAEL E MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66902	41	Internal Medicine	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
30766	Fee-for-Service	1285848861	1285848861	1	1	DANIEL, LORI JEANE	5/11/2007	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	41002 FLAGSTONE ST	None	PALMDALE	CA	93551	1859	19	06037	34.62647864	-118.2107988	Los Angeles County
30812	Fee-for-Service	1518971464	1518971464	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2715 FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
30848	Fee-for-Service	1700919529	1700919529	1	1	DUDUKGIAN, EDUARD MD	1/1/1979	208600000X	NA	General Surgery	026	PHYSICIANS	26649	02	General Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 715	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
30854	Fee-for-Service	1952332157	1952332157	1	1	DANTIN, JULIET W PHD	12/11/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	874 GRAVENSTEIN HWY S	STE 7	SEBASTOPOL	CA	95472	4555	49	06097	38.3933079	-122.8184087	Sonoma County
30863	Fee-for-Service	1528283538	1528283538	1	1	DR. ROBIN I. BOHRA MD	5/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3050 TWIN RIVERS DR	None	ARKADELPHIA	AR	71923	4218	00	None	34.123185	-93.088503	Clark County
30890	Fee-for-Service	1851338917	1851338917	1	1	DUX, PETER H MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	09	Gynecology (D.O. only)	1	Border provider	None	101 CIVIC CENTER LN	None	LK HAVASU CTY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
30895	Fee-for-Service	1508075482	1508075482	1	1	DELEON, RECTO F MD INC	4/22/1975	193400000X	NA	Other	026	PHYSICIANS	24912	08	Family Practice	0	In state provider	None	1130 COFFEE RD	STE 9B	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
30972	Fee-for-Service	1326749003	1326749003	1	1	DONAHUE, REBECCA J NP	4/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1374 E ALLUVIAL AVE	None	FRESNO	CA	93720	2608	10	06019	36.84475352	-119.758806	Fresno County
30974	Fee-for-Service	1447339452	1447339452	1	1	DICUS, MICHAEL E MD	3/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66902	13	Neurology (M.D. only)	0	In state provider	None	917 BLANCO CIR	None	SALINAS	CA	93901	4446	27	06053	36.65433288	-121.6377316	Monterey County
30993	Fee-for-Service	1497015267	1497015267	1	1	DHADWAL, JAGTAR MD INC	3/25/2014	207R00000X	NA	Other	026	PHYSICIANS	47802	41	Internal Medicine	0	In state provider	None	250 WEST BONITA AVE	SUITE 250	POMONA	CA	91767	1863	19	06037	34.09664881	-117.751261	Los Angeles County
31017	Fee-for-Service	1285160432	1285160432	1	1	DAO, DIANE K MD	9/12/2022	207L00000X	NA	Other	026	PHYSICIANS	172186	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
31057	Fee-for-Service	1285848861	1285848861	1	1	DANIEL, LORI JEANE	5/11/2007	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	41002 FLAGSTONE ST	None	PALMDALE	CA	93551	1859	19	06037	34.62647864	-118.2107988	Los Angeles County
31073	Fee-for-Service	1023796687	1023796687	1	1	DIAZ, JACQUELINE DOULA	7/20/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
31076	Fee-for-Service	1184659542	1184659542	1	1	DYNE, PAMELA L MD	12/2/1992	207PE0004X	NA	Other	026	PHYSICIANS	75622	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
31101	Fee-for-Service	1518971464	1518971464	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2715 FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
31110	Fee-for-Service	1083744775	1083744775	1	1	DOUGHERTY, PAUL J MD	8/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	70688	18	Ophthalmology	0	In state provider	None	2705 LOMA VISTA RD	None	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
31176	Fee-for-Service	1851338917	1851338917	1	1	DUX, PETER H MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	101 CIVIC CENTER LN	None	LK HAVASU CTY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
31184	Fee-for-Service	1144225426	1144225426	1	8	DESERT TRAUMA SURGEONS INC	1/1/2023	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
31185	Fee-for-Service	1295383602	1295383602	1	1	DE GUZMAN, SANDRA E CNM	7/27/2020	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
31195	Fee-for-Service	1528445012	1528445012	1	1	DHAH, KULRAJ S DO	5/8/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31207	Fee-for-Service	1780772897	1780772897	1	1	DE BOSE, RENEE A MD	2/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91369	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 N VERMONT AVE	STE 60	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
31211	Fee-for-Service	1699974634	1699974634	1	1	DIZON, CARMINA I MD	3/7/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	100108	08	Family Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
31297	Fee-for-Service	1952796047	1952796047	1	1	DREW, SCOTT DO	7/6/2018	207R00000X	NA	Other	026	PHYSICIANS	15304	41	Internal Medicine	0	In state provider	None	1661 SOQUEL DR	STE D	SANTA CRUZ	CA	95065	1816	44	06087	36.98895429	-121.9821088	Santa Cruz County
31331	Fee-for-Service	1033174784	1033174784	1	1	DONSON, JENNIFER T MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91286	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
31388	Fee-for-Service	1124001417	1124001417	1	1	DUCORE, JONATHAN M MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62311	78	Neoplastic Diseases/Oncology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
31397	Fee-for-Service	1336348853	1336348853	1	2	DIVINE HEALTHCARE SERVICES,I	8/23/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	405 W. MANCHESTER BLVD	SUITE A & 4	INGLEWOOD	CA	90301	1196	19	06037	33.96175122	-118.3621356	Los Angeles County
31420	Fee-for-Service	1841781499	1841781499	1	2	DR. BLINK OPTOMETRY	9/20/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	170 TOWN CENTER PKWY	None	SANTEE	CA	92071	5801	37	06073	32.84159782	-116.9885467	San Diego County
31440	Fee-for-Service	1477807139	1477807139	1	1	DIALYSIS CLINIC INC	3/24/2014	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1545 MEADOWVIEW ROAD	SUITE 130-180	SACRAMENTO	CA	95832	1081	34	06067	38.4822	-121.5007425	Sacramento County
31462	Fee-for-Service	1134260706	1134260706	1	1	DRS WELLS NEWTON &	12/31/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SADORF	14349 AMARGOSA RD	None	VICTORVILLE	CA	92392	2317	36	06071	34.51147781	-117.3301402	San Bernardino County
31471	Fee-for-Service	1144225426	1144225426	1	8	DESERT TRAUMA SURGEONS INC	1/1/2023	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ICAL GROUP INC	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
31528	Fee-for-Service	1497999445	1497999445	1	1	DELA CRUZ, JUNE T MD INC	10/29/2010	193400000X	NA	Other	026	PHYSICIANS	54445	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
31571	Fee-for-Service	1487237020	1487237020	1	1	DALEY, CHANTAL LMFT	9/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
31572	Fee-for-Service	1861769432	1861769432	1	1	DOUGLAS, MADELINE C LCSW	11/14/2018	103K00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	1255 W COLTON AVE	#19	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
31576	Fee-for-Service	1164713269	1164713269	1	1	DWORETZKY, JOSHUA MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114488	41	Internal Medicine	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
31596	Fee-for-Service	1447361183	1447361183	1	1	DAY, JAMES R MD	3/26/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30100	40	Pediatrics	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
31642	Fee-for-Service	1497791693	1497791693	1	1	DANIELE, TERESA P MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56123	42	Nuclear Medicine	0	In state provider	None	2210 E ILLINOIS AVE	STE 508	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
31651	Fee-for-Service	1568727857	1568727857	1	1	DALISKY, RYAN J DO	7/31/2020	208600000X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6850 N DURANGO DR	SUITE 204	LAS VEGAS	NV	89149	4596	00	None	36.285876	-115.285266	Clark County
31675	Fee-for-Service	1124001417	1124001417	1	1	DUCORE, JONATHAN M MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62311	68	Hematology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
31683	Fee-for-Service	1124076401	1124076401	1	1	DECATUR HOSP AUTHORITY	12/9/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2000 S FM 51	None	DECATUR	TX	76234	3702	00	None	33.217803	-97.5978225	Wise County
31689	Fee-for-Service	1407885585	1407885585	1	1	DALLAS, JAMES R OD	9/1/2001	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1356A E MAIN ST	None	BARSTOW	CA	92311	3220	36	06071	34.89517129	-117.0057978	San Bernardino County
31699	Fee-for-Service	1497734057	1497734057	1	1	DOUGLAS WILFORD PERKINS D.O.	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N HOSPITAL DR	None	PRICE	UT	84501	4218	00	None	39.605337	-110.832525	Carbon County
31710	Fee-for-Service	1093823239	1093823239	1	1	DAVID BARTELT	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
31742	Fee-for-Service	1336145689	1336145689	1	1	DAVIS, WILLIAM B MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54959	08	Family Practice	0	In state provider	None	107 MAIN ST	None	WINTERS	CA	95694	1930	57	06113	38.52115822	-121.9708485	Yolo County
31760	Fee-for-Service	1144225426	1144225426	1	8	DESERT TRAUMA SURGEONS INC	1/1/2023	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
31765	Fee-for-Service	1114968971	1114968971	1	1	DUDELL, GOLDE G	7/1/1987	174400000X	NA	Other	026	PHYSICIANS	62598	01	General Practice	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
31790	Fee-for-Service	1326564634	1326564634	1	1	DASH, SIDDHANT MD	12/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	188077	None	None	0	In state provider	None	150 W. WASHINGTON STREET	None	SAN DIEGO	CA	92103	2005	37	06073	32.74999225	-117.1647027	San Diego County
31794	Fee-for-Service	1295798676	1295798676	1	1	DIAL, RUSSELL M	4/25/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
31799	Fee-for-Service	1386074607	1386074607	2	1	DR. IKE'S PHARMACARE LLC	10/13/2019	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15853 MONTE ST	101	SYLMAR	CA	91342	7671	19	06037	34.31033165	-118.4760766	Los Angeles County
31834	Fee-for-Service	1528575461	1528575461	1	1	DHALIWAL, HARPREET NP	5/25/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
31863	Fee-for-Service	1114164357	1114164357	1	1	DAVIS, YESHIVA D MFT	2/19/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 W SLAUSON AVE	STE 178	CULVER CITY	CA	90230	6582	19	06037	33.98900447	-118.37979	Los Angeles County
31908	Fee-for-Service	1457417453	1457417453	1	1	DOWNIEVILLE FIRE PROTECT	4/1/1989	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	321 MAIN ST	None	DOWNIEVILLE	CA	95936	0000	46	06091	39.56056523	-120.8273545	Sierra County
31929	Fee-for-Service	1497791693	1497791693	1	1	DANIELE, TERESA P MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56123	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2210 E ILLINOIS AVE	STE 508	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
31950	Fee-for-Service	1932683406	1932683406	1	1	DANAI, MAHTAB M MD	1/27/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185842	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
31962	Fee-for-Service	1124001417	1124001417	1	1	DUCORE, JONATHAN M MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62311	40	Pediatrics	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
31999	Fee-for-Service	1124076401	1124076401	1	1	DECATUR HOSP AUTHORITY	1/4/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2000 S FM 51	None	DECATUR	TX	76234	3702	00	None	33.217803	-97.5978225	Wise County
32005	Fee-for-Service	1255629846	1255629846	1	1	DYTIAPCO, ERNEST D MD	11/10/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	136945	None	None	0	In state provider	None	620 CALIFORNIA BLVD BLDG	SUITE P1	SAN LUIS OBISPO	CA	93401	2541	40	06079	35.28923398	-120.6579938	San Luis Obispo County
32019	Fee-for-Service	1720635873	1720635873	1	1	DELA CRUZ, CARL CRNA	3/8/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
32027	Fee-for-Service	1346650306	1346650306	1	1	DAI, QUEENA MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139770	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	SUITE 230 & 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
32048	Fee-for-Service	1144573585	1144573585	1	1	DILLON, LEAH J LMFT	7/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
32066	Fee-for-Service	1215919147	1215919147	1	1	DOBKIN, JEFFREY A MD	2/4/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73366	42	Nuclear Medicine	0	In state provider	None	2888 LONG BEACH BLVD	STE 110	LONG BEACH	CA	90806	7501	19	06037	33.809706	-118.189343	Los Angeles County
32099	Fee-for-Service	1942507405	1942507405	1	1	DAVID PALESTRANT MD INC	8/17/2021	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1125 SIR FRANCIS DRAKE	None	KENTFIELD	CA	94904	1418	21	06041	37.95899686	-122.5520873	Marin County
32103	Fee-for-Service	1285195628	1285195628	1	1	DAKOTA BUNCH	7/16/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	419 E WASHINGTON ST	None	ARMA	KS	66712	4126	00	None	37.54425433	-94.70003431	Crawford County
32108	Fee-for-Service	1184806606	1184806606	1	1	DADIVAS, ALFRED B MD INC	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	48522	41	Internal Medicine	0	In state provider	None	7950 CHERRY AVENUE	None	FONTANA	CA	92336	4023	36	06071	34.109892	-117.4887375	San Bernardino County
32133	Fee-for-Service	1861464612	1861464612	1	1	DINSAY, ROSELYN M MD	12/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85448	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
32145	Fee-for-Service	1568771244	1568771244	1	1	DAVIDS HOUSE LLC	8/30/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3 CEDAR RIDGE	None	IRVINE	CA	92603	3601	30	06059	33.63377966	-117.8094396	Orange County
32176	Fee-for-Service	1740254648	1740254648	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	MISSION VIEJO DIALYSIS	27640 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	3604	30	06059	33.56216443	-117.6582314	Orange County
32180	Fee-for-Service	1336173996	1336173996	1	1	DOYLE, ALAN F LCSW	11/1/2005	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	260 MAPLE CT	STE 130	VENTURA	CA	93003	9121	56	06111	34.27027545	-119.24562	Ventura County
32203	Fee-for-Service	1962617332	1962617332	1	1	DOO, BRYAN C MD	4/22/2010	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	65648	77	Infectious Disease	0	In state provider	A MEDICAL CORPORATION	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
32215	Fee-for-Service	1912185075	1912185075	1	1	DHILLON, RAJESH S MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127963	30	Radiology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
32281	Fee-for-Service	1952720450	1952720450	1	1	DHARWADKAR, POOJA MD	5/29/2020	390200000X	NA	Other	026	PHYSICIANS	166031	10	Gastroenterology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
32359	Fee-for-Service	1679867071	1679867071	1	1	DURSUN, ABDULMETIN MD	7/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2865 DAGGETT AVENUE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25240042	-121.7859055	Klamath County
32382	Fee-for-Service	1942507405	1942507405	1	1	DAVID PALESTRANT MD INC	3/21/2011	207RC0200X	NA	Other	026	PHYSICIANS	75862	None	None	0	In state provider	None	1125 SIR FRANCIS DRAKE	None	KENTFIELD	CA	94904	1418	21	06041	37.95899686	-122.5520873	Marin County
32391	Fee-for-Service	1346021755	1346021755	1	1	DEVARAJ, AMIT NP	3/1/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
32413	Fee-for-Service	1831291889	1831291889	1	1	DAWSON, PETER K DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	DAWSON & MA CHIROPRACTIC	8900 BENSON AVE	STE 3	MONTCLAIR	CA	91763	1669	36	06071	34.09232227	-117.6810176	San Bernardino County
32451	Fee-for-Service	1740571165	1740571165	1	1	DONOFRIO-ODMANN, JOY J DO	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11581	None	None	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
32469	Fee-for-Service	1730105198	1730105198	1	1	DAHLE, MICHAEL D MD	9/30/1983	174400000X	NA	Other	026	PHYSICIANS	41111	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	105 MARGARET LN	None	GRASS VALLEY	CA	95945	5211	29	06057	39.22948777	-121.0465057	Nevada County
32471	Fee-for-Service	1659751782	1659751782	1	1	DUNGCA, REYNALDO J OT	11/16/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
32516	Fee-for-Service	1568540235	1568540235	1	1	DIAMOND, ROBERT P MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	26115	36	Psychiatry	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
32526	Fee-for-Service	1659522290	1659522290	1	1	DYSON, LINDSEY N MD	4/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121798	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
32593	Fee-for-Service	1164451894	1164451894	1	1	DUQUETTE, AMANDA M	11/3/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
32654	Fee-for-Service	1558355156	1558355156	1	1	DER, ROGER E MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65753	22	Pathology (M.D. only)	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
32669	Fee-for-Service	1821561572	1821561572	1	1	DZENAN LULIC, M.D., A MEDICA	11/8/2019	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	L CORPORATION	40700 CALIFORNIA OAKS RD	SUITE 206	MURRIETA	CA	92562	5789	33	06065	33.57067363	-117.2045035	Riverside County
32679	Fee-for-Service	1013446046	1013446046	1	1	DHILLON, GIPANJOT MD	2/5/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	165245	-	NOT APPLICABLE	0	In state provider	None	18700 OXNARD STREET	None	TARZANA	CA	91356	1413	19	06037	34.18014349	-118.5410025	Los Angeles County
32714	Fee-for-Service	1255968392	1255968392	1	1	DHILLON, RUMMIT K DO	8/1/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	22586	07	Dermatology	0	In state provider	None	11370 ANDERSON ST	# 2600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
32719	Fee-for-Service	1013094515	1013094515	1	1	DRISCOLL, JAMES A MD	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113201	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
32829	Fee-for-Service	1861239691	1861239691	1	1	DR JOANNA MIRANDA OD INC	10/29/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5237 ARROW HWY	None	MONTCLAIR	CA	91763	1308	36	06071	34.0922757	-117.6906956	San Bernardino County
32850	Fee-for-Service	1306962477	1306962477	1	1	DAZA-PINTO, JENNY LMFT	7/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
32947	Fee-for-Service	1376555938	1376555938	1	1	DICK, ALICE R MD	8/1/1995	174400000X	NA	Other	026	PHYSICIANS	71916	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 204	LOS ANGELES	CA	90036	4663	19	06037	34.05764121	-118.3603115	Los Angeles County
32974	Fee-for-Service	1982644043	1982644043	1	1	DURALDE, THOMAS MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52204	08	Family Practice	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
32977	Fee-for-Service	1851436638	1851436638	1	1	DAHL-ROSENBAUM, HEIDI A MD	9/20/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	70866	36	Psychiatry	0	In state provider	C.	1211 MARICOPA HWY	263	OJAI	CA	93023	3162	56	06111	34.44201622	-119.2632073	Ventura County
32984	Fee-for-Service	1386813004	1386813004	1	1	DESERT OASIS CLINIC AMC	5/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	63404	41	Internal Medicine	0	In state provider	None	1041 N CHINA LAKE BLVD	STE A	RIDGECREST	CA	93555	3169	15	06029	35.63953945	-117.669891	Kern County
32990	Fee-for-Service	1194850834	1194850834	1	1	DE GUZMAN, CESAR N	9/24/2005	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	24881 ALICIA PKWY	# 278	LAGUNA HILLS	CA	92653	4617	30	06059	33.60104538	-117.6916176	Orange County
32994	Fee-for-Service	1659396539	1659396539	1	1	DANIEL SCHEURICH MD	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6000 HOSPITAL DR	None	HANNIBAL	MO	63401	6887	00	None	39.71060756	-91.44988518	Marion County
32999	Fee-for-Service	1851785141	1851785141	1	1	DOWNEY VISION OPTOMETRY INC	8/2/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10353 LAKEWOOD BLVD	None	DOWNEY	CA	90241	2743	19	06037	33.94478549	-118.1187678	Los Angeles County
33113	Fee-for-Service	1588754410	1588754410	1	1	DARDEN, TED D MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87457	08	Family Practice	0	In state provider	None	14124 FOOTHILL BLVD	STE 100	SYLMAR	CA	91342	8051	19	06037	34.31598785	-118.4413895	Los Angeles County
33128	Fee-for-Service	1942699574	1942699574	1	1	DEL ROSARIO, RUSSELL S NP	5/25/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33137	Fee-for-Service	1952783029	1952783029	1	1	DZERHACHOU, VASILI A MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153416	01	General Practice	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
33141	Fee-for-Service	1386011047	1386011047	2	1	DELGADILLO, KAREN I LMFT	6/4/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3935 NORMAL ST	APT 107	SAN DIEGO	CA	92103	2401	37	06073	32.74981042	-117.1490213	San Diego County
33149	Fee-for-Service	1982133039	1982133039	1	1	DIMASCIO, JAMES S PT	8/9/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2820 BELLFLOWER BLVD	None	LONG BEACH	CA	90815	1125	19	06037	33.80733578	-118.125179	Los Angeles County
33151	Fee-for-Service	1689321747	1689321747	1	2	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
33163	Fee-for-Service	1477636207	1477636207	1	1	DODDS, STEVEN J MD	1/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71780	40	Pediatrics	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
33176	Fee-for-Service	1053339507	1053339507	1	1	DAYTON OSTEOPATHIC HOSP	9/16/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	405 W GRAND AVE	None	DAYTON	OH	45405	4720	00	None	39.76902986	-84.20292671	Montgomery County
33197	Fee-for-Service	1194049205	1194049205	1	1	DASILVA, THERESE M LCSW	2/23/2010	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1835 EL CAJON BLVD	STE A	SAN DIEGO	CA	92103	2591	37	06073	32.75515551	-117.1453277	San Diego County
33203	Fee-for-Service	1578641460	1578641460	1	1	DRAVES, MAISHA S MD	3/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79541	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
33215	Fee-for-Service	1144225426	1144225426	1	6	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
33216	Fee-for-Service	1144225426	1144225426	1	4	DESERT TRAUMA SURGEONS INC	6/14/2023	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
33225	Fee-for-Service	1710046446	1710046446	1	1	DOMINGUEZ, SYLVIA C NP	9/4/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
33246	Fee-for-Service	1083263990	1083263990	1	1	D'ABREU, ANA C PHD	8/1/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
33262	Fee-for-Service	1588712459	1588712459	1	1	DRUCKER, RICHARD D MD	8/1/1983	207RP1001X	NA	Pulmonology	026	PHYSICIANS	43180	01	General Practice	0	In state provider	None	1560 CAPALINA RD	STE A	SAN MARCOS	CA	92069	1288	37	06073	33.15089345	-117.1946501	San Diego County
33281	Fee-for-Service	1538529789	1538529789	1	1	DAVISON, AIYANA D P CNM	6/22/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
33285	Fee-for-Service	1194218495	1194218495	1	1	DONATO, CARMEN LCSW	1/29/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
33348	Fee-for-Service	1871735324	1871735324	1	1	DOWNS, NANCY S MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59624	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
33381	Fee-for-Service	1578799342	1578799342	1	1	DAVID BRENT MABEY M.D.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
33440	Fee-for-Service	1689321747	1689321747	1	2	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
33447	Fee-for-Service	1942357645	1942357645	1	1	DAIGLE, ROBERT D MD	10/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42355	None	None	0	In state provider	None	1425 FRUITDALE AVE	None	SAN JOSE	CA	95128	3234	43	06085	37.31069947	-121.915098	Santa Clara County
33450	Fee-for-Service	1477636207	1477636207	1	1	DODDS, STEVEN J MD	1/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71780	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
33462	Fee-for-Service	1053339507	1053339507	1	1	DAYTON OSTEOPATHIC HOSP	9/16/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	405 W GRAND AVE	None	DAYTON	OH	45405	4720	00	None	39.76902986	-84.20292671	Montgomery County
33470	Fee-for-Service	1124031042	1124031042	1	1	DAVID R ZULAUF, MD	3/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 NE MEDICAL CENTER D	None	BEND	OR	97701	6061	00	None	44.064765	-121.2666635	Deschutes County
33503	Fee-for-Service	1144225426	1144225426	1	6	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ICAL GROUP INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
33504	Fee-for-Service	1144225426	1144225426	1	4	DESERT TRAUMA SURGEONS INC	6/14/2023	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
33538	Fee-for-Service	1811927031	1811927031	1	1	DANIEL, CHANCELOR MD	8/22/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45227	08	Family Practice	0	In state provider	None	1704 W MANCHESTER AVE	# 202	LOS ANGELES	CA	90047	3034	19	06037	33.9599425	-118.307079	Los Angeles County
33539	Fee-for-Service	1134181142	1134181142	1	1	DONG-MATSUDA, SUZIE X PSYD	3/11/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	13075 BLACKBIRD ST	None	GARDEN GROVE	CA	92843	2902	30	06059	33.77353611	-117.9130729	Orange County
33578	Fee-for-Service	1770569329	1770569329	1	1	DIAZ, MARK A MD	5/31/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42657	08	Family Practice	0	In state provider	None	2615 I ST	None	SACRAMENTO	CA	95816	4395	34	06067	38.575656	-121.470867	Sacramento County
33615	Fee-for-Service	1669533907	1669533907	2	1	DOROTHY MAE MEDICAL	6/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CLINIC INC	8880 S BROADWAY	None	LOS ANGELES	CA	90003	3635	19	06037	33.955875	-118.2781835	Los Angeles County
33637	Fee-for-Service	1871735324	1871735324	1	1	DOWNS, NANCY S MD	3/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59624	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
33641	Fee-for-Service	1417509431	1417509431	1	1	DE LA CRUZ, CAROLINE LPCC	1/17/2025	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
33665	Fee-for-Service	1689321416	1689321416	1	1	DEMING, ALEXIS J PT	5/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
33718	Fee-for-Service	1245426048	1245426048	1	1	DEL MUNDO, JENNIFER PSYD	3/14/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
33730	Fee-for-Service	1689321747	1689321747	1	2	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
33731	Fee-for-Service	1902337827	1902337827	1	1	DENYSIAK, JACQUELINE J MD	7/30/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164420	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
33735	Fee-for-Service	1932265774	1932265774	1	1	DIAMOND, DAVID DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 N MACARTHUR BLVD	None	IRVING	TX	75061	2220	00	None	32.834691	-96.95924802	Dallas County
33762	Fee-for-Service	1639161672	1639161672	1	1	DAVID M. BAILEY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DAVID M. BAILEY	1225 WEST MAIN #205	None	NORMA	OK	73069	0000	00	None	35.21846549	-97.459947	Cleveland County
33776	Fee-for-Service	1205863552	1205863552	1	1	DOLLBAUM, CHARLES M MD	8/31/1986	207RX0202X	NA	Oncology	026	PHYSICIANS	48211	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	# A502	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33792	Fee-for-Service	1881651917	1881651917	1	1	DELANO, BRIGID H LCSW	2/1/2003	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	31751 ROCKING HORSE RD	None	ESCONDIDO	CA	92026	4704	37	06073	33.2871848	-117.14202	San Diego County
33794	Fee-for-Service	1144225426	1144225426	1	6	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
33795	Fee-for-Service	1144225426	1144225426	1	4	DESERT TRAUMA SURGEONS INC	6/16/2023	163W00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP INC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
33799	Fee-for-Service	1073538708	1073538708	1	1	DISHAKJIAN, RAFFI M MD	12/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47717	05	Anesthesiology	0	In state provider	None	7300 MEDICAL CENTER	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
33809	Fee-for-Service	1194207886	1194207886	1	1	DEVOTED HOME HEALTH CARE INC	3/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	STE 208	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
33812	Fee-for-Service	1942657697	1942657697	1	1	DUN-MELLI, GEALINA MD	1/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152217	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
33823	Fee-for-Service	1790859304	1790859304	1	1	DY, JACQUELINE G MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52435	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
33830	Fee-for-Service	1467745042	1467745042	1	1	DAVIS, BARAK J MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129421	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
33859	Fee-for-Service	1932968195	1932968195	1	1	DENNIS J SANCHEZ MD A PROFES	7/31/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3529 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3031	19	06037	33.95422949	-118.2050894	Los Angeles County
33882	Fee-for-Service	1497152144	1497152144	1	1	DIVINE MERCY HOME HEALTH	6/11/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	805 E BROADWAY	SUITE A & H	GLENDALE	CA	91205	4527	19	06037	34.14632152	-118.245339	Los Angeles County
33894	Fee-for-Service	1609989268	1609989268	1	1	DAVIN HATLESTAD M.D.	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
33895	Fee-for-Service	1265599401	1265599401	1	1	DOS PALOS ORO LOMA JOINT	11/5/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	UNIFIED SCHOOL DISTRICT	2041 ALMOND ST	None	DOS PALOS	CA	93620	2303	24	06047	36.98482353	-120.6287505	Merced County
33905	Fee-for-Service	1669533907	1669533907	2	1	DOROTHY MAE MEDICAL	6/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CLINIC INC	8880 S BROADWAY	None	LOS ANGELES	CA	90003	3635	19	06037	33.955875	-118.2781835	Los Angeles County
33919	Fee-for-Service	1134291958	1134291958	1	1	DAO, THANH MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62089	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
34006	Fee-for-Service	1346846284	1346846284	1	1	DEMANIGOLD, CARINA LCSW	8/30/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
34015	Fee-for-Service	1689321747	1689321747	1	2	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
34021	Fee-for-Service	1124139803	1124139803	1	1	DIN, ARFAN DO	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7280	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
34022	Fee-for-Service	1891758256	1891758256	1	2	DOLNIKOVA, JANA MD	5/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	63577	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
34029	Fee-for-Service	1497588800	1497588800	1	1	DANA FORMAN, INC.	8/28/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
34034	Fee-for-Service	1699722819	1699722819	1	1	DI JOHN, DAVID MD	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	3006 S MARYLAND PKWY	SUITE 315	LAS VEGAS	NV	89109	2225	00	None	36.135288	-115.1368705	Clark County
34036	Fee-for-Service	1760493076	1760493076	2	1	DELSHAD, GEORGE M MD	12/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	83566	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	14640 PARTHENIA ST	None	PANORAMA CITY	CA	91402	2905	19	06037	34.22760324	-118.4512906	Los Angeles County
34046	Fee-for-Service	1184719940	1184719940	1	1	DANIEL DALE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MCMINNVILLE HOSPITAL	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	6239	00	None	45.20010494	-123.1656951	Yamhill County
34073	Fee-for-Service	1427112408	1427112408	1	1	DE VASQUES, DANIELA M PSYD	5/15/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	819 THIRD ST	STE 103	SANTA ROSA	CA	95404	4546	49	06097	38.44161	-122.709573	Sonoma County
34112	Fee-for-Service	1790859304	1790859304	1	1	DY, JACQUELINE G MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52435	67	Endocrinology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
34142	Fee-for-Service	1932968195	1932968195	1	1	DENNIS J SANCHEZ MD A PROFES	7/31/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3529 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3031	19	06037	33.95422949	-118.2050894	Los Angeles County
34149	Fee-for-Service	1639176456	1639176456	1	1	DALLAM-HARTLEY COUNTIES HOSP	12/7/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1411 DENVER AVE	None	DALHART	TX	79022	4809	00	None	36.05159253	-102.5218509	Hartley County
34189	Fee-for-Service	1942387956	1942387956	1	1	DO, TONY D DO	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9266	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
34192	Fee-for-Service	1669533907	1669533907	2	1	DOROTHY MAE MEDICAL	6/19/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CLINIC INC	8880 S BROADWAY	None	LOS ANGELES	CA	90003	3635	19	06037	33.955875	-118.2781835	Los Angeles County
34242	Fee-for-Service	1972727832	1972727832	1	1	DOWNEY, RYAN T MD	4/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116536	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
34281	Fee-for-Service	1023128196	1023128196	1	1	DALY, JEFF PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15525 POMERADO RD	STE B-1	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
34320	Fee-for-Service	1699722819	1699722819	1	1	DI JOHN, DAVID MD	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	SUITE 315	LAS VEGAS	NV	89109	2225	00	None	36.135288	-115.1368705	Clark County
34335	Fee-for-Service	1427084839	1427084839	1	1	DESAGANI, KISHORE K MD	11/16/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	99666	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
34336	Fee-for-Service	1881652030	1881652030	1	1	DELGADO-ESPINOZA, SANDRA Y	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	92119	01	General Practice	0	In state provider	MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
34366	Fee-for-Service	1124131065	1124131065	1	1	DAN B TRAN MEDICAL CORPORATI	5/2/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83738	None	None	0	In state provider	COASTAL VISION MED GROUP	709 E ANAHEIM ST	None	LONG BEACH	CA	90813	3507	19	06037	33.78263447	-118.1827035	Los Angeles County
34466	Fee-for-Service	1689722522	1689722522	1	1	DE CARO, THERESA K CRNA	10/12/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
34491	Fee-for-Service	1902064561	1902064561	1	1	DELANO-WOOD, LISA M PHD	1/15/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
34504	Fee-for-Service	1801130554	1801130554	1	1	DONOVAN, HEATHER J	12/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	116 E WALNUT AVE	None	MONROVIA	CA	91016	3431	19	06037	34.14367921	-118.0000903	Los Angeles County
34538	Fee-for-Service	1366468589	1366468589	1	1	DALITZ, DOUGLAS M CRNA	2/8/2015	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 STR MARY COLUMBA DR	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
34544	Fee-for-Service	1396037941	1396037941	1	1	DELITTO, DANIEL J MD	8/9/2021	208600000X	NA	General Surgery	026	PHYSICIANS	173758	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
34564	Fee-for-Service	1881154409	1881154409	1	1	DARMAWAN, DAPHNE O MD	6/17/2022	390200000X	NA	Other	026	PHYSICIANS	179253	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
34586	Fee-for-Service	1659821080	1659821080	1	1	DUONG, MICHELLE T H NP	1/27/2017	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
34595	Fee-for-Service	1851534549	1851534549	1	1	DANILOVA, OLGA V MD	10/7/2020	207ZH0000X	NA	Other	026	PHYSICIANS	168054	22	Pathology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
34643	Fee-for-Service	1083732853	1083732853	1	2	DIGNITY HEALTH	8/1/1985	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2550 SR MARY COLUMBA DR	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
34686	Fee-for-Service	1912931403	1912931403	1	1	DANN, FRANCIS J MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	25590	07	Dermatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
34715	Fee-for-Service	1619963444	1619963444	1	1	DIETRICK, TODD B MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70565	89	Surgery-Traumatic	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3229	19	06037	34.133598	-118.1534895	Los Angeles County
34726	Fee-for-Service	1528137619	1528137619	1	1	DUONG, TUOC K MD INC	8/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88590	08	Family Practice	0	In state provider	None	9009 MCFADDEN AVE	None	WESTMINSTER	CA	92683	6408	30	06059	33.73761316	-117.971121	Orange County
34749	Fee-for-Service	1396022026	1396022026	1	1	DHHS IHS PHOENIX AREA	7/6/2022	261QP0904X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	1970 PALO VERDE DR.	None	HAVASU LAKE	CA	92363	1858	36	06071	34.51484141	-114.395508	San Bernardino County
34780	Fee-for-Service	1912183328	1912183328	1	1	DEKORTE, MICHELE L MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97456	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
34789	Fee-for-Service	1194775890	1194775890	1	1	DENG, SOPHIE X MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91205	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
34831	Fee-for-Service	1639585482	1639585482	1	1	DADABHOY, SHAHIDA A	9/22/2014	193400000X	NA	Other	026	PHYSICIANS	51315	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	145 W WILLOW STREET	None	POMONA	CA	91768	1829	19	06037	34.07899674	-117.7533706	Los Angeles County
34856	Fee-for-Service	1568502953	1568502953	1	1	DE SILVA, JANESRI W MD	6/16/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	88991	40	Pediatrics	0	In state provider	A PROFESSIONAL CORP	10550 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1934	19	06037	34.2624709	-118.4672518	Los Angeles County
34858	Fee-for-Service	1720478829	1720478829	1	1	DE GUIA, CHRISTIAN	3/1/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1335 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5385	36	06071	34.124274	-117.2787625	San Bernardino County
34880	Fee-for-Service	1851534549	1851534549	1	1	DANILOVA, OLGA V MD	10/7/2020	207ZH0000X	NA	Other	026	PHYSICIANS	168054	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
34927	Fee-for-Service	1750314225	1750314225	1	1	DOUGHTY, TIMOTHY C CRNA	11/21/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	450 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
34966	Fee-for-Service	1447545249	1447545249	1	1	DAGENAIS, PAUL M MD	3/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122416	01	General Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
34974	Fee-for-Service	1346659075	1346659075	1	1	DEGUZMAN, SAGIE D NP	5/2/2017	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1127 WILSHIRE BLVD	STE 1001	LOS ANGELES	CA	90017	4001	19	06037	34.05270508	-118.2641005	Los Angeles County
34980	Fee-for-Service	1336524891	1336524891	1	1	DU, HYONGOAK	3/7/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	30313 CANWOOD ST	STE 23	AGOURA HILLS	CA	91301	2034	19	06037	34.14784973	-118.7817678	Los Angeles County
35010	Fee-for-Service	1366433419	1366433419	1	1	DAVID M CHISHOLM, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5757 W. THUNDERBIRD RD	E157	GLENDALE	AZ	85306	5601	00	None	33.609672	-112.182786	Maricopa County
35038	Fee-for-Service	1396022026	1396022026	1	1	DHHS IHS PHOENIX AREA	7/6/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1970 PALO VERDE DR.	None	HAVASU LAKE	CA	92363	1858	36	06071	34.51484141	-114.395508	San Bernardino County
35063	Fee-for-Service	1164575924	1164575924	1	1	DIERST DAVIES, CERI PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
35148	Fee-for-Service	1821158205	1821158205	1	1	DOUR, BRANDI R LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PKWY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
35165	Fee-for-Service	1093780017	1093780017	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	995 GATEWAY CENTER WAY	STE 101	SAN DIEGO	CA	92102	4550	37	06073	32.71405516	-117.1158459	San Diego County
35170	Fee-for-Service	1073855326	1073855326	1	1	DRALLA, SHANNON S MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134226	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7520 ARROYO CIRCLE	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
35181	Fee-for-Service	1437144797	1437144797	1	2	DONN & DOFF INC.	2/9/2024	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	THETICS	2102 CIVIC CENTER DRIVE	None	REDDING	CA	96001	2704	45	06089	40.57610996	-122.3804753	Shasta County
35294	Fee-for-Service	1871961292	1871961292	1	1	DIGGINS, INDIA E LMFT	9/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
35311	Fee-for-Service	1003348830	1003348830	1	1	DEARDORFF, WILLIAM J MD	6/21/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	169642	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35361	Fee-for-Service	1346207693	1346207693	1	1	DIAZ, JORGE A MD	1/21/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	44167	66	Emergency Medicine (Urgent Care)	0	In state provider	SANTA MARTA HOSPITAL	1395 HUMPHRIES AVE	None	LOS ANGELES	CA	90022	0000	19	06037	34.04056949	-118.1713815	Los Angeles
35376	Fee-for-Service	1386756930	1386756930	1	1	DAVIS, PAMELA D MD INC	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46258	01	General Practice	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
35379	Fee-for-Service	1346359445	1346359445	1	1	DI GRANDE, PETER J MD	9/30/1988	207LP2900X	NA	Other	026	PHYSICIANS	55335	05	Anesthesiology	0	In state provider	None	1400 BRISTOL ST N	STE 240	NEWPORT BEACH	CA	92660	2981	30	06059	33.65928642	-117.8694286	Orange County
35392	Fee-for-Service	1548282700	1548282700	1	1	DMITRIY, PALES DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HEALTHONE CLINIC SERVICE	9191 GRANT ST	None	THORNTON	CO	80229	0000	00	None	39.86420881	-104.9846155	Adams County
35409	Fee-for-Service	1790775971	1790775971	1	1	DINH, ANH MD	3/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64010	08	Family Practice	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
35417	Fee-for-Service	1750485140	1750485140	1	1	DEBRA L DAVIS	1/10/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
35437	Fee-for-Service	1275849069	1275849069	1	1	DIAMANTAKOS, EVANGELOS A DO	8/16/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14860	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
35452	Fee-for-Service	1053999540	1053999540	1	1	DARMAL, SEAN MD	11/15/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
35467	Fee-for-Service	1821535055	1821535055	1	1	DJEUSSOUNG, ARIANE NP	12/19/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
35497	Fee-for-Service	1225320310	1225320310	1	1	DHAWAN, MALLIKA S MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129814	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35511	Fee-for-Service	1174564256	1174564256	1	1	DINH, SON T	11/21/2007	207RN0300X	NA	Nephrology	026	PHYSICIANS	99736	41	Internal Medicine	0	In state provider	None	3650 E SOUTH ST	STE 301	LAKEWOOD	CA	90712	1513	19	06037	33.8601747	-118.1494013	Los Angeles County
35513	Fee-for-Service	1518139914	1518139914	1	1	DR. MARK GREAVES M.D.	11/13/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	110 REHILL AVE	None	SOMERVILLE	NJ	08876	2519	00	None	40.56800039	-74.59590885	Somerset County
35582	Fee-for-Service	1265620132	1265620132	1	1	DA JUSTA, DANIEL G MD	5/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	34	Urology and Urological Surgery	2	Out of state provider	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
35651	Fee-for-Service	1104195353	1104195353	1	1	DHHS IHS PHOENIX AREA DESERT	1/4/2016	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	2	Out of state provider	VISIONS YOUTH WELLNESS	198 S SKILL CENTER RD	None	SACATON	AZ	85147	0008	00	None	33.0753543	-111.7572489	Pinal County
35668	Fee-for-Service	1386756930	1386756930	1	1	DAVIS, PAMELA D MD INC	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	46258	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
35724	Fee-for-Service	1275849069	1275849069	1	1	DIAMANTAKOS, EVANGELOS A DO	8/16/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	14860	41	Internal Medicine	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
35798	Fee-for-Service	1336244508	1336244508	1	1	DANG, THUAN T MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	55492	30	Radiology	0	In state provider	None	2224 MEDICAL CENTER DR	None	PERRIS	CA	92571	2638	33	06065	33.8123212	-117.2217309	Riverside County
35848	Fee-for-Service	1285711135	1285711135	1	1	DOAN, CAITLIN C MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73740	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
35878	Fee-for-Service	1528393006	1528393006	1	1	DESAI, HARIT V MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139374	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39755 MURRIETA HOT SPRI	SUITE E-130	MURRIETA	CA	92563	9116	33	06065	33.55575954	-117.1627899	Riverside County
35883	Fee-for-Service	1578648507	1578648507	2	1	D&B HEALTH CARE	6/15/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONALS BURBANK IN	12140 ARTESIA BLVD	SUITE 202	ARTESIA	CA	90701	4058	19	06037	33.87301048	-118.073313	Los Angeles County
35936	Fee-for-Service	1104195353	1104195353	1	1	DHHS IHS PHOENIX AREA DESERT	1/4/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	2	Out of state provider	VISIONS YOUTH WELLNESS	198 S SKILL CENTER RD	None	SACATON	AZ	85147	0008	00	None	33.0753543	-111.7572489	Pinal County
35946	Fee-for-Service	1750465738	1750465738	1	1	DENHAM, ANNA M MD	12/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77232	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
36030	Fee-for-Service	1619068103	1619068103	1	1	DAWSON, SHELLY R MD	8/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	146662	08	Family Practice	0	In state provider	None	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
36055	Fee-for-Service	1467513705	1467513705	1	1	DAVILA-CRUZ, SONIA G LCSW	3/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
36060	Fee-for-Service	1437205424	1437205424	1	1	DONN E JOHNSON, M.D.	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
36077	Fee-for-Service	1114314846	1114314846	1	1	DUYANEN, JENNIFER A MD	9/20/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143836	36	Psychiatry	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
36135	Fee-for-Service	1285711135	1285711135	1	1	DOAN, CAITLIN C MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73740	10	Gastroenterology (M.D. only)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
36151	Fee-for-Service	1316365521	1316365521	1	1	DECALUWE, BRANDON G MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154285	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
36153	Fee-for-Service	1033645312	1033645312	1	1	DOMINGUEZ, EVELYN NP	8/2/2019	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
36196	Fee-for-Service	1467714782	1467714782	1	1	DREDAR, ABDULMALIK S MD	8/8/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	133687	30	Radiology	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
36220	Fee-for-Service	1851475842	1851475842	1	1	DAHMEN,JOHN J MD	10/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55060	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
36255	Fee-for-Service	1417993213	1417993213	1	1	DORNBLUTH, NELLA C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
36256	Fee-for-Service	1649533555	1649533555	1	2	DO, STEPHANIE T MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121644	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
36262	Fee-for-Service	1649529819	1649529819	1	1	DO, THUY-PHUONG Q PSYD	2/13/2020	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
36273	Fee-for-Service	1831109792	1831109792	1	1	DREISBACH, LUKE P MD	12/1/2000	207RH0003X	NA	Oncology	026	PHYSICIANS	70978	68	Hematology	0	In state provider	None	39800 BOB HOPE DR	# C	RANCHO MIRAGE	CA	92270	3920	33	06065	33.759432	-116.408062	Riverside County
36291	Fee-for-Service	1225384456	1225384456	1	1	DEFTEREOS, GEORGIOS MD	9/13/2022	207ZP0102X	NA	Other	026	PHYSICIANS	181692	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
36356	Fee-for-Service	1912120379	1912120379	1	1	DE LEON, LIBERATION B MD	10/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	32018	40	Pediatrics	0	In state provider	None	16660 PARAMOUNT BLVD	STE 211	PARAMOUNT	CA	90723	5469	19	06037	33.882723	-118.1599535	Los Angeles County
36369	Fee-for-Service	1497786628	1497786628	1	1	DOHERTY, JONI K MD	1/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74042	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
36419	Fee-for-Service	1386934974	1386934974	1	1	DINARDO, LAURA A MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126320	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
36471	Fee-for-Service	1437343399	1437343399	1	1	DUNLAP, NEKA A MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	101400	05	Anesthesiology	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
36479	Fee-for-Service	1144322579	1144322579	1	1	DEL CARMEN, JOCELYN MD	1/31/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	80674	18	Ophthalmology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
36538	Fee-for-Service	1174814701	1174814701	1	1	DER HOVANESSIAN, ARISS MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100344	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
36554	Fee-for-Service	1740555887	1740555887	1	1	DASHIELL-EARP, CODY N MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127960	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
36583	Fee-for-Service	1043204092	1043204092	1	1	DAURIA, VINCENT G MD	11/28/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39214	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
36636	Fee-for-Service	1538865134	1538865134	1	1	DI YORIO, EMILY LMFT	2/6/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
36670	Fee-for-Service	1295700201	1295700201	1	1	DVA RENAL HEALTHCARE INC	1/3/2001	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN YSIDRO	1445 30TH ST	STE A, B	SAN DIEGO	CA	92154	3496	37	06073	32.57094541	-117.0669533	San Diego County
36688	Fee-for-Service	1598713794	1598713794	1	1	DRS TATUM AND TREZZA INC	5/23/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10165 FOOTHILL BLVD	STE 6	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
36740	Fee-for-Service	1366416273	1366416273	1	1	DVA HEALTHCARE RENAL	12/10/1998	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	3501 MALL VIEW RD	SUITE 109	BAKERSFIELD	CA	93306	3045	15	06029	35.39489504	-118.9531578	Kern County
36762	Fee-for-Service	1659055911	1659055911	1	1	DIVINE DOULALITY LLC	6/14/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
36787	Fee-for-Service	1245728518	1245728518	1	1	DUSTIN BRIGGS M.D., INC.	7/25/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	W201	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
36825	Fee-for-Service	1437112158	1437112158	1	1	DOWLATSHAHI, MORTEZA MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55256	32	Radiation Therapy (D.O. only)	0	In state provider	None	200 JOSE FIGURES AVE	STE 199	SAN JOSE	CA	95116	1599	43	06085	37.36122014	-121.8505998	Santa Clara County
36878	Fee-for-Service	1770715575	1770715575	1	2	DOKUKIN, ANDREI N MD	2/21/2020	2081P2900X	NA	Physical Medicine and Rehabilitation	086	MEDICAL DIRECTORS	110631	-	NOT APPLICABLE	0	In state provider	None	3939 ATLANTIC AVE	SUITE 102	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
36886	Fee-for-Service	1376543256	1376543256	1	1	DE LA CRUZ, ZELDA S MD	1/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88683	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
36887	Fee-for-Service	1841258621	1841258621	1	1	DONALD LEVIN DO	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21 E MAPLE ST	None	HAILEY	ID	83333	4900	00	None	43.5142111	-114.3101842	Blaine County
36934	Fee-for-Service	1457038333	1457038333	1	1	DEAN, MEGAN POSTPARTUM DOUL	5/2/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
36993	Fee-for-Service	1205851151	1205851151	1	1	DEL NORTE CLINICS, INC	3/17/2005	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1574 KIRK RD	None	GRIDLEY	CA	95948	9417	04	06007	39.36270256	-121.6504936	Butte County
37017	Fee-for-Service	1316272818	1316272818	1	1	DOIL, CATHERINE R MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111120	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
37025	Fee-for-Service	1720156912	1720156912	1	1	DRAZAN, ERIKA S MD	11/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75360	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
37042	Fee-for-Service	1285751024	1285751024	1	1	DANESH, REZA MD	5/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	55334	01	General Practice	0	In state provider	SAN JOSE COMMUNITY	11865 INGLEWOOD AVE	None	HAWTHORNE	CA	90250	2744	19	06037	33.92566935	-118.3613911	Los Angeles County
37111	Fee-for-Service	1437112158	1437112158	1	1	DOWLATSHAHI, MORTEZA MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55256	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 JOSE FIGURES AVE	STE 199	SAN JOSE	CA	95116	1599	43	06085	37.36122014	-121.8505998	Santa Clara County
37185	Fee-for-Service	1790313120	1790313120	1	1	DONOHUE, KYNA S MD	1/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	190254	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
37206	Fee-for-Service	1821165762	1821165762	1	1	DO, BINH QUANG MD	12/4/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	79878	None	None	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
37236	Fee-for-Service	1174993844	1174993844	1	1	DRAPALA, DREW-ANNE MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138682	08	Family Practice	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
37269	Fee-for-Service	1710054523	1710054523	1	1	DUERKSEN, JONATHAN S MD	5/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	63303	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
37270	Fee-for-Service	1902332547	1902332547	1	2	DFAD INC	10/7/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	29 N BALDWIN AVE	None	SIERRA MADRE	CA	91024	1903	19	06037	34.16247767	-118.0526817	Los Angeles County
37285	Fee-for-Service	1487950523	1487950523	1	1	DIGNITY HEALTH MEDICAL	2/8/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
37290	Fee-for-Service	1437221025	1437221025	1	1	DIAZ, GERVACIO D III MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69801	41	Internal Medicine	0	In state provider	INC	2013 COFFEE RD	None	MODESTO	CA	95355	2405	50	06099	37.673127	-120.975776	Stanislaus County
37296	Fee-for-Service	1023435906	1023435906	1	1	DAI, DAVID W MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138674	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
37319	Fee-for-Service	1013299627	1013299627	1	1	DALPRAT, JOSE R DO	8/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11851	08	Family Practice	0	In state provider	None	15625 IMPERIAL HWY	None	LA MIRADA	CA	90638	1627	19	06037	33.91736145	-117.9981225	Los Angeles County
37346	Fee-for-Service	1255645172	1255645172	1	1	DIABLO VALLEY PERINATAL	1/12/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	ASSOCIATES INC	1656 N CALIFORNIA BLVD	STE 300	WALNUT CREEK	CA	94596	0018	07	06013	37.90154552	-122.0644219	Contra Costa County
37397	Fee-for-Service	1174004402	1174004402	1	1	DUONG, QUYEN TU RCP	7/30/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
37398	Fee-for-Service	1033195052	1033195052	1	1	DUNFEE,WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4809 ARGONNE ST 120	None	DENVER	CO	80249	6835	00	None	39.7841371	-104.7649375	Denver County
37401	Fee-for-Service	1639526692	1639526692	1	1	DUKE FACILITIES, INC	6/26/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	620 EAST GARNER LANE	None	STOCKTON	CA	95207	4805	39	06077	38.0074423	-121.3011412	San Joaquin County
37416	Fee-for-Service	1538459540	1538459540	1	1	DURAIRAJ, PRASANNA S DO	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14210	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
37418	Fee-for-Service	1134699457	1134699457	1	1	DELACRUZ, TED P RCP	12/30/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
37427	Fee-for-Service	1053817155	1053817155	1	1	DUNAWAY, RAIN MD	10/3/2023	207R00000X	NA	Other	026	PHYSICIANS	184270	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
37447	Fee-for-Service	1841202983	1841202983	1	1	DARTEY, MAXWELL A MD INC	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	33447	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1360 W 6TH ST	STE 165	SAN PEDRO	CA	90732	3540	19	06037	33.73886546	-118.3075065	Los Angeles County
37469	Fee-for-Service	1215404835	1215404835	1	1	DUPREE, ENDENNE L OT	11/29/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7313 WHITTIER AVE	None	WHITTIER	CA	90602	1132	19	06037	33.975027	-118.043219	Los Angeles County
37492	Fee-for-Service	1437662863	1437662863	1	1	DELVECCHIO, MEGAN J CNP	12/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
37506	Fee-for-Service	1528418696	1528418696	1	1	DOMINIQUE GAGNE MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
37525	Fee-for-Service	1174993844	1174993844	1	1	DRAPALA, DREW-ANNE MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138682	01	General Practice	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
37547	Fee-for-Service	1538808779	1538808779	1	1	DE LEON, HANZ B NP	7/12/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37549	Fee-for-Service	1013978527	1013978527	1	1	DINH, BICHHUONG M MD	4/6/2022	208M00000X	NA	Other	026	PHYSICIANS	165400	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
37554	Fee-for-Service	1053378760	1053378760	1	1	DUNG NGOC PHAN	2/18/1998	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DAWN PHARMACY	4776 EL CAJON BLVD	STE 105	SAN DIEGO	CA	92115	4521	37	06073	32.75619526	-117.0914139	San Diego County
37573	Fee-for-Service	1487950523	1487950523	1	1	DIGNITY HEALTH MEDICAL	6/4/2019	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
37580	Fee-for-Service	1154716389	1154716389	1	1	DIDIGU, CHUKWUKA A MD	8/22/2024	208M00000X	NA	Other	026	PHYSICIANS	147301	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
37596	Fee-for-Service	1710975420	1710975420	1	1	DALERE, MENTE F MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50921	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
37636	Fee-for-Service	1194803080	1194803080	1	1	DOYLE, JOHN K MD	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42854	18	Ophthalmology	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
37696	Fee-for-Service	1437100609	1437100609	1	1	DIEFENBACH, PAMELA N MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64167	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
37730	Fee-for-Service	1134207210	1134207210	1	1	DALLAS, DALE C MD	7/28/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37540	01	General Practice	0	In state provider	None	2038 HEARST AVE	APT 7	BERKELEY	CA	94709	2175	01	06001	37.87373583	-122.2693067	Alameda County
37733	Fee-for-Service	1982059044	1982059044	1	1	DOLLAND, STEVEN C CRNA	5/3/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
37736	Fee-for-Service	1841202983	1841202983	1	1	DARTEY, MAXWELL A MD INC	2/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	33447	01	General Practice	0	In state provider	None	1360 W 6TH ST	STE 165	SAN PEDRO	CA	90732	3540	19	06037	33.73886546	-118.3075065	Los Angeles County
37764	Fee-for-Service	1770870446	1770870446	1	1	DAO, ADAM H M MD	7/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136640	18	Ophthalmology	0	In state provider	None	2400 N BROADWAY	None	LOS ANGELES	CA	90031	2219	19	06037	34.07360257	-118.2166466	Los Angeles County
37827	Fee-for-Service	1083217434	1083217434	1	1	DONNELLY, ANDREW E PT	4/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
37847	Fee-for-Service	1912125071	1912125071	1	1	DE ALBA, VERONICA LCSW	1/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1398 W INDIANAPOLIS AVE	SUITE 101	FRESNO	CA	93705	0300	10	06019	36.79989153	-119.8276065	Fresno County
37862	Fee-for-Service	1487950523	1487950523	1	1	DIGNITY HEALTH MEDICAL	2/8/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
37868	Fee-for-Service	1134230881	1134230881	1	1	DEVRIES, AUGUSTUS C	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
37871	Fee-for-Service	1003807983	1003807983	1	1	DR SHYAM PARKHIE	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
37923	Fee-for-Service	1972541498	1972541498	1	1	DIGNITY HEALTH	12/31/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
37970	Fee-for-Service	1851378236	1851378236	1	1	DARAMOLA, IYABO O	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63633	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2401 REO DR	None	SAN DIEGO	CA	92139	3025	37	06073	32.67512422	-117.064198	San Diego County
38120	Fee-for-Service	1255645172	1255645172	1	2	DIABLO VALLEY PERINATAL ASSO	1/12/2011	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	47	Miscellaneous	0	In state provider	CIATES, INC.	110 TAMPICO DR	100	WALNUT CREEK	CA	94598	2961	07	06013	37.91113845	-122.0458263	Contra Costa County
38126	Fee-for-Service	1952861056	1952861056	1	1	DELGADO, CARLOS MD	9/11/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	205 RIVER PARK CIR	None	FRESNO	CA	93720	1571	10	06019	36.85456375	-119.7863981	Fresno County
38150	Fee-for-Service	1487950523	1487950523	1	1	DIGNITY HEALTH MEDICAL	2/8/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
38156	Fee-for-Service	1669547501	1669547501	1	2	DICARLO, JOSEPH V	4/4/2017	2080P0203X	NA	Other	026	PHYSICIANS	50024	None	None	0	In state provider	None	3777 S BASCOM AVE	None	CAMPBELL	CA	95008	7320	43	06085	37.26018902	-121.9474115	Santa Clara County
38163	Fee-for-Service	1104927300	1104927300	1	1	DOGGWILER, KURT MD PHD LTD	6/16/2008	193400000X	NA	Other	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	2001 ERRECART BLVD	None	ELKO	NV	89801	8333	00	None	40.82273666	-115.7288989	Elko County
38173	Fee-for-Service	1568439081	1568439081	1	1	DESERT AIDS PROJECT	3/7/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
38180	Fee-for-Service	1679875389	1679875389	1	1	DIRKX, BENJAMIN N DO	8/13/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	13373	25	Physical Medicine and Rehabilitation	0	In state provider	None	1100 PASEO CAMARILLO	None	CAMARILLO	CA	93010	6073	56	06111	34.22086527	-119.0555438	Ventura County
38213	Fee-for-Service	1972541498	1972541498	1	1	DIGNITY HEALTH	12/31/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
38258	Fee-for-Service	1851378236	1851378236	1	1	DARAMOLA, IYABO O	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63633	41	Internal Medicine	0	In state provider	None	2401 REO DR	None	SAN DIEGO	CA	92139	3025	37	06073	32.67512422	-117.064198	San Diego County
38311	Fee-for-Service	1174011647	1174011647	1	1	DUGGINENI, DHEERAJ MD	5/24/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38329	Fee-for-Service	1376271106	1376271106	1	1	DANIELS, STEVEN M CPO	4/3/2024	174400000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 5TH AVE	None	OROVILLE	CA	95965	5816	04	06007	39.50224134	-121.564901	Butte County
38355	Fee-for-Service	1437328747	1437328747	1	1	DARLING, SEAN P	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
38454	Fee-for-Service	1720267354	1720267354	1	1	DON, ANGUS S MD	3/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38462	Fee-for-Service	1568439081	1568439081	1	1	DESERT AIDS PROJECT	1/2/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
38471	Fee-for-Service	1316144199	1316144199	1	1	DORN, GWEN D	7/12/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
38516	Fee-for-Service	1689702664	1689702664	1	1	DUPREY ALVALOS, VIVIAN	2/18/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
38526	Fee-for-Service	1013351790	1013351790	1	1	DANG, HONG T MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143049	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
38528	Fee-for-Service	1851451439	1851451439	1	1	DOWNING, KRISTOPHER L MD	4/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106278	20	Orthopedic Surgery	0	In state provider	None	955 LANE AVENUE	SUITE 200	CHULA VISTA	CA	91914	4525	37	06073	32.65121611	-116.9615942	San Diego County
38531	Fee-for-Service	1396893269	1396893269	1	1	DEFONTES, JAMES III MD	8/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38735	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
38539	Fee-for-Service	1477013324	1477013324	1	1	DESAI, NIRALI S MD	9/25/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177888	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
38545	Fee-for-Service	1750307864	1750307864	1	1	DANOVITCH, GABRIEL M MD	1/1/1995	207RN0300X	NA	Nephrology	026	PHYSICIANS	34636	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
38582	Fee-for-Service	1720432438	1720432438	1	1	DUBEY, ANURADHA MD INC	4/21/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	87166	40	Pediatrics	0	In state provider	None	4312 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70179874	-120.999101	Stanislaus County
38588	Fee-for-Service	1477948479	1477948479	1	1	DIEP, THUAN MD	3/6/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146685	40	Pediatrics	0	In state provider	None	12036 SCRIPPS HIGHLANDS	SUITE 102	SAN DIEGO	CA	92131	5155	37	06073	32.936787	-117.109413	San Diego County
38599	Fee-for-Service	1811003718	1811003718	1	1	DE LICONA, CORNELIA M MD	9/1/1999	207K00000X	NA	Other	026	PHYSICIANS	55761	03	Allergy	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
38611	Fee-for-Service	1356449029	1356449029	1	1	DELLA LANA, DAVID F MD	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52465	08	Family Practice	0	In state provider	None	1501 S OREGON ST	None	YREKA	CA	96097	3425	47	06093	41.71817542	-122.6419397	Siskiyou County
38750	Fee-for-Service	1568439081	1568439081	1	1	DESERT AIDS PROJECT	10/23/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
38784	Fee-for-Service	1720036205	1720036205	1	1	DRAKE, MARY KAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
38803	Fee-for-Service	1821424003	1821424003	1	1	DURRELL, BROOKE J LCSW	12/28/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	36914 AVENUE 12	10	MADERA	CA	93636	8129	20	06039	36.92302255	-119.877696	Madera County
38872	Fee-for-Service	1932714987	1932714987	1	1	DIOSDADO, RACHELLE NP	1/25/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
38912	Fee-for-Service	1629607403	1629607403	1	1	DING, JULIE DO	4/13/2023	207R00000X	NA	Other	026	PHYSICIANS	20500	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
38951	Fee-for-Service	1699700112	1699700112	1	1	DAO, KY MD INC	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44188	08	Family Practice	0	In state provider	None	13918 BROOKHURST ST	STE B	GARDEN GROVE	CA	92843	4333	30	06059	33.761034	-117.954832	Orange County
38954	Fee-for-Service	1831342252	1831342252	1	1	DAWSON-SITTRE, DIANE LMFT	1/22/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
38963	Fee-for-Service	1780780163	1780780163	1	1	DAVIDIAN, MICHAEL H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 N 30TH ST	None	OMAHA	NE	68131	2137	00	None	41.2654263	-95.95644327	Douglas County
38975	Fee-for-Service	1912438409	1912438409	1	1	DAVIS, AUSTIN P MD	6/2/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159058	08	Family Practice	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
38983	Fee-for-Service	1083753008	1083753008	1	1	DURAN, ANNA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
39006	Fee-for-Service	1114162732	1114162732	1	1	DAVIDSON, MICHAEL J	10/13/2005	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	11406 LOMA LINDA DR	None	LOMA LINDA	CA	92354	3711	36	06071	34.04642588	-117.2480303	San Bernardino County
39032	Fee-for-Service	1154317964	1154317964	1	1	DESERT SPRINGS HOSP	10/1/1998	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	2075 E FLAMINGO RD	None	LAS VEGAS	NV	89119	5188	00	None	36.112671	-115.1248725	Clark County
39036	Fee-for-Service	1568439081	1568439081	1	1	DESERT AIDS PROJECT	3/7/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
39044	Fee-for-Service	1992181440	1992181440	1	1	DI SANO, DAVID A LMFT	1/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7257 BEVERLY BLVD	108	LOS ANGELES	CA	90036	2503	19	06037	34.07620151	-118.3477545	Los Angeles County
39057	Fee-for-Service	1750641874	1750641874	1	1	DUGAN, JASON A MD	7/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120759	41	Internal Medicine	0	In state provider	None	250 E YALE LOOP	SUITE 200	IRVINE	CA	92604	4697	30	06059	33.67473753	-117.7880547	Orange County
39096	Fee-for-Service	1164927927	1164927927	1	1	DAVIS, CLAYTON DO	7/28/2023	208800000X	NA	Other	026	PHYSICIANS	20823	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
39153	Fee-for-Service	1659952620	1659952620	1	1	DEJBA, NIKI MD	6/7/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	19	06037	34.04624254	-118.267606	Los Angeles County
39163	Fee-for-Service	1831503762	1831503762	1	1	DUFEK, SARAH A PHD	11/9/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
39262	Fee-for-Service	1063461846	1063461846	1	1	DAWIT,ANTONIOS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1170 CLEVELAND AVE	None	EAST POINT	GA	30344	3615	00	None	33.68127228	-84.42742435	Fulton County
39320	Fee-for-Service	1154317964	1154317964	1	1	DESERT SPRINGS HOSP	10/1/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	2075 E FLAMINGO RD	None	LAS VEGAS	NV	89119	5188	00	None	36.112671	-115.1248725	Clark County
39324	Fee-for-Service	1699926741	1699926741	1	1	DANIELYAN, MARGARITA LMFT	10/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
39329	Fee-for-Service	1306282751	1306282751	1	1	DIETZEN, FREDRICK J DC	6/3/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	742 ARNOLD DR	STE C	MARTINEZ	CA	94553	6866	07	06013	37.99654931	-122.1189592	Contra Costa County
39336	Fee-for-Service	1619997103	1619997103	1	1	DANIEL, ALTHEA MD	6/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	67162	40	Pediatrics	0	In state provider	None	1505 W 17TH ST	None	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
39360	Fee-for-Service	1467185215	1467185215	1	1	DU, TIANWEI PHD	8/22/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
39389	Fee-for-Service	1083904221	1083904221	1	1	DOSSICK, DEBORAH S MD	9/20/2018	207P00000X	NA	Other	026	PHYSICIANS	155940	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
39399	Fee-for-Service	1245205137	1245205137	1	1	DE SANTIS, JOHN G DO	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10304	20	Orthopedic Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
39408	Fee-for-Service	1104255298	1104255298	1	1	DUTTON, SALLY L LCSW	5/31/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	940 RAMONA AVE	SUITE M	GROVER BEACH	CA	93433	2155	40	06079	35.12247373	-120.6192522	San Luis Obispo County
39413	Fee-for-Service	1013446046	1013446046	1	2	DHILLON, GIPANJOT MD	6/17/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	165245	26	Psychiatry (child)	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
39417	Fee-for-Service	1811424542	1811424542	1	1	DELELLIS, AMY MD	6/1/2020	390200000X	NA	Other	026	PHYSICIANS	163967	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
39428	Fee-for-Service	1437524345	1437524345	1	1	DASS, RICHARD J NP	2/29/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
39510	Fee-for-Service	1073582979	1073582979	1	1	DARBONNE, DAWN M MD	3/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78518	22	Pathology (M.D. only)	0	In state provider	DR BANUELOS	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
39560	Fee-for-Service	1679511638	1679511638	1	1	DOH, PHILIP S MD	12/8/2010	207L00000X	NA	Other	026	PHYSICIANS	53318	05	Anesthesiology	0	In state provider	None	9535 GARDEN GROVE BLVD	STE 102	GARDEN GROVE	CA	92844	1551	30	06059	33.77399686	-117.9666648	Orange County
39562	Fee-for-Service	1962440750	1962440750	1	1	DU, DAI VIEN MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69210	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
39619	Fee-for-Service	1356362883	1356362883	1	1	DRAISIN, JEFFREY A MD	5/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51658	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM WAR	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
39634	Fee-for-Service	1639175581	1639175581	2	1	DHALIWAL, NARINDER S MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45148	None	None	0	In state provider	None	1901 W KETTLEMAN LN	STE 200	LODI	CA	95242	4337	39	06077	38.11558533	-121.2964501	San Joaquin County
39641	Fee-for-Service	1750670477	1750670477	1	1	DALEY, THERESA G MD	10/1/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	123203	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	969 PLUMAS ST	STE 116	YUBA CITY	CA	95991	4011	51	06101	39.14263634	-121.6176593	Sutter County
39647	Fee-for-Service	1578835864	1578835864	1	1	DIAZ, GABRIELA R MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119759	01	General Practice	0	In state provider	None	2115 S CENTERPOINTE PKWY	None	SANTA MARIA	CA	93455	1334	42	06083	34.92292048	-120.428709	Santa Barbara County
39664	Fee-for-Service	1558385997	1558385997	1	1	DHAWAN, KAPIL MD	7/1/2011	207RP1001X	NA	Pulmonology	026	PHYSICIANS	116493	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5423	34	06067	38.572551	-121.4181585	Sacramento County
39698	Fee-for-Service	1861570442	1861570442	1	1	DHILLON, DALVINDER S MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75155	41	Internal Medicine	0	In state provider	None	2101 VALE RD	STE 300	SAN PABLO	CA	94806	3846	07	06013	37.95420174	-122.3372902	Contra Costa County
39699	Fee-for-Service	1013446046	1013446046	1	2	DHILLON, GIPANJOT MD	6/17/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	165245	36	Psychiatry	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	29	06057	39.3245308	-120.2013097	Nevada County
39700	Fee-for-Service	1841552858	1841552858	1	1	DPD RX, INC.	7/21/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12440 BROOKHURST STREET	None	GARDEN GROVE	CA	92840	4712	30	06059	33.78201943	-117.9584701	Orange County
39720	Fee-for-Service	1992876817	1992876817	1	1	DELL, RICHARD MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50204	20	Orthopedic Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
39790	Fee-for-Service	1245216498	1245216498	1	1	DAMO, ELAINE M	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
39826	Fee-for-Service	1285098962	1285098962	1	1	DELVECCHIO, STEFANIE A MD	2/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181870	None	None	0	In state provider	None	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	44	06087	36.962588	-122.0439201	Santa Cruz County
39854	Fee-for-Service	1811944028	1811944028	1	1	DOWIS, JANET MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	35579	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
39858	Fee-for-Service	1902280969	1902280969	1	1	DONALDSON, STACY L LMFT	9/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
39915	Fee-for-Service	1386940781	1386940781	1	1	DOUGLAS, ZAKIYA MD	4/11/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	163711	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3226	04	06007	39.741948	-121.848921	Butte County
39966	Fee-for-Service	1255650313	1255650313	1	1	DOWNES, COURTNEY M T MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 NORTH TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
39969	Fee-for-Service	1508577735	1508577735	1	1	DUONG, JENNIFER T PT	1/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
39990	Fee-for-Service	1245650985	1245650985	1	1	DRIVER, TODD H MD	3/26/2018	390200000X	NA	Other	026	PHYSICIANS	140821	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
40017	Fee-for-Service	1497101323	1497101323	1	1	DOLBEER ST MEDICAL SERVICES	7/6/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	AMC	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
40076	Fee-for-Service	1235488313	1235488313	1	1	DELGADO, MANUEL R LMFT	11/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
40121	Fee-for-Service	1881213064	1881213064	1	1	DEEN, JAMES MD	10/21/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	183657	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
40133	Fee-for-Service	1639397839	1639397839	1	1	DESERT PRECIOUS CARGO	12/2/2005	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10966 HESPERIA RD	STE C	HESPERIA	CA	92345	2168	36	06071	34.45014365	-117.2962065	San Bernardino County
40148	Fee-for-Service	1255321014	1255321014	1	1	DREW, JACK M MD	4/5/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	128100	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
40198	Fee-for-Service	1942763446	1942763446	1	1	DHALIWAL, RAVNEET S MD	12/22/2022	208M00000X	NA	Other	026	PHYSICIANS	181414	None	None	0	In state provider	None	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
40205	Fee-for-Service	1700263480	1700263480	1	1	DEV PHARMA INC	10/5/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	731 INDIAN HILL BLVD	None	POMONA	CA	91767	5305	19	06037	34.06600226	-117.7192682	Los Angeles County
40245	Fee-for-Service	1942535703	1942535703	1	1	DORFMAN, DAVID W MD	1/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	106340	24	Plastic Surgery	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
40299	Fee-for-Service	1750895991	1750895991	1	1	DE LEON CARIZON, SHELLA CRN	6/8/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
40315	Fee-for-Service	1548545882	1548545882	1	1	DOUCETTE, MANIA D LMFT	8/6/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1501 CORPORATE WAY	STE 200	SACRAMENTO	CA	95831	3887	34	06067	38.492604	-121.5201645	Sacramento County
40392	Fee-for-Service	1831484294	1831484294	1	1	DORANTES, MIGUEL	2/4/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	128733	08	Family Practice	0	In state provider	None	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
40405	Fee-for-Service	1659494946	1659494946	1	1	DELGADO, CARLOS H DO	11/30/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	11016	08	Family Practice	0	In state provider	None	2505 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
40418	Fee-for-Service	1740241660	1740241660	1	1	DANIEL C HUDDLE, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 E HAMPDEN	None	ENGLEWOOD	CO	80113	2702	00	None	39.6531952	-104.9810967	Arapahoe County
40514	Fee-for-Service	1073647269	1073647269	1	1	DESERT FAMILY PRACTICE	7/1/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ASSOCIATES	15863 KASOTA RD	None	APPLE VALLEY	CA	92307	4507	36	06071	34.53957208	-117.2667471	San Bernardino County
40540	Fee-for-Service	1508222647	1508222647	1	2	DIGNITY HEALTH MEDICAL FOUND	11/12/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	FL 2	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
40564	Fee-for-Service	1891548640	1891548640	1	1	DE SANTIAGO, EDUARDO AU	6/21/2024	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	44407 10TH STREET W	None	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
40583	Fee-for-Service	1699712232	1699712232	1	1	DOUGHERTY, THOMAS M MD	6/18/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	27977	41	Internal Medicine	0	In state provider	None	12675 LA MIRADA BLVD	STE 201	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
40595	Fee-for-Service	1982626578	1982626578	1	1	DEBRA S BORGESON NP	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
40611	Fee-for-Service	1558375774	1558375774	1	1	DAVEY, JAMES E MD	1/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83372	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
40614	Fee-for-Service	1497425417	1497425417	1	1	DUENES, TARYN LCSW	8/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
40684	Fee-for-Service	1770655599	1770655599	1	1	DONG, JINGYU MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74273	22	Pathology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
40723	Fee-for-Service	1649211533	1649211533	1	1	DARIN EYE CENTER, AMC	1/1/1994	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1250 LA VENTA RD	STE 208	WESTLAKE VILLAGE	CA	91361	3763	56	06111	34.14827603	-118.8227637	Ventura County
40736	Fee-for-Service	1538247440	1538247440	1	1	DAMROSE, JOHN F MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91368	84	Surgery-Head and Neck	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
40757	Fee-for-Service	1619997103	1619997103	1	2	DANIEL, ALTHEA MD	1/1/2005	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 CAMPUS ST COLEMAN	PAVILION RM A1121	LOMA LINDA	CA	92354	0000	36	06071	34.05060717	-117.2656018	San Bernardino County
40759	Fee-for-Service	1083938096	1083938096	1	1	DANG, LISA H MD	2/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	154089	18	Ophthalmology	0	In state provider	None	14501 MAGNOLIA STREET	SUITE 103	WESTMINSTER	CA	92683	1307	30	06059	33.75188963	-117.9723601	Orange County
40761	Fee-for-Service	1376769539	1376769539	1	1	DE GUZMAN, MAGNOLIA K MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98689	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
40765	Fee-for-Service	1871538033	1871538033	1	1	DANON, SAAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78517	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2865 ALTANTIC AVE	#149	LONG BEACH	CA	90806	7411	19	06037	33.809418	-118.185058	Los Angeles County
40812	Fee-for-Service	1801908397	1801908397	1	1	DADOYAN, TALIN A MD	9/25/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	52825	None	None	0	In state provider	None	4955 VAN NUYS BLVD	STE 301	SHERMAN OAKS	CA	91403	1815	19	06037	34.160805	-118.4487295	Los Angeles County
40827	Fee-for-Service	1508222647	1508222647	1	2	DIGNITY HEALTH MEDICAL FOUND	11/12/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	FL 2	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
40864	Fee-for-Service	1821592809	1821592809	1	1	DELAGNES, ELISE A MD	10/27/2023	390200000X	NA	Other	026	PHYSICIANS	166455	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
40900	Fee-for-Service	1558375774	1558375774	1	1	DAVEY, JAMES E MD	1/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83372	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
40949	Fee-for-Service	1649469800	1649469800	1	1	DATTARAY, PIALI P MD	11/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98120	None	None	0	In state provider	None	2557 MOWRY AVE	SUITE 30	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
41010	Fee-for-Service	1811944341	1811944341	1	1	DAVEY, IAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	1309	00	None	43.61455048	-116.256231	Ada County
41060	Fee-for-Service	1689321747	1689321747	1	1	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	600 HIGHLAND SPRINGS AVE	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
41099	Fee-for-Service	1699987552	1699987552	1	1	DAVENPORT, JOHN A MD	10/29/2009	207R00000X	NA	Other	026	PHYSICIANS	101848	41	Internal Medicine	0	In state provider	None	5550 UNIVERSITY AVENUE	None	SAN DIEGO	CA	92105	2307	37	06073	32.74809744	-117.0773303	San Diego County
41111	Fee-for-Service	1912637992	1912637992	1	1	DIZON, JESSICA F PT	1/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 TORRANCE BLVD	SUITE 520	TORRANCE	CA	90503	4009	19	06037	33.8375955	-118.358748	Los Angeles County
41116	Fee-for-Service	1568089738	1568089738	1	1	DUONG-MAC, JUSTIN	4/15/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
41120	Fee-for-Service	1508222647	1508222647	1	2	DIGNITY HEALTH MEDICAL FOUND	11/12/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	FL 2	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
41140	Fee-for-Service	1154486165	1154486165	1	1	DENHAM, MELODY F MD	3/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	69283	05	Anesthesiology	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
41179	Fee-for-Service	1063019727	1063019727	1	1	DA HOME HEALTH CARE INC	11/16/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 313	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
41233	Fee-for-Service	1053653873	1053653873	1	5	DIGNITY HEALTH MEDICAL	8/25/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	2150 N WATERMAN AVE	STE 303	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
41245	Fee-for-Service	1871769448	1871769448	1	1	DABELA-BIKETI, AMSALU MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117169	30	Radiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
41276	Fee-for-Service	1407944002	1407944002	1	1	DESILVA, NEELANTHA M MD	1/10/2019	174400000X	NA	Other	026	PHYSICIANS	68917	13	Neurology (M.D. only)	0	In state provider	None	1140 W LA VETA AVE	STE 730	ORANGE	CA	92868	4229	30	06059	33.7802984	-117.8651669	Orange County
41296	Fee-for-Service	1366445785	1366445785	1	1	DAVEY, MICHELLE DO	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7876	08	Family Practice	0	In state provider	None	305 GARDEN GULCH	None	WEAVERVILLE	CA	96093	0000	53	06105	40.7371495	-122.9405013	Trinity County
41313	Fee-for-Service	1861850075	1861850075	1	1	DESERT HI TRANSPORTATION, CO	6/29/2020	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RPORATION	15000 7TH STREET	208-C	VICTORVILLE	CA	92392	3852	36	06071	34.52357581	-117.3058419	San Bernardino County
41352	Fee-for-Service	1689321747	1689321747	1	1	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	600 HIGHLAND SPRINGS AVE	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
41364	Fee-for-Service	1801822606	1801822606	1	1	DEYOUNG, MICHAEL D MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	30264	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
41365	Fee-for-Service	1881190015	1881190015	1	1	DUHANCIOGLU, GABRIEL MD	5/25/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184274	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
41384	Fee-for-Service	1508972209	1508972209	1	1	DEETER, KRISTINA H MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1155 MILL ST	2ND FL BLDG 55	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
41385	Fee-for-Service	1922120708	1922120708	1	1	DASANU, CONSTANTIN MD	4/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129085	78	Neoplastic Diseases/Oncology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
41454	Fee-for-Service	1194267070	1194267070	1	1	DAVYDOV, ANZHELA CNP	11/19/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12358 POWAY RD	None	POWAY	CA	92064	4219	37	06073	32.9519463	-117.0635682	San Diego County
41457	Fee-for-Service	1457476558	1457476558	1	1	DELTA RADIOLOGY MED GRP	10/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
41481	Fee-for-Service	1184612194	1184612194	1	1	DE QUEEN MEDICAL CENTER, INC	5/29/2009	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1306 W COLLIN RAYE DR	None	DE QUEEN	AR	71832	2502	00	None	34.048125	-94.352562	Sevier County
41489	Fee-for-Service	1326173204	1326173204	1	1	DEANDA, MARIA E PHD	8/9/2005	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
41498	Fee-for-Service	1659900785	1659900785	1	1	DUNBAR, TREVOR DO	8/17/2023	207R00000X	NA	Other	026	PHYSICIANS	20992	None	None	0	In state provider	None	31625 DE PORTOLA RD	SUITE 101	TEMECULA	CA	92592	2770	33	06065	33.48359715	-117.1048345	Riverside County
41520	Fee-for-Service	1053653873	1053653873	1	5	DIGNITY HEALTH MEDICAL	8/25/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FOUNDATION	2150 N WATERMAN AVE	STE 303	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
41581	Fee-for-Service	1942366604	1942366604	1	1	DONEY, MICHAEL K MD	12/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	74217	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5974 PENTZ ROAD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
41638	Fee-for-Service	1689321747	1689321747	1	1	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	600 HIGHLAND SPRINGS AVE	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
41647	Fee-for-Service	1750482360	1750482360	1	1	DAVIDSON, JAMES R. MD	9/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
41675	Fee-for-Service	1922120708	1922120708	1	1	DASANU, CONSTANTIN MD	4/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129085	68	Hematology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
41706	Fee-for-Service	1801980859	1801980859	1	1	DIEKMANN-GUIROY,	12/16/2008	193400000X	NA	Other	026	PHYSICIANS	53311	None	None	0	In state provider	BERNADETTE MD INC	236 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
41745	Fee-for-Service	1265417372	1265417372	1	2	DHAMRAIT, RAJVINDER S MD	7/6/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106845	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
41766	Fee-for-Service	1184612194	1184612194	1	1	DE QUEEN MEDICAL CENTER, INC	5/29/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1306 W COLLIN RAYE DR	None	DE QUEEN	AR	71832	2502	00	None	34.048125	-94.352562	Sevier County
41771	Fee-for-Service	1376543140	1376543140	1	1	DORNE, HOWARD L MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57108	30	Radiology	0	In state provider	None	1140 W LA VETA AVE	STE 850	ORANGE	CA	92868	4218	30	06059	33.7802984	-117.8651669	Orange County
41787	Fee-for-Service	1649213398	1649213398	1	1	DANG, CHAU V MD	5/31/1989	208600000X	NA	General Surgery	026	PHYSICIANS	41112	02	General Surgery	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 270	PLEASANTON	CA	94588	5803	01	06001	37.69214859	-121.8796532	Alameda County
41798	Fee-for-Service	1891486916	1891486916	1	1	DYLAN CIMBURA-HERNANDEZ LICE	5/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NSED MARRIAGE AND FAMILY	2625 WILSON ST	None	EUREKA	CA	95503	4829	12	06023	40.77932692	-124.1380059	Humboldt County
41861	Fee-for-Service	1982324653	1982324653	1	1	DCB OPTOMETRY, INC	5/1/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12819 VALLEY VIEW AVE	None	LA MIRADA	CA	90638	1945	19	06037	33.91521727	-118.0293935	Los Angeles County
41924	Fee-for-Service	1689321747	1689321747	1	1	DARIN RENTZ DO PC	5/1/2022	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	600 HIGHLAND SPRINGS AVE	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
41941	Fee-for-Service	1114783743	1114783743	1	1	DOMINGO THERAPY A MARRIAGE A	7/24/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4127 SANTA ROSA AVENUE	None	SACRAMENTO	CA	95819	3442	34	06067	38.545272	-121.458726	Sacramento County
41962	Fee-for-Service	1235231333	1235231333	1	1	DANG, MINH N MD	2/12/1980	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	32864	01	General Practice	0	In state provider	None	12302 GARDEN GROVE BLVD	STE 7	GARDEN GROVE	CA	92843	1893	30	06059	33.77428392	-117.9181185	Orange County
41969	Fee-for-Service	1578902144	1578902144	1	1	DELIZ-GUZMAN, CLAUDIA A MD	8/4/2021	207P00000X	NA	Other	026	PHYSICIANS	159375	None	None	0	In state provider	None	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
41972	Fee-for-Service	1366756249	1366756249	1	1	DATTA, BABITA MD	6/26/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	116009	None	None	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
42002	Fee-for-Service	1184721821	1184721821	1	1	DOUD, ROBERT B MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	20651	45	Nephrology (Renal-Kidney)	0	In state provider	None	14020 SAN PABLO AVE	STE A	SAN PABLO	CA	94806	3604	07	06013	37.96124162	-122.3434731	Contra Costa County
42003	Fee-for-Service	1083785844	1083785844	1	1	DOWLING, DAVID D JR MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80714	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
42022	Fee-for-Service	1356439038	1356439038	1	1	DALY, JOSEPH T MD	3/22/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	26296	18	Ophthalmology	0	In state provider	None	810 E OHIO AVE	None	ESCONDIDO	CA	92025	3421	37	06073	33.12651511	-117.0715892	San Diego County
42040	Fee-for-Service	1174683502	1174683502	1	1	DUNLOP, THOMAS J MD	5/31/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58686	08	Family Practice	0	In state provider	None	3170 LOMA VISTA RD	None	VENTURA	CA	93003	2970	56	06111	34.27597804	-119.2533398	Ventura County
42047	Fee-for-Service	1376175232	1376175232	1	1	DUONG, MICHAEL N	11/8/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2626 COLORADO BLVD	None	LOS ANGELES	CA	90041	1070	19	06037	34.14236825	-118.2236654	Los Angeles County
42051	Fee-for-Service	1346761103	1346761103	1	1	DANES, KAREN L NP	4/26/2024	208600000X	NA	General Surgery	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
42109	Fee-for-Service	1710043997	1710043997	1	1	DEWEY, APRIL L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
42172	Fee-for-Service	1851591259	1851591259	1	1	DOYLE, VALERIE J LMFT	4/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	433 CALLAN AVE	309	SAN LEANDRO	CA	94577	4641	01	06001	37.72706807	-122.1519034	Alameda County
42206	Fee-for-Service	1164568655	1164568655	1	1	DANE R FLIEDNER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
42225	Fee-for-Service	1912176264	1912176264	1	1	DR M FORGHANI S CORP	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8699	09	Gynecology (D.O. only)	0	In state provider	DO	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
42236	Fee-for-Service	1639300684	1639300684	1	1	DEWITT, BARRY M PT	6/10/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	670 RIO LINDO AVE	SUITE 700	CHICO	CA	95926	1830	04	06007	39.75339021	-121.847691	Butte County
42257	Fee-for-Service	1083639470	1083639470	1	1	DELGADO, GEORGE MD INC	2/5/2009	207R00000X	NA	Other	026	PHYSICIANS	66807	66	Emergency Medicine (Urgent Care)	0	In state provider	None	550 WASHINGTON ST	STE 801	SAN DIEGO	CA	92103	2232	37	06073	32.75003652	-117.1603431	San Diego County
42284	Fee-for-Service	1033151857	1033151857	1	1	DAY, CHARLES S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	608 STRICKLAND DR	None	ORANGE	TX	77630	4717	00	None	30.09918175	-93.76742785	Orange County
42287	Fee-for-Service	1184721821	1184721821	1	1	DOUD, ROBERT B MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	20651	41	Internal Medicine	0	In state provider	None	14020 SAN PABLO AVE	STE A	SAN PABLO	CA	94806	3604	07	06013	37.96124162	-122.3434731	Contra Costa County
42293	Fee-for-Service	1083785844	1083785844	1	1	DOWLING, DAVID D JR MD	3/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80714	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
42298	Fee-for-Service	1831651983	1831651983	1	1	DR ANNIE LE, OD INC	4/5/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	29260 CENTRAL AVE	None	LAKE ELSINORE	CA	92532	9785	33	06065	33.69463178	-117.3345917	Riverside County
42334	Fee-for-Service	1548295975	1548295975	1	1	DE EDWARDS, SHARON Y MD	9/11/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	44611	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2240 GLADSTONE DR	STE 1	PITTSBURG	CA	94565	5126	07	06013	38.00627609	-121.8667626	Contra Costa County
42350	Fee-for-Service	1235101874	1235101874	1	1	DUNGO, MARIA C MD	4/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66606	68	Hematology	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	19	06037	33.80318951	-118.066068	Orange County
42352	Fee-for-Service	1912624040	1912624040	1	1	DIALOGIX LABORATORY L L C	3/8/2024	291U00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	570 NEVADA ST	STE K	REDLANDS	CA	92373	3139	36	06071	34.060464	-117.217422	San Bernardino County
42359	Fee-for-Service	1578532289	1578532289	1	1	DILDEN, DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
42361	Fee-for-Service	1043200504	1043200504	1	1	DAVID ROWE MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	455 TOLL GATE RD	None	WARWICK	RI	02886	2759	00	None	41.70484367	-71.47855402	Kent County
42369	Fee-for-Service	1265897862	1265897862	1	1	DAVIES, WHITNEY E	4/18/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6670 ALTON PARKWAY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
42383	Fee-for-Service	1336378454	1336378454	1	1	DEFAZIO, LORETTA R	7/16/2009	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2232 MEADOWBROOK ROAD	None	SACRAMENTO	CA	95825	1857	34	06067	38.606814	-121.3948665	Sacramento County
42457	Fee-for-Service	1427570126	1427570126	1	1	DAKHANE, PRIYA	1/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
42480	Fee-for-Service	1083216659	1083216659	1	1	DEFINITIVE HOSPICE CARE	1/4/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1122 E LINCOLN AVE	STE B400	ORANGE	CA	92865	1947	30	06059	33.83616558	-117.8412916	Orange County
42509	Fee-for-Service	1427509140	1427509140	1	1	DOLATABADI, SOHA MD APC	7/24/2017	207RR0500X	NA	Other	026	PHYSICIANS	93675	83	Rheumatology	0	In state provider	None	1127 WILSHIRE BLVD	STE 708	LOS ANGELES	CA	90017	3908	19	06037	34.05270508	-118.2641005	Los Angeles County
42515	Fee-for-Service	1912176264	1912176264	1	1	DR M FORGHANI S CORP	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8699	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	DO	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
42562	Fee-for-Service	1801109038	1801109038	1	1	DEHGHAN, HOOMAN MD	3/26/2025	207RR0500X	NA	Other	026	PHYSICIANS	122140	83	Rheumatology	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
42637	Fee-for-Service	1235101874	1235101874	1	1	DUNGO, MARIA C MD	4/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66606	41	Internal Medicine	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	19	06037	33.80318951	-118.066068	Orange County
42673	Fee-for-Service	1336378454	1336378454	1	1	DEFAZIO, LORETTA R	7/16/2009	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2232 MEADOWBROOK ROAD	None	SACRAMENTO	CA	95825	1857	34	06067	38.606814	-121.3948665	Sacramento County
42724	Fee-for-Service	1235206186	1235206186	1	1	DUFFY, JOAN M MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	72810	None	None	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
42740	Fee-for-Service	1922292267	1922292267	2	1	DREAMWEAVER CONSULTANCY A	5/13/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL CORPORATION	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08622063	-117.9606346	Los Angeles County
42753	Fee-for-Service	1083255129	1083255129	1	1	DESERT BEST PHARMACY, INC.	3/5/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	170 E TAHQUITZ CANYON WA	None	PALM SPRINGS	CA	92262	6431	33	06065	33.8231463	-116.5458646	Riverside County
42768	Fee-for-Service	1083216659	1083216659	1	1	DEFINITIVE HOSPICE CARE	1/4/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1122 E LINCOLN AVE	STE B400	ORANGE	CA	92865	1947	30	06059	33.83616558	-117.8412916	Orange County
42770	Fee-for-Service	1386930873	1386930873	1	1	DIABLO PROSTHETICS &	2/12/2014	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	3700 SUNSET LANE	SUITE 6	ANTIOCH	CA	94509	6199	07	06013	37.98481899	-121.8042927	Contra Costa County
42804	Fee-for-Service	1912176264	1912176264	1	1	DR M FORGHANI S CORP	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8699	15	Obstetrics (D.O. only)	0	In state provider	DO	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
42825	Fee-for-Service	1518156090	1518156090	1	1	DEACON, JOHN M MD INC	4/18/2008	207P00000X	NA	Other	026	PHYSICIANS	66064	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 W LEGION RD. BLDG 2	SUITE 205	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
42921	Fee-for-Service	1861931834	1861931834	1	1	DHAMMI, NAVJOT K MD	1/16/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178834	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
42926	Fee-for-Service	1235101874	1235101874	1	1	DUNGO, MARIA C MD	4/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66606	78	Neoplastic Diseases/Oncology	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	19	06037	33.80318951	-118.066068	Orange County
42959	Fee-for-Service	1699951830	1699951830	1	1	DESAI, MANISH J DO	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9850	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
43019	Fee-for-Service	1134250418	1134250418	1	1	DAVIS, SANDRA G MFT	12/27/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5619 NORTH FIGUEROA ST	SUITE 216	LOS ANGELES	CA	90042	4979	19	06037	34.10918419	-118.1936708	Los Angeles County
43029	Fee-for-Service	1922292267	1922292267	2	1	DREAMWEAVER CONSULTANCY A	5/13/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL CORPORATION	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08622063	-117.9606346	Los Angeles County
43048	Fee-for-Service	1265854798	1265854798	1	1	DREUTH, ERIC PT	7/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
43072	Fee-for-Service	1184632606	1184632606	1	1	DADA, FESTUS B MD	8/28/2019	208600000X	NA	General Surgery	026	PHYSICIANS	40801	02	General Surgery	0	In state provider	None	25470 MEDICAL CENTER DR	SUITE 203	MURRIETA	CA	92562	4901	33	06065	33.55723646	-117.1859554	Riverside County
43175	Fee-for-Service	1831325679	1831325679	1	1	DO, HA K MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130446	07	Dermatology	0	In state provider	None	4125 BANGS AVENUE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
43223	Fee-for-Service	1689674053	1689674053	1	1	DEBACK, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OLOL-FAMILY CENTER	7777 HENNESSY BLVD,	SUITE 4001	BATON ROUGE	LA	70808	0000	00	None	30.404223	-91.108638	East Baton Rouge Parish
43257	Fee-for-Service	1336259290	1336259290	1	1	DIETZE, PETER JR MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79877	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8010 FROST ST	STE 301	SAN DIEGO	CA	92123	4237	37	06073	32.80026879	-117.1520059	San Diego County
43268	Fee-for-Service	1275548737	1275548737	1	1	DELLMORE, DEBORAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
43275	Fee-for-Service	1891830758	1891830758	1	1	DABBY, LISA F MD	3/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92939	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
43276	Fee-for-Service	1992914170	1992914170	1	1	DENSMORE, ERIN D	1/23/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW ST	STE 137	GARDEN GROVE	CA	92845	1741	30	06059	33.78720885	-118.028413	Orange County
43294	Fee-for-Service	1114448651	1114448651	1	1	DUONG, KIM S OD	7/18/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
43307	Fee-for-Service	1467544486	1467544486	1	1	DEL MUNDO, CONCHITA L MD	12/7/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	47983	40	Pediatrics	0	In state provider	None	12660 STANTON AVE	None	TUSTIN	CA	92782	1027	30	06059	33.74138637	-117.7912313	Orange County
43317	Fee-for-Service	1922292267	1922292267	2	1	DREAMWEAVER CONSULTANCY A	5/13/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08622063	-117.9606346	Los Angeles County
43376	Fee-for-Service	1336825488	1336825488	1	1	DINOGO LLC	7/5/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4868 CALAVERAS AVE	APT 203	OAKLAND	CA	94619	2762	01	06001	37.78466327	-122.1883838	Alameda County
43394	Fee-for-Service	1013989490	1013989490	1	1	DAVIS-REED, LINDA MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70085	07	Dermatology	0	In state provider	None	270 COHASSET RD	STE 110	CHICO	CA	95926	2262	04	06007	39.75182825	-121.8521039	Butte County
43441	Fee-for-Service	1023656048	1023656048	1	1	DUGAN, GEE YEOUN CNP	2/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5644 MISSION CENTER RD	None	SAN DIEGO	CA	92108	4328	37	06073	32.77449	-117.1570815	San Diego County
43491	Fee-for-Service	1750371407	1750371407	1	1	DZINDZIO, BARRY S MD	6/1/2000	174400000X	NA	Other	026	PHYSICIANS	18510	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
43561	Fee-for-Service	1174033062	1174033062	1	1	DARDEN, JENNIFER D CNP	6/7/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
43567	Fee-for-Service	1720413123	1720413123	1	1	DARYANI SAEED, KEIVAN MD	11/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136204	41	Internal Medicine	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
43571	Fee-for-Service	1457486177	1457486177	2	1	DHHS PHS IHS PHOENIX AREA	7/6/2017	332800000X	NA	Indian Health Care Provider	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 PICACHO RD	None	WINTERHAVEN	CA	92283	0000	13	06025	32.7364143	-114.6186113	Imperial County
43596	Fee-for-Service	1922183243	1922183243	1	1	DIAZ, MANUEL G MD	9/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	54412	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
43675	Fee-for-Service	1619397551	1619397551	1	1	DANIELS, MORGAINE E MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137985	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON STREET	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
43695	Fee-for-Service	1235346339	1235346339	1	1	DIVANOVIC, ALLISON	5/28/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
43805	Fee-for-Service	1508816232	1508816232	1	1	DONALDSON, TERESA CRNA	9/20/2007	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1444 LAKEHILLS DR	None	EL DORADO HLS	CA	95762	3609	09	06017	38.73662378	-121.0817695	El Dorado County
43827	Fee-for-Service	1538932777	1538932777	1	1	DR. PM CORP.	1/28/2025	207RS0012X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	12395 EL CAMINO REAL	SUITE 209	SAN DIEGO	CA	92130	3084	37	06073	32.94324259	-117.2396525	San Diego County
43852	Fee-for-Service	1689932436	1689932436	1	1	DAKOJI, SRIKANTH R MD	12/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133618	01	General Practice	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
43885	Fee-for-Service	1477618817	1477618817	1	1	DINUBA UNIFIED SCHOOL	11/16/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1327 E EL MONTE WAY	None	DINUBA	CA	93618	1825	54	06107	36.54556162	-119.3810375	Tulare County
43890	Fee-for-Service	1548303407	1548303407	1	1	DESERT SANDS UNIFIED SCHOOL	9/1/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	47950 DUNE PALMS RD	None	LA QUINTA	CA	92253	4000	33	06065	33.70220565	-116.2774057	Riverside County
43899	Fee-for-Service	1700804069	1700804069	1	1	DAVID W DRURY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE & C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.778496	-111.8805615	Salt Lake County
43901	Fee-for-Service	1750872362	1750872362	1	1	DOROW, BENJAMIN L PT	3/9/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
43938	Fee-for-Service	1487606760	1487606760	1	1	DANIEL ERIC MAGILL	4/4/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1808 W MAIN ST	None	RUSSELLVILLE	AR	72801	2724	00	None	35.283456	-93.1502205	Pope County
43983	Fee-for-Service	1285839027	1285839027	1	1	DHILLON, AMANPREET S MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100626	08	Family Practice	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
44036	Fee-for-Service	1720524168	1720524168	1	1	DESANTIAGO, BRIANNA LMFT	5/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
44086	Fee-for-Service	1871750257	1871750257	1	2	DEPRATI, KIM PA	2/20/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53971	-	NOT APPLICABLE	0	In state provider	None	13525 CIELO AZUL WAY	None	DESERT HOT SPRING	CA	92240	6235	33	06065	33.95048031	-116.4811265	Riverside County
44106	Fee-for-Service	1083703631	1083703631	2	1	DRACARYS HEALTH	4/23/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 W 7TH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516303	-119.1889271	Ventura County
44114	Fee-for-Service	1285605691	1285605691	1	1	DAVIS, KONRAD L MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120706	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
44136	Fee-for-Service	1306875679	1306875679	1	1	DACANAY, RHODEL G MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78592	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
44156	Fee-for-Service	1912989237	1912989237	1	1	DONALD, PAUL J MD	4/24/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	25512	04	Otology, Laryngology, Rhinology	0	In state provider	UCD PROF SVC GRP	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
44172	Fee-for-Service	1336659861	1336659861	1	1	DUNN, TITIANNA PT	10/8/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1676 EAST 6TH ST	None	BEAUMONT	CA	92223	2550	33	06065	33.92948188	-116.9484306	Riverside County
44199	Fee-for-Service	1356568711	1356568711	1	1	DEFTU, ILEANA MD	5/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
44241	Fee-for-Service	1770017840	1770017840	1	1	DELONG, EMILY DO	12/28/2022	207L00000X	NA	Other	026	PHYSICIANS	20426	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
44282	Fee-for-Service	1124142435	1124142435	1	1	DE GUZMAN, LISA H	10/23/2020	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
44290	Fee-for-Service	1811166846	1811166846	1	1	DUEL, EBRAHIM MD INC	9/3/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1400 W MCFADDEN AVE	STE 4	SANTA ANA	CA	92704	3438	30	06059	33.73443251	-117.8870445	Orange County
44293	Fee-for-Service	1437332194	1437332194	1	1	DULDULAO, EDMUNDO F MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104281	08	Family Practice	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
44304	Fee-for-Service	1972900637	1972900637	1	1	DACANAY, GRACE J OD INC	8/18/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15909 E MAIN STREET	None	LA PUENTE	CA	91744	4720	19	06037	34.02017089	-117.951122	Los Angeles County
44320	Fee-for-Service	1710973037	1710973037	1	1	DEBJOTI SENSHARMA MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
44347	Fee-for-Service	1326078288	1326078288	1	1	DELRAY MEDICAL CENTER INC	6/21/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5352 LINTON BEACH	None	DELRAY BEACH	FL	33484	6514	00	None	26.436987	-80.127792	Palm Beach County
44356	Fee-for-Service	1932755741	1932755741	1	1	DOUGHERTY, MEGAN M LCSW	1/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4182 MISSISSIPPI ST	None	SAN DIEGO	CA	92104	1627	37	06073	32.75381314	-117.1413113	San Diego County
44396	Fee-for-Service	1255538781	1255538781	1	1	DEAN, TERESA M MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131033	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
44398	Fee-for-Service	1285605691	1285605691	1	1	DAVIS, KONRAD L MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120706	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
44412	Fee-for-Service	1376530501	1376530501	1	1	DAVIS, THOMAS L III MD	12/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30895	08	Family Practice	0	In state provider	None	4381 BROCKTON AVE	STE A	RIVERSIDE	CA	92501	3470	33	06065	33.97856436	-117.3829171	Riverside County
44414	Fee-for-Service	1144417130	1144417130	1	1	DHOKARH, RAJANIGANDHA MD	8/1/2018	207RC0200X	NA	Other	026	PHYSICIANS	156257	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
44419	Fee-for-Service	1720019904	1720019904	1	1	DECOCK, JAMES P MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81309	08	Family Practice	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
44444	Fee-for-Service	1710419338	1710419338	1	1	DEMKO, JOHN E MD	7/19/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	161777	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44477	Fee-for-Service	1982956942	1982956942	1	1	DOWDY, BRENTON	9/3/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3240 FORDHAM ST	None	SAN DIEGO	CA	92110	5339	37	06073	32.7501009	-117.2142444	San Diego County
44502	Fee-for-Service	1205915774	1205915774	1	1	DAYLIGHT ADULT DAY HEALTH	10/8/2009	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE INC	905 E COLORADO ST	None	GLENDALE	CA	91205	1223	19	06037	34.14267946	-118.243647	Los Angeles County
44519	Fee-for-Service	1316205875	1316205875	1	1	DUPLER, SUZANNE P DO	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15537	05	Anesthesiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
44558	Fee-for-Service	1851350839	1851350839	1	1	DIN, ADNAN MOHAMMAD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68717	02	General Surgery	0	In state provider	None	4050 BARRANCA PKWY	STE 260	IRVINE	CA	92604	1719	30	06059	33.68293726	-117.8067799	Orange County
44576	Fee-for-Service	1437332194	1437332194	1	1	DULDULAO, EDMUNDO F MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104281	41	Internal Medicine	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
44595	Fee-for-Service	1205215480	1205215480	1	1	DALLAS, LAUREN N DO	10/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20181	None	None	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
44596	Fee-for-Service	1366901415	1366901415	1	1	DUPREE, JAKE W MD	6/10/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176607	None	None	0	In state provider	None	2501 N SEPULVEDA BLVD	100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
44608	Fee-for-Service	1952550295	1952550295	1	1	DR. CODY HOOVER	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10004 204TH AVE E	STE 2700	BONNEY LAKE	WA	98391	6377	00	None	47.16582243	-122.1577467	Pierce County
44636	Fee-for-Service	1326078288	1326078288	1	1	DELRAY MEDICAL CENTER INC	6/21/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5352 LINTON BEACH	None	DELRAY BEACH	FL	33484	6514	00	None	26.436987	-80.127792	Palm Beach County
44663	Fee-for-Service	1962793299	1962793299	1	1	DANOPOULOS, PANOS G MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126983	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
44671	Fee-for-Service	1306053780	1306053780	1	1	DEBONIS, KATRINA L MD	1/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106818	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
44685	Fee-for-Service	1891474037	1891474037	1	1	DULOG, TALI MARIE	7/25/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1684 WHITTIER AVE	SPC 49	COSTA MESA	CA	92627	4454	30	06059	33.63505181	-117.940558	Orange County
44700	Fee-for-Service	1376530501	1376530501	1	1	DAVIS, THOMAS L III MD	12/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30895	01	General Practice	0	In state provider	None	4381 BROCKTON AVE	STE A	RIVERSIDE	CA	92501	3470	33	06065	33.97856436	-117.3829171	Riverside County
44707	Fee-for-Service	1316495047	1316495047	1	2	DANIEL RECALDE DPM, INC	11/10/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	11100 WARNER AVE	SUITE 306	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
44720	Fee-for-Service	1427475417	1427475417	1	2	DAVIS, TARON R MD	6/1/2021	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1595 QUINTARA ST	None	SAN FRANCISCO	CA	94116	1273	38	06075	37.74829578	-122.4824422	San Francisco County
44779	Fee-for-Service	1538152145	1538152145	1	1	DUNCAN, WENDY K OD	3/4/2004	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8190 MANGO AVE	None	FONTANA	CA	92335	3610	36	06071	34.10497032	-117.4314648	San Bernardino County
44784	Fee-for-Service	1295202158	1295202158	1	1	DONG, LIN CCC-SLP	1/21/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
44823	Fee-for-Service	1083175475	1083175475	1	1	DENNIS, NICOLE MD	9/12/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176854	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
44827	Fee-for-Service	1679575344	1679575344	1	1	DAUGHERTY, DAVID L MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	47884	20	Orthopedic Surgery	0	In state provider	None	2300 CALIFORNIA ST	STE 300	SAN FRANCISCO	CA	94115	2754	38	06075	37.78910083	-122.4323944	San Francisco County
44851	Fee-for-Service	1033173638	1033173638	1	1	DARSHAN ACHARYA M.D.	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	725 SW WAHANNA RD	None	SEASIDE	OR	97138	0000	00	None	45.99034686	-123.9131204	Clatsop County
44873	Fee-for-Service	1710915038	1710915038	2	1	DERBOGHOSSIANS, SHAHIN	11/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	42661	34	Urology and Urological Surgery	0	In state provider	None	1030 S GLENDALE AVE	SUITE 301	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
44909	Fee-for-Service	1235422676	1235422676	1	1	DAVIS, WARREN B MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126164	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
44948	Fee-for-Service	1407893266	1407893266	1	1	DEROCHI, ANDREA LCSW	2/8/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44970	Fee-for-Service	1073699971	1073699971	1	1	DESTA DIGESTIVE DISEASE	3/6/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
44973	Fee-for-Service	1891474037	1891474037	1	1	DULOG, TALI MARIE	7/25/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1684 WHITTIER AVE	SPC 49	COSTA MESA	CA	92627	4454	30	06059	33.63505181	-117.940558	Orange County
44977	Fee-for-Service	1215950092	1215950092	1	1	DIFIORI, JOHN P MD	7/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74087	01	General Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
44995	Fee-for-Service	1467741207	1467741207	1	1	DANG, LINH T MD	4/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115515	08	Family Practice	0	In state provider	None	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	38	06075	37.79989786	-122.4090369	San Francisco County
45025	Fee-for-Service	1124217690	1124217690	1	1	DENNIS, NILOUFER S MD	1/2/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	101524	None	None	0	In state provider	None	25775 MCBEAN PKY	#118	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
45038	Fee-for-Service	1942333075	1942333075	1	1	DALSTROM, DAVID J MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112715	20	Orthopedic Surgery	0	In state provider	None	9850 GENESEE AVE	STE 210	LA JOLLA	CA	92037	1206	37	06073	32.882913	-117.226341	San Diego County
45048	Fee-for-Service	1922593243	1922593243	1	1	DARKSMITH, THOMAS R LMFT	12/27/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1820 SCENIC AVE	None	BERKELEY	CA	94709	1324	01	06001	37.87536985	-122.2622489	Alameda County
45093	Fee-for-Service	1710130976	1710130976	1	1	DAWN MARIE LARSON M.D.	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
45097	Fee-for-Service	1114938842	1114938842	1	1	DE PICCIOTTO, FREDRIC MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86846	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
45105	Fee-for-Service	1437517497	1437517497	1	1	DUNFORD, KATELYN C LMFT	9/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45126	Fee-for-Service	1174581227	1174581227	1	1	DICKMAN, JEROME I MD	11/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	21070	04	Otology, Laryngology, Rhinology	0	In state provider	None	7230 MEDICAL CENTER DR	STE 604	WEST HILLS	CA	91307	4021	19	06037	34.20172814	-118.6294322	Los Angeles County
45129	Fee-for-Service	1609441138	1609441138	1	1	DESERT HOT SPRINGS CHIROPRAC	9/2/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	TIC, A DR. TIFFANY RAI	12561 PALM DR	E	DESERT HOT SPRING	CA	92240	4521	33	06065	33.95736	-116.501348	Riverside County
45144	Fee-for-Service	1588058721	1588058721	1	1	DO, ANNA T MD	7/6/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172035	None	None	0	In state provider	None	3939 3RD AVE	None	SAN DIEGO	CA	92103	3002	37	06073	32.74905668	-117.16268	San Diego County
45217	Fee-for-Service	1669415857	1669415857	1	1	DU, CHI C MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78856	08	Family Practice	0	In state provider	None	1172 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.1456234	-121.6208185	Sutter County
45258	Fee-for-Service	1073699971	1073699971	1	1	DESTA DIGESTIVE DISEASE	4/13/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
45275	Fee-for-Service	1336293653	1336293653	1	1	DAVIS, WENDY Z MD	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55217	10	Gastroenterology (M.D. only)	0	In state provider	None	1350 S ELISEO DR	STE 130	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
45285	Fee-for-Service	1124131065	1124131065	1	2	DAN B TRAN MEDICAL CORPORATI	5/24/2021	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	4300 LONG BEACH BLVD	SUITE 400	LONG BEACH	CA	90807	2008	19	06037	33.83662572	-118.1900605	Los Angeles County
45322	Fee-for-Service	1245768910	1245768910	1	1	DEOL, MADHVI MD	5/25/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175668	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
45357	Fee-for-Service	1265795892	1265795892	1	1	DOTI, MICHAEL MD	6/13/2018	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	154548	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
45374	Fee-for-Service	1184810806	1184810806	1	1	DREW, TRACY L CNP	12/7/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
45376	Fee-for-Service	1588975643	1588975643	1	1	DHAVAL SHAH	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1960 W FRYE RD	STE 5	CHANDLER	AZ	85224	6238	00	None	33.299361	-111.875625	Maricopa County
45412	Fee-for-Service	1629020136	1629020136	1	1	DEAN EDWARD SCHANEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11113 RESEARCH BLVD	None	AUSTIN	TX	78759	5236	00	None	30.40569387	-97.74490655	Travis County
45419	Fee-for-Service	1144809575	1144809575	1	1	DEOL, NAVNEET DO	2/6/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23192	08	Family Practice	0	In state provider	None	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
45466	Fee-for-Service	1528058633	1528058633	1	1	DE CASTRO, MARIA A MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84804	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
45475	Fee-for-Service	1427033703	1427033703	1	1	DELA ROSA, RUSSELL A CO	2/15/2006	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
45492	Fee-for-Service	1720577851	1720577851	1	1	DESAI, SNEHA J	9/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
45522	Fee-for-Service	1366621799	1366621799	1	1	DAVIS, AMY M MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144410	08	Family Practice	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
45533	Fee-for-Service	1598906802	1598906802	1	1	DAOUADI, MUSTAPHA MD	10/6/2022	208600000X	NA	General Surgery	026	PHYSICIANS	158538	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
45536	Fee-for-Service	1295836963	1295836963	1	1	DATNOW, STACEY F LCSW	11/12/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5012 CHESEBRO RD	100	AGOURA HILLS	CA	91301	2272	19	06037	34.14123897	-118.7393414	Los Angeles County
45540	Fee-for-Service	1144425711	1144425711	1	1	DHILLON, ANAHAT K MD	7/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90024	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
45543	Fee-for-Service	1891853842	1891853842	1	1	DIEL, RICHARD H RPT	2/8/2015	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SUMMIT PHYSICAL THERAPY	200 BROADWAY ST	STE 28	KING CITY	CA	93930	2866	27	06053	36.2133658	-121.1256124	Monterey County
45550	Fee-for-Service	1154518793	1154518793	1	1	DZHIMBASHYAN, LUSINE	7/21/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8949 RESEDA BLVD	SUITE 225	NORTHRIDGE	CA	91324	3916	19	06037	34.233255	-118.536109	Los Angeles County
45560	Fee-for-Service	1326202748	1326202748	1	1	DESAI, BHUPAT H MD INC	3/17/2009	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	630 N 13TH AVE	STE B	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
45572	Fee-for-Service	1124131065	1124131065	1	2	DAN B TRAN MEDICAL CORPORATI	1/27/2021	174400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	INC	4300 LONG BEACH BLVD	SUITE 400	LONG BEACH	CA	90807	2008	19	06037	33.83662572	-118.1900605	Los Angeles County
45586	Fee-for-Service	1366636250	1366636250	1	1	DALE, JEANA D LCSW	2/2/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
45598	Fee-for-Service	1023185857	1023185857	1	1	DIETHELM, SUSAN K MD	3/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77782	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
45603	Fee-for-Service	1861687873	1861687873	1	1	DO, NGUYEN T DO	1/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	9031	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
45604	Fee-for-Service	1427428788	1427428788	1	1	DIGNITY HOSPICE CARE INC	3/25/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	22030 MAIN STREET	STE 204	CARSON	CA	90745	2941	19	06037	33.82708315	-118.2767048	Los Angeles County
45636	Fee-for-Service	1538258413	1538258413	1	1	DESAI, NALINI MD	1/30/1997	207L00000X	NA	Other	026	PHYSICIANS	73150	05	Anesthesiology	0	In state provider	C/O SHEARS MEDICAL SERV	1255 POST ST	STE 831	SAN FRANCISCO	CA	94109	6711	38	06075	37.78646213	-122.4225308	San Francisco County
45698	Fee-for-Service	1720144603	1720144603	3	1	D-PROFESSIONAL RX INC	12/6/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9114 EDINGER AVE	None	FOUNTAIN VALLEY	CA	92708	1437	30	06059	33.73026798	-117.9701014	Orange County
45711	Fee-for-Service	1255959359	1255959359	1	1	DUONG, HERRICK OD	6/10/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 HARRIMAN PL	None	SAN BERNARDINO	CA	92408	4203	36	06071	34.06663955	-117.262629	San Bernardino County
45732	Fee-for-Service	1447755871	1447755871	1	1	DAYO, OLUMAYOWA M MD	9/21/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165757	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45737	Fee-for-Service	1952539280	1952539280	1	1	DOMZALSKI, JEROME T MD	10/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113976	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
45800	Fee-for-Service	1336210236	1336210236	1	1	DOSHI, FALGUNI P MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67278	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
45824	Fee-for-Service	1497980932	1497980932	1	1	DARWISH, OMAR S DO	4/30/2012	207R00000X	NA	Other	026	PHYSICIANS	10612	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
45892	Fee-for-Service	1427428788	1427428788	1	1	DIGNITY HOSPICE CARE INC	3/25/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	22030 MAIN STREET	STE 204	CARSON	CA	90745	2941	19	06037	33.82708315	-118.2767048	Los Angeles County
45930	Fee-for-Service	1023486859	1023486859	1	1	DIETZE, NICOLE	5/20/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
45968	Fee-for-Service	1699437939	1699437939	1	1	DE DIOS-DEL MUNDO, LUDIVINA	12/11/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	A NP	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
45984	Fee-for-Service	1225477268	1225477268	1	1	DOAN, LINDA MD	7/15/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	156270	07	Dermatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
45993	Fee-for-Service	1134748486	1134748486	1	1	DEOL, KULWARN S OT	3/25/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
46054	Fee-for-Service	1336472299	1336472299	1	1	DOMINISE, CARMELA CONCEPCION	1/16/2023	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C PT	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
46058	Fee-for-Service	1366516478	1366516478	1	1	DOAN, STEVEN P MD	12/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75950	38	Geriatrics	0	In state provider	None	9515 SOQUEL DR	None	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
46063	Fee-for-Service	1689634974	1689634974	1	1	DAVIS, PAMELA D MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	46258	05	Anesthesiology	0	In state provider	None	1211 W LA PALMA AVE	STE 209	ANAHEIM	CA	92801	2802	30	06059	33.84718298	-117.933758	Orange County
46129	Fee-for-Service	1194984666	1194984666	1	1	DINSAY, LINDBERGH M DO	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10306	05	Anesthesiology	0	In state provider	None	1600 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
46185	Fee-for-Service	1033326699	1033326699	1	1	DODGE, REBECCA A PHD	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	145 S WASHINGTON ST	STE H2	SONORA	CA	95370	9733	55	06109	37.98347745	-120.3821927	Tuolumne County
46238	Fee-for-Service	1841890365	1841890365	1	1	DUCHATEAU, REBEKAH J CMF	8/5/2022	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	25880 TOURNAMENT RD	SUITE 109	VALENCIA	CA	91355	2384	19	06037	34.39184204	-118.5626441	Los Angeles County
46266	Fee-for-Service	1538458005	1538458005	1	1	DESAI, NAMAN S MD	6/17/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	151688	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
46276	Fee-for-Service	1063448785	1063448785	1	1	DORY, CHRISTOPHER E MD	11/30/1990	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	65183	30	Radiology	0	In state provider	None	8008 FROST ST	STE 106	SAN DIEGO	CA	92123	4229	37	06073	32.80027859	-117.1524832	San Diego County
46311	Fee-for-Service	1730237769	1730237769	1	1	DE ROSALES, LEDESMA L MD	11/15/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65252	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
46344	Fee-for-Service	1366516478	1366516478	1	1	DOAN, STEVEN P MD	12/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75950	01	General Practice	0	In state provider	None	9515 SOQUEL DR	None	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
46358	Fee-for-Service	1740381870	1740381870	1	1	DEL ROSARIO, ROY B MD	5/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	44914	36	Psychiatry	0	In state provider	None	43770 15TH ST W	STE 245	LANCASTER	CA	93534	4761	19	06037	34.67821348	-118.1566389	Los Angeles County
46365	Fee-for-Service	1154419034	1154419034	1	1	DO, TIN M MD	1/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84566	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
46372	Fee-for-Service	1568416147	1568416147	1	3	DESERT ADVANCED IMAGING MEDI	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	41120 WASHINGTON ST	None	BERMUDA DUNES	CA	92203	9215	33	06065	33.75029437	-116.3037097	Riverside County
46398	Fee-for-Service	1699794388	1699794388	1	1	DELANEY, THOMAS P PHD	3/1/2001	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1173 N DIXIE DR	STE 101	SAN DIMAS	CA	91773	1200	19	06037	34.123185	-117.800536	Los Angeles County
46404	Fee-for-Service	1154390391	1154390391	1	1	DAVIS-KINGSTON, HEATHER L MD	5/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71940	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 102	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
46429	Fee-for-Service	1376593921	1376593921	1	1	DENIOUS, EDWARD MD	10/2/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
46435	Fee-for-Service	1174969505	1174969505	1	1	DUNN, JOIE C MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124926	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
46464	Fee-for-Service	1710560404	1710560404	1	1	DANG, ANDREW-HUY Q MD	1/15/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
46536	Fee-for-Service	1831554682	1831554682	1	1	DAUGHERTY, BRETTNEY R	11/11/2019	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	19	06037	33.98867148	-118.3837334	Los Angeles County
46540	Fee-for-Service	1164738803	1164738803	1	1	DV URGENT CARE MEDICAL GROUP	9/25/2012	261QU0200X	NA	Other	026	PHYSICIANS	6930	None	None	0	In state provider	INC	6080 HAMNER AVE	STE 100	EASTVALE	CA	91752	3663	33	06065	33.977817	-117.5582515	Riverside County
46544	Fee-for-Service	1336318070	1336318070	1	1	DOEVE, KARNADI P CRNA	3/3/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
46580	Fee-for-Service	1073507786	1073507786	1	1	DEBRUIN, ROBERT J MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42656	41	Internal Medicine	0	In state provider	None	1600 CREEKSIDE DR	STE 3800	FOLSOM	CA	95630	3483	34	06067	38.669994	-121.147488	Sacramento County
46633	Fee-for-Service	1366516478	1366516478	1	1	DOAN, STEVEN P MD	12/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	75950	41	Internal Medicine	0	In state provider	None	9515 SOQUEL DR	None	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
46640	Fee-for-Service	1437447877	1437447877	1	1	DUONG, ANNIE LYNN P MD	12/13/2018	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
46651	Fee-for-Service	1013687151	1013687151	1	1	DAISY HOME HEALTH	12/7/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1480 COLORADO BLVD	STE 270	LOS ANGELES	CA	90041	2283	19	06037	34.13925431	-118.1972852	Los Angeles County
46673	Fee-for-Service	1902069487	1902069487	1	1	DUBRAY, BERNARD J JR MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135669	02	General Surgery	0	In state provider	None	10833 LECONTE AVE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
46691	Fee-for-Service	1154390391	1154390391	1	1	DAVIS-KINGSTON, HEATHER L MD	5/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71940	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 102	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
46718	Fee-for-Service	1376593921	1376593921	1	1	DENIOUS, EDWARD MD	10/2/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	1095 MARSHALL WAY	2N FL	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
46728	Fee-for-Service	1558484964	1558484964	1	1	DE VERA, MAGNOLIA B LMFT	7/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	TION, AND CONSULTING SER	400 OLD COUNTY RD.	4	PACIFICA	CA	94044	3221	41	06081	37.60993039	-122.494463	San Mateo County
46762	Fee-for-Service	1114402492	1114402492	1	1	DUDLEY, CHANELL LCSW	9/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	40	06079	35.48962035	-120.670989	San Luis Obispo County
46764	Fee-for-Service	1023005444	1023005444	1	1	DAVIS, MARCIA J MD	2/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77530	08	Family Practice	0	In state provider	None	4327 GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	6260	09	06017	38.70662835	-120.8276613	El Dorado County
46789	Fee-for-Service	1922594662	1922594662	1	1	DAVIS, ALISHA J DO	2/1/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19067	None	None	0	In state provider	None	401 SCHOOL	None	VISALIA	CA	93291	5032	54	06107	36.332757	-119.288682	Tulare County
46808	Fee-for-Service	1871871053	1871871053	1	1	DATE, PRAVIN R MD	8/29/2019	208M00000X	NA	Other	026	PHYSICIANS	147458	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
46850	Fee-for-Service	1952315699	1952315699	1	1	DIXIT, PURUSHOTTAM MD	1/10/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54718	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
46900	Fee-for-Service	1053761809	1053761809	1	1	DEL ROSARIO, GERARD LPT	3/6/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	130	GARDENA	CA	90247	4129	19	06037	33.89247044	-118.2931941	Los Angeles County
46936	Fee-for-Service	1821875840	1821875840	1	1	DEGUZMAN, CHARLEEN PT	1/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
46940	Fee-for-Service	1538265442	1538265442	1	1	DAVID C FOLKERS M.D.	11/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4007 JAMES CASEY ST	STE B130	AUSTIN	TX	78745	3327	00	None	30.22682102	-97.77348449	Travis County
47008	Fee-for-Service	1891164307	1891164307	1	1	DEL ROSARIO, MICHAEL P MD	11/8/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	151675	None	None	0	In state provider	None	2653 ELM	300	LONG BEACH	CA	90806	1652	19	06037	33.805512	-118.188348	Los Angeles County
47043	Fee-for-Service	1578724373	1578724373	1	1	DESYLVIA, DAWN A MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107278	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
47067	Fee-for-Service	1477848703	1477848703	1	1	DRICKEN, JULIE E MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	131243	01	General Practice	0	In state provider	None	3307 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239431	-124.1358906	Humboldt County
47074	Fee-for-Service	1679762702	1679762702	1	3	DEVORE, GREGGORY R MD	1/30/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORPORATION	44241 15TH ST W	STE 205	LANCASTER	CA	93534	5501	19	06037	34.68712999	-118.1569096	Los Angeles County
47176	Fee-for-Service	1023184322	1023184322	1	1	DHANANI, YURZUL N MD	6/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41153	01	General Practice	0	In state provider	None	1275 E LATHAM AVE	STE C	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
47210	Fee-for-Service	1215224241	1215224241	1	1	DAMIAN-SANTANA, CLARA Y OD	4/22/2013	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 N BUSH ST	#203	SANTA ANA	CA	92706	4114	30	06059	33.76135364	-117.8664136	Orange County
47282	Fee-for-Service	1083791917	1083791917	1	1	DRAY, TODD G MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84734	04	Otology, Laryngology, Rhinology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
47296	Fee-for-Service	1194204024	1194204024	1	1	DUDLEY, QUINN S	11/23/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1201 ALHAMBRA BLVD	STE 210	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
47344	Fee-for-Service	1518054808	1518054808	2	1	DHILLON, UJAGGER S MD	1/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	36464	10	Gastroenterology (M.D. only)	0	In state provider	None	7405 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.8450311	-119.7839039	Fresno County
47356	Fee-for-Service	1477848703	1477848703	1	1	DRICKEN, JULIE E MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	131243	02	General Surgery	0	In state provider	None	3307 RENNER DR	None	FORTUNA	CA	95540	3119	12	06023	40.58239431	-124.1358906	Humboldt County
47412	Fee-for-Service	1316339146	1316339146	1	1	DAVIES, EILEEN E CNP	3/13/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
47464	Fee-for-Service	1023184322	1023184322	1	1	DHANANI, YURZUL N MD	6/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	41153	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1275 E LATHAM AVE	STE C	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
47491	Fee-for-Service	1922339738	1922339738	1	1	DHARMAR, CHITRA S MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110183	40	Pediatrics	0	In state provider	None	4125 BANGS AVENUE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
47543	Fee-for-Service	1134727282	1134727282	1	1	DESTRUEL, ANNE MARIE N NP	11/3/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
47556	Fee-for-Service	1376614602	1376614602	1	1	DE LEON, RAMON V MD	8/31/1993	174400000X	NA	Other	026	PHYSICIANS	78593	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
47602	Fee-for-Service	1376001552	1376001552	1	1	DUARTE, DERRICK A CRNA	4/25/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
47605	Fee-for-Service	1346531639	1346531639	1	1	DEBACKER, JULIE L MD	2/22/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	160195	13	Neurology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
47654	Fee-for-Service	1558503870	1558503870	1	1	DOMBOURIAN, MELKON G MD	4/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
47682	Fee-for-Service	1588632715	1588632715	1	1	DATO, PAUL E MD	1/26/2006	208800000X	NA	Other	026	PHYSICIANS	43540	34	Urology and Urological Surgery	0	In state provider	None	8851 CENTER DR	STE 501	LA MESA	CA	91942	3058	37	06073	32.78189749	-117.0075062	San Diego County
47731	Fee-for-Service	1861427163	1861427163	1	1	DOUGLAS, PAUL L MD	8/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81267	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
47741	Fee-for-Service	1457321242	1457321242	2	1	DICKEY, JAMES W III MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	37842	02	General Surgery	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
47783	Fee-for-Service	1508840547	1508840547	1	1	DESERT HEART PHYSICIANS	1/1/1996	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP INC	1180 N INDIAN CANYON DR	STE E319	PALM SPRINGS	CA	92262	4809	33	06065	33.839505	-116.5455735	Riverside County
47835	Fee-for-Service	1881760452	1881760452	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
47857	Fee-for-Service	1659371748	1659371748	1	1	DESANTIS, JEFFREY R DPM	7/1/1991	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1038 E CHAPMAN AVE	None	ORANGE	CA	92866	2111	30	06059	33.78782652	-117.84249	Orange County
47861	Fee-for-Service	1043331788	1043331788	1	1	DOMINGO, SHIRLEY R MD	10/28/2019	208600000X	NA	General Surgery	026	PHYSICIANS	115602	02	General Surgery	0	In state provider	None	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
47903	Fee-for-Service	1134755457	1134755457	1	1	DEJONG, ELIZABETH A LMFT	3/25/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	518 SCHOOL ST	SUITE 202	UKIAH	CA	95482	5479	23	06045	39.14644789	-123.2079137	Mendocino County
47936	Fee-for-Service	1144451824	1144451824	1	1	DANAEI, DELARAM MD	10/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113847	01	General Practice	0	In state provider	None	43112 15TH ST W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
47984	Fee-for-Service	1912176264	1912176264	1	2	DR M FORGHANI S CORP	7/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8699	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1515 N BROADWAY	None	SANTA ANA	CA	92706	3906	30	06059	33.75846	-117.8696205	Orange County
48002	Fee-for-Service	1063547420	1063547420	1	2	DASSOFF, DAVID S MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137536	41	Internal Medicine	0	In state provider	None	211 13TH STREET	None	RAMONA	CA	92065	2711	37	06073	33.04020023	-116.8739786	San Diego County
48019	Fee-for-Service	1972566693	1972566693	1	1	DADDIO, JUDITH P PNP	8/1/1994	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	595 BUCKINGHAM WAY	STE 355	SAN FRANCISCO	CA	94132	1955	38	06075	37.73012679	-122.4767395	San Francisco County
48032	Fee-for-Service	1104105030	1104105030	1	1	DAM, TANYA H	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12410	None	None	0	In state provider	None	1541 FLORIDA AVENUE	SUITE 200	MODESTO	CA	95354	0105	50	06099	37.666863	-120.9962775	Stanislaus County
48034	Fee-for-Service	1508055039	1508055039	1	1	DARBINIAN, SIRAK MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102585	05	Anesthesiology	0	In state provider	None	2131 W THIRD STREET	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
48060	Fee-for-Service	1174113534	1174113534	1	4	DIAGNOSTIC PATHOLOGY LABORAT	3/3/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORY SERVICES, INC.	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	6039	57	06113	38.570805	-121.4696385	Sacramento County
48099	Fee-for-Service	1851942569	1851942569	1	1	DIEP, KAREN OD	7/27/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
48114	Fee-for-Service	1538227335	1538227335	1	1	DIKIO, NICOLAS A MD INC	11/1/2000	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40344	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13939 SAN ANTONIO DR	None	NORWALK	CA	90650	4036	19	06037	33.90444257	-118.0803356	Los Angeles County
48124	Fee-for-Service	1881760452	1881760452	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
48149	Fee-for-Service	1760688386	1760688386	1	1	DOTSON, RACHEL H MD	11/1/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	82150	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
48158	Fee-for-Service	1558584482	1558584482	1	1	DENOPRA, MICHELLE C	5/23/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
48162	Fee-for-Service	1326116898	1326116898	1	1	DIAMOND, JAN	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57275	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
48180	Fee-for-Service	1174659593	1174659593	1	1	DAVIN K. QUINN, MD	7/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
48274	Fee-for-Service	1376668632	1376668632	1	1	DAUB, SHELLEY	7/1/2004	1041C0700X	NA	Mental Health Outpatient Services	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	12941 2ND ST	SPC 8	YUCAIPA	CA	92399	5617	36	06071	34.01869396	-117.0431728	San Bernardino County
48288	Fee-for-Service	1063547420	1063547420	1	2	DASSOFF, DAVID S MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137536	01	General Practice	0	In state provider	None	211 13TH STREET	None	RAMONA	CA	92065	2711	37	06073	33.04020023	-116.8739786	San Diego County
48306	Fee-for-Service	1871790006	1871790006	1	1	DEHDASHTI, SAMAN	6/17/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVENUE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
48313	Fee-for-Service	1568500395	1568500395	1	1	DUMSER, MAXINE A LMFT	7/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 SPRING ST	STE 307	LA MESA	CA	91942	0274	37	06073	32.76503682	-117.0203822	San Diego County
48314	Fee-for-Service	1912031030	1912031030	1	1	DIA, ALI R MD	7/29/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	47803	36	Psychiatry	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
48327	Fee-for-Service	1093172165	1093172165	1	1	DNX MEDICAL INC	6/27/2016	193400000X	NA	Other	026	PHYSICIANS	62375	41	Internal Medicine	0	In state provider	None	14541 BROOKHURST ST	STE D2	WESTMINSTER	CA	92683	5790	30	06059	33.75135	-117.954936	Orange County
48328	Fee-for-Service	1235113473	1235113473	1	1	DOZIER, KENNETH E MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	37890	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6729 E LEAFWOOD DR	None	ANAHEIM	CA	92807	5027	30	06059	33.83280514	-117.7548823	Orange County
48345	Fee-for-Service	1255762340	1255762340	1	1	DE ANZA ORTHOPEDIC MEDICAL	12/23/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	GROUP INC	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
48349	Fee-for-Service	1407938061	1407938061	1	1	DEHGHAN, AMIR A	12/9/1987	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	39190 STATE ST	None	FREMONT	CA	94538	1436	01	06001	37.54945968	-121.9834643	Alameda County
48376	Fee-for-Service	1992784292	1992784292	1	1	DAO, STEVE M OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
48430	Fee-for-Service	1487831558	1487831558	1	1	DORSCH, KATHERINE W	10/12/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DELANEYS PLACE	3065 PORTER STREET	SUITE 102	SOQUEL	CA	95073	2231	44	06087	36.989559	-121.957318	Santa Cruz County
48439	Fee-for-Service	1366952962	1366952962	1	1	DE GUZMAN, ISMAEL LMFT	6/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	74 ELGIN PARK	None	SAN FRANCISCO	CA	94103	1106	38	06075	37.77040864	-122.4232282	San Francisco County
48469	Fee-for-Service	1104205483	1104205483	1	1	DASS, SHERMEIL K MD APC	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	78214	26	Psychiatry (child)	0	In state provider	None	655 CAPITOLA RD	STE 200	SANTA CRUZ	CA	95062	2742	44	06087	36.97934903	-121.9919259	Santa Cruz County
48479	Fee-for-Service	1750522736	1750522736	1	1	DONDE, MEDHA A MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106847	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
48482	Fee-for-Service	1245328483	1245328483	1	1	DOAN, TUYET-LINH T MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65841	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
48567	Fee-for-Service	1841610219	1841610219	1	1	DIAZ, JUDITH L NP	10/5/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1096 CALIMESA BLVD	STE 105	CALIMESA	CA	92320	0001	33	06065	33.99811401	-117.0594965	Riverside County
48568	Fee-for-Service	1386938124	1386938124	1	1	DOSHI, RISHI R MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106060	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
48575	Fee-for-Service	1528027273	1528027273	1	1	DO, LONG TRANG OD	7/23/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1601 W 17TH ST	STE B1	SANTA ANA	CA	92706	3340	30	06059	33.7600735	-117.890325	Orange County
48595	Fee-for-Service	1649091448	1649091448	1	1	DENZEL SUMLIN LICENSED CLINI	3/11/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5207 PRAIRIE WHEAT AVE	None	BAKERSFIELD	CA	93313	5269	15	06029	35.2720006	-119.0603109	Kern County
48629	Fee-for-Service	1770676256	1770676256	1	1	DUDUM, HILDA MD	6/12/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46178	40	Pediatrics	0	In state provider	None	1350 S ELISEO DR	None	GREENBRAE	CA	94904	2011	21	06041	37.94490653	-122.537021	Marin County
48630	Fee-for-Service	1508024878	1508024878	1	1	DEVIN SPERA	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	521 ADAMS AVE	None	MORTON	WA	98356	9323	00	None	46.55593249	-122.2798365	Lewis County
48634	Fee-for-Service	1255762340	1255762340	1	1	DE ANZA ORTHOPEDIC MEDICAL	5/20/2024	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GROUP INC	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
48666	Fee-for-Service	1922114685	1922114685	1	1	DAVIS, JUDY J MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46030	40	Pediatrics	0	In state provider	None	7405 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.8450311	-119.7839039	Fresno County
48689	Fee-for-Service	1821744913	1821744913	1	1	DAVIS, YESENIA I NP	11/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18663 VENTURA BLVD	STE 202	TARZANA	CA	91356	4151	19	06037	34.17051848	-118.5402557	Los Angeles County
48714	Fee-for-Service	1760666499	1760666499	1	1	DONG, STEVEN N MD	6/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118100	None	None	0	In state provider	None	489 E 21ST ST	None	SAN BERNARDINO	CA	92404	4816	36	06071	34.13403455	-117.2756115	San Bernardino County
48755	Fee-for-Service	1548329154	1548329154	1	1	DRU, DENISE MD	1/1/1982	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	37458	04	Otology, Laryngology, Rhinology	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
48762	Fee-for-Service	1104205483	1104205483	1	1	DASS, SHERMEIL K MD APC	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	78214	36	Psychiatry	0	In state provider	None	655 CAPITOLA RD	STE 200	SANTA CRUZ	CA	95062	2742	44	06087	36.97934903	-121.9919259	Santa Cruz County
48780	Fee-for-Service	1417986753	1417986753	1	1	DANG, CHRISTIAN H MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79517	11	Aviation (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
48785	Fee-for-Service	1356387138	1356387138	1	1	DOMINGUEZ, KARINA	8/2/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1940 N ORANGE GROVE AVE	None	POMONA	CA	91767	3002	19	06037	34.07889352	-117.7478982	Los Angeles County
48793	Fee-for-Service	1902481005	1902481005	1	1	DIXON, NORA E OT	4/3/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1640 MARENGO ST	SUITE 500	LOS ANGELES	CA	90033	1036	19	06037	34.05946374	-118.213356	Los Angeles County
48794	Fee-for-Service	1942645502	1942645502	1	1	DYNAMIC HEALTH AND WELLNESS	6/8/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC APMC	441 COLUSA AVE	SUITE B	YUBA CITY	CA	95991	4143	51	06101	39.14097656	-121.6168547	Sutter County
48857	Fee-for-Service	1457813610	1457813610	1	1	DANG, LONG H MD	4/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181854	None	None	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
48914	Fee-for-Service	1184783847	1184783847	1	1	DE LA RIVA, PATRICIA L	2/28/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	66468	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
48930	Fee-for-Service	1093778649	1093778649	1	1	DOSTZADA, GHULAM Y MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76019	41	Internal Medicine	0	In state provider	None	1240 S CHINA LAKE BLVD	STE A	RIDGECREST	CA	93555	5201	15	06029	35.60122832	-117.679094	Kern County
48938	Fee-for-Service	1184658338	1184658338	1	1	DALALI, MICHAEL J.	11/30/1993	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52553	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
48945	Fee-for-Service	1699779090	1699779090	1	1	DERDERIAN,RAYMOND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2965 HARRISON ST	STE 317	BEAUMONT	TX	77702	0000	00	None	30.08949215	-94.13243217	Jefferson County
48955	Fee-for-Service	1922114685	1922114685	1	1	DAVIS, JUDY J MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46030	10	Gastroenterology (M.D. only)	0	In state provider	None	7405 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.8450311	-119.7839039	Fresno County
48974	Fee-for-Service	1508914326	1508914326	1	1	DIMARTINI, PATRICK A MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65005	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
48981	Fee-for-Service	1518031376	1518031376	1	1	DOMINGUEZ-BARROS, INES N PHD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
49007	Fee-for-Service	1891221511	1891221511	1	1	DIAMOND, JONATHAN MD	12/27/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158521	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
49013	Fee-for-Service	1699237099	1699237099	1	1	DARR, JASON T DO	7/29/2022	207P00000X	NA	Other	026	PHYSICIANS	19330	70	Clinic (mixed specialty)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
49021	Fee-for-Service	1689108151	1689108151	1	1	DARCY, CHRISTINE DO	3/7/2025	208G00000X	NA	General Surgery	026	PHYSICIANS	22878	33	Thoracic Surgery	0	In state provider	None	2888 LONG BEACH BLVD	165	LONG BEACH	CA	90806	1561	19	06037	33.809706	-118.189343	Los Angeles County
49071	Fee-for-Service	1447294194	1447294194	1	1	DELIKYAN, LIANA PSYD	10/8/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2403 S MORAY AVE	SUITE 1	SAN PEDRO	CA	90732	4342	19	06037	33.72448582	-118.3146015	Los Angeles County
49075	Fee-for-Service	1891835872	1891835872	1	1	DEVRIES, MATHEW J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
49081	Fee-for-Service	1144824285	1144824285	1	1	DONALD J PORTOCARRERO D O IN	10/30/2024	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	C	623 W DUARTE RD	STE 8	ARCADIA	CA	91007	7349	19	06037	34.12648672	-118.0522757	Los Angeles County
49109	Fee-for-Service	1083763692	1083763692	1	1	DAVIS, JUSTIN A MD	6/11/2008	207P00000X	NA	Other	026	PHYSICIANS	97213	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
49120	Fee-for-Service	1932308301	1932308301	1	1	DENISE T ROBINSON	3/6/2012	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5353 E 2ND ST	SUITE 203	LONG BEACH	CA	90803	5300	19	06037	33.75878091	-118.1311809	Los Angeles County
49122	Fee-for-Service	1124281761	1124281761	1	1	DODAKIAN, WAYNE S DO	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12340	08	Family Practice	0	In state provider	None	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
49146	Fee-for-Service	1376678490	1376678490	1	1	DAVID A GROVE	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 S WOODWORTH LOOP	None	PALMER	AK	99645	8984	00	None	61.56185332	-149.2602134	Matanuska-Susitna Borough
49147	Fee-for-Service	1538248927	1538248927	1	1	DE LISSER, ROSALIND M NP	5/30/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
49172	Fee-for-Service	1063939718	1063939718	1	1	DIAZ, DALIA M LCSW	10/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
49230	Fee-for-Service	1164433132	1164433132	1	1	DARCHANGELO, EMILY T	8/5/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 S MOORPARK ROAD	None	THOUSAND OAKS	CA	91361	1008	56	06111	34.17369227	-118.8765488	Ventura County
49244	Fee-for-Service	1679718399	1679718399	1	1	DUONG, MAN C MD	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105702	41	Internal Medicine	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95242	3635	39	06077	38.12188356	-121.285872	San Joaquin County
49255	Fee-for-Service	1154378693	1154378693	1	1	DE LA ROSA, HEIDELENE E MD	7/14/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52214	None	None	0	In state provider	None	15203 11TH ST	SUITE C	VICTORVILLE	CA	92395	3737	36	06071	34.52758919	-117.2925085	San Bernardino County
49257	Fee-for-Service	1417579467	1417579467	1	1	DIAZ, FRANCISCO MD	7/26/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184713	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
49281	Fee-for-Service	1467660233	1467660233	1	1	DIAZ, PATRICK H MD	6/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100075	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
49285	Fee-for-Service	1730235540	1730235540	1	1	DAY, JASON S MD	12/11/2020	207P00000X	NA	Other	026	PHYSICIANS	96623	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
49301	Fee-for-Service	1699237099	1699237099	1	1	DARR, JASON T DO	7/29/2022	207P00000X	NA	Other	026	PHYSICIANS	19330	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
49315	Fee-for-Service	1699391995	1699391995	1	1	DELTA HOSPICE INC	1/25/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8921 DE SOTO AVE	STE 202	CANOGA PARK	CA	91304	1910	19	06037	34.23241304	-118.5885517	Los Angeles County
49325	Fee-for-Service	1376070102	1376070102	2	1	DEGIOVANNI, ALBERTO MD	5/19/2023	207R00000X	NA	Other	026	PHYSICIANS	163757	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
49366	Fee-for-Service	1679085518	1679085518	1	1	DURBOROUGH, PATRICIA L	12/20/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1637 QUAILS NEST STREET	None	ROSEVILLE	CA	95747	8165	31	06061	38.79972073	-121.3237166	Placer County
49444	Fee-for-Service	1932162385	1932162385	1	1	DANG, DAVID D MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72475	41	Internal Medicine	0	In state provider	None	13872 HARBOR BLVD	UNIT 1A	GARDEN GROVE	CA	92843	4000	30	06059	33.760971	-117.920161	Orange County
49530	Fee-for-Service	1992972897	1992972897	1	1	DRAKAKI, ALEXANDRA MD	8/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124517	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
49544	Fee-for-Service	1427408103	1427408103	1	1	DESANTY, DANIELLE S	9/23/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
49558	Fee-for-Service	1689646572	1689646572	1	1	DE LA ROSA, JOSE B MD	3/6/2020	207R00000X	NA	Other	026	PHYSICIANS	49267	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
49570	Fee-for-Service	1760450399	1760450399	1	1	DENNIS-ZARATE, KATHLEEN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81715	18	Ophthalmology	0	In state provider	None	222 W EULALIA ST	STE 110	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
49593	Fee-for-Service	1003578196	1003578196	1	1	DHARMASENA, SHANI LCSW	12/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1545 SAINT MARKS PLZ	5	STOCKTON	CA	95207	6411	39	06077	37.98892524	-121.3254177	San Joaquin County
49601	Fee-for-Service	1699391995	1699391995	1	1	DELTA HOSPICE INC	1/25/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8921 DE SOTO AVE	STE 202	CANOGA PARK	CA	91304	1910	19	06037	34.23241304	-118.5885517	Los Angeles County
49609	Fee-for-Service	1427475417	1427475417	1	1	DAVIS, TARON R MD	10/8/2019	2081P0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	163233	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
49631	Fee-for-Service	1558360834	1558360834	1	1	D'ANDREA, JON MICHAEL MD	1/1/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61484	40	Pediatrics	0	In state provider	None	2486 N PONDEROSA DR	STE 211	CAMARILLO	CA	93010	2376	56	06111	34.24266768	-119.0228157	Ventura County
49654	Fee-for-Service	1679085518	1679085518	1	1	DURBOROUGH, PATRICIA L	12/20/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1637 QUAILS NEST STREET	None	ROSEVILLE	CA	95747	8165	31	06061	38.79972073	-121.3237166	Placer County
49686	Fee-for-Service	1588307508	1588307508	1	1	DIXON, MONIQUE C LMFT	3/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
49739	Fee-for-Service	1932162385	1932162385	1	1	DANG, DAVID D MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72475	84	Surgery-Head and Neck	0	In state provider	None	13872 HARBOR BLVD	UNIT 1A	GARDEN GROVE	CA	92843	4000	30	06059	33.760971	-117.920161	Orange County
49793	Fee-for-Service	1447273263	1447273263	1	2	DAN LA MD INC	8/11/2006	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	6673 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2706	19	06037	34.24711056	-118.2779523	Los Angeles County
49794	Fee-for-Service	1376735688	1376735688	1	1	DEHYAR, MARIAM MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102480	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
49821	Fee-for-Service	1336912294	1336912294	1	1	DEEN ENTERPRISES MEDICAL COR	1/1/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	PORATION	435 W ATEN ROAD	SUITE 2	IMPERIAL	CA	92251	9819	13	06025	32.82551409	-115.5729141	Imperial County
49823	Fee-for-Service	1861617078	1861617078	1	2	DR. MICHAEL TAN, D.O., INC.	10/1/2000	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	1200 S ATLANTIC BLVD	128	ALHAMBRA	CA	91803	5406	19	06037	34.079274	-118.1344905	Los Angeles County
49825	Fee-for-Service	1154757755	1154757755	1	1	DANIAL, ERIN M CNP	12/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	121 SOTOYOME ST	None	SANTA ROSA	CA	95405	4823	49	06097	38.44224	-122.70195	Sonoma County
49829	Fee-for-Service	1104145861	1104145861	1	1	DON MICHAEL ENDRESS MD	9/7/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3191 EL PRADO ROAD	STE D	LA GRANGE	CA	95329	9761	55	06109	37.682568	-120.326651	Tuolumne County
49858	Fee-for-Service	1053802579	1053802579	1	1	DAFNEY, KADIATOU NP	2/24/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
49873	Fee-for-Service	1871562017	1871562017	1	1	DOHERTY, NEIL E MD	3/1/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51688	None	None	0	In state provider	None	412 W CARROLL AVE	STE 210	GLENDORA	CA	91741	4712	19	06037	34.13415622	-117.8702547	Los Angeles County
49911	Fee-for-Service	1689601866	1689601866	1	1	DONALD HASLAM,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1002 E CENTRAL BLVD	None	ANADARKO	OK	73005	4405	00	None	35.07226041	-98.22848079	Caddo County
50008	Fee-for-Service	1912319278	1912319278	1	1	DE LA FUENTE, ALEXANDRIA M	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149435	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
50083	Fee-for-Service	1447273263	1447273263	1	2	DAN LA MD INC	8/11/2006	207RR0500X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	6673 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2706	19	06037	34.24711056	-118.2779523	Los Angeles County
50101	Fee-for-Service	1255375879	1255375879	1	1	DICAPUA, LAWRENCE MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39078	30	Radiology	0	In state provider	None	995 SAINT JOHN PL	None	HEMET	CA	92543	4436	33	06065	33.74848448	-116.9616465	Riverside County
50109	Fee-for-Service	1336912294	1336912294	1	1	DEEN ENTERPRISES MEDICAL COR	1/1/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	PORATION	435 W ATEN ROAD	SUITE 2	IMPERIAL	CA	92251	9819	13	06025	32.82551409	-115.5729141	Imperial County
50117	Fee-for-Service	1104145861	1104145861	1	1	DON MICHAEL ENDRESS MD	5/23/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3191 EL PRADO ROAD	STE D	LA GRANGE	CA	95329	9761	55	06109	37.682568	-120.326651	Tuolumne County
50136	Fee-for-Service	1275658882	1275658882	1	1	DIGGES, JOHN L MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	63525	40	Pediatrics	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
50183	Fee-for-Service	1720568959	1720568959	1	1	DY, GREGORY W LMFT	8/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
50213	Fee-for-Service	1508193889	1508193889	1	1	DUONG, HOANG MINH MD	7/22/2011	207N00000X	NA	Dermatology	026	PHYSICIANS	53823	07	Dermatology	0	In state provider	None	991 MONTAGUE EXPY	STE 104	MILPITAS	CA	95035	6809	43	06085	37.41304686	-121.8852862	Santa Clara County
50243	Fee-for-Service	1295352037	1295352037	1	1	DARYAIPOUR, YEGANEH MD	10/18/2023	207R00000X	NA	Other	026	PHYSICIANS	184968	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
50278	Fee-for-Service	1487113726	1487113726	1	1	DESMOND, LESLEY N MD	11/14/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182358	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
50297	Fee-for-Service	1063453330	1063453330	1	1	DANGVU, PETER V MD	5/19/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63928	None	None	0	In state provider	None	31001 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	8703	30	06059	33.50974262	-117.6596065	Orange County
50305	Fee-for-Service	1992417893	1992417893	1	1	DOKLA, MONA AU	4/17/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	197 E CAROLINE ST	None	SAN BERNARDINO	CA	92408	3731	36	06071	34.06143353	-117.2822085	San Bernardino County
50306	Fee-for-Service	1639145972	1639145972	1	1	DAS, ANINDA MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55664	40	Pediatrics	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
50356	Fee-for-Service	1326012311	1326012311	1	1	DVA HEALTHCARE RENAL CARE	8/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	17590 FOOTHILL BLVD	SUITE 301	FONTANA	CA	92335	8416	36	06071	34.10671149	-117.4208355	San Bernardino County
50379	Fee-for-Service	1730149006	1730149006	1	1	DYLESKI, ROBIN A MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67091	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
50393	Fee-for-Service	1962199893	1962199893	1	1	DE SILVA, MIA	5/7/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
50405	Fee-for-Service	1497154751	1497154751	1	1	DUALE, FAIZA M PSYD	8/20/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
50406	Fee-for-Service	1104145861	1104145861	1	1	DON MICHAEL ENDRESS MD	9/7/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3191 EL PRADO ROAD	STE D	LA GRANGE	CA	95329	9761	55	06109	37.682568	-120.326651	Tuolumne County
50444	Fee-for-Service	1376548107	1376548107	1	1	DOUGLAS R DEHAAN	11/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 S ELLIS RD	None	SIOUX FALLS	SD	57106	7067	00	None	43.519626	-96.832179	Minnehaha County
50449	Fee-for-Service	1346750783	1346750783	1	1	DAVID P. SCHREIBER, M.D., PR	4/29/2020	2085R0001X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	35800 BOB HOPE DRIVE	215	RANCHO MIRAGE	CA	92270	1739	33	06065	33.790527	-116.4058645	Riverside County
50542	Fee-for-Service	1033286919	1033286919	1	1	DELO, WILLIAM J D.O.	10/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6548	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
50547	Fee-for-Service	1124177183	1124177183	1	1	DARKENWALD, KAREN L OD	9/30/1992	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
50558	Fee-for-Service	1063519932	1063519932	1	1	DIAMOND, MAXIMO C MD	3/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74989	41	Internal Medicine	0	In state provider	None	600 CITY PARKWAY WEST	STE 400	ORANGE	CA	92868	2900	30	06059	33.78299646	-117.89694	Orange County
50591	Fee-for-Service	1639145972	1639145972	1	1	DAS, ANINDA MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55664	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11600 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
50625	Fee-for-Service	1740572270	1740572270	1	1	DATTA, SUMIT MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121538	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
50640	Fee-for-Service	1174850622	1174850622	1	1	DAVIS, HUGH C MD	11/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113098	41	Internal Medicine	0	In state provider	None	959 E WALNUT ST	STE 120	PASADENA	CA	91106	1438	19	06037	34.14962102	-118.1305187	Los Angeles County
50685	Fee-for-Service	1689733271	1689733271	1	1	DAVIS, JONG K MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51917	10	Gastroenterology (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
50736	Fee-for-Service	1346785631	1346785631	1	1	DHILLON, MANPREET K NP	10/3/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	481 PLUMAS BLVD	SUITE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
50763	Fee-for-Service	1568416147	1568416147	1	11	DESERT ADVANCED IMAGING MEDI	11/26/2024	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	79440 CORPORATE CENTER D	SUITE 118	LA QUINTA	CA	92253	0000	33	06065	33.70937862	-116.2788139	Riverside County
50792	Fee-for-Service	1508222647	1508222647	1	3	DIGNITY HEALTH MEDICAL FOUND	11/12/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	FL 3	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
50811	Fee-for-Service	1124093968	1124093968	1	1	DELARIA, GIACOMO A MD	1/16/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	17970	01	General Practice	0	In state provider	None	10170 SORRENTO VALLEY RD	STE 200	SAN DIEGO	CA	92121	1604	37	06073	32.88947089	-117.2089084	San Diego County
50829	Fee-for-Service	1447874920	1447874920	1	1	DELGADO, SERGIO MD	4/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192148	None	None	0	In state provider	None	6789 N BLACKSTONE AVE	None	FRESNO	CA	93710	3530	10	06019	36.83695148	-119.7904013	Fresno County
50834	Fee-for-Service	1962676064	1962676064	1	1	DIAMOND NEIGHBORHOODS	5/8/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FAMILY HEALTH CENTER	4725 MARKET STREET	None	SAN DIEGO	CA	92102	4715	37	06073	32.71127386	-117.0929781	San Diego County
50838	Fee-for-Service	1093312373	1093312373	1	1	DANIEL NIKU MD INC	7/23/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	1300 N. VERMONT AVENUE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
50843	Fee-for-Service	1629170501	1629170501	1	1	DESLAURIERS, RICHARD	2/28/1989	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	58870	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
50898	Fee-for-Service	1306519442	1306519442	1	1	DEGA HOME HEALTH	1/29/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6356 VAN NUYS BLVD	SUITE 240	VAN NUYS	CA	91401	2627	19	06037	34.185861	-118.4487045	Los Angeles County
50900	Fee-for-Service	1992379242	1992379242	1	1	DHANANI, KAUSHIK H PT	6/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	79440 CORPORATE CENTER D	None	LA QUINTA	CA	92253	7243	33	06065	33.70937862	-116.2788139	Riverside County
50927	Fee-for-Service	1174850622	1174850622	1	1	DAVIS, HUGH C MD	11/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113098	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	959 E WALNUT ST	STE 120	PASADENA	CA	91106	1438	19	06037	34.14962102	-118.1305187	Los Angeles County
50950	Fee-for-Service	1689748980	1689748980	1	1	DENARI, GREGORY A MD	3/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	38228	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
50961	Fee-for-Service	1265408975	1265408975	1	1	DAVID BICKLER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OAK MEDICAL LLC DBA ADVC	2301 N 44TH ST	None	PHOENIX	AZ	85008	0000	00	None	33.47325	-111.9866535	Maricopa County
50972	Fee-for-Service	1689733271	1689733271	1	1	DAVIS, JONG K MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51917	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
51028	Fee-for-Service	1912494808	1912494808	1	1	DOWNES, WILLIAM MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	163443	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
51045	Fee-for-Service	1265629000	1265629000	1	1	DEWAR, KAREN N MD	5/25/2010	207R00000X	NA	Other	026	PHYSICIANS	93536	41	Internal Medicine	0	In state provider	None	23928 LYONS AVE	STE 205	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
51080	Fee-for-Service	1508222647	1508222647	1	3	DIGNITY HEALTH MEDICAL FOUND	11/12/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	FL 3	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
51090	Fee-for-Service	1629155569	1629155569	1	1	DAMEWOOD, JENIFER J MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50867	05	Anesthesiology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
51099	Fee-for-Service	1124093968	1124093968	1	1	DELARIA, GIACOMO A MD	1/16/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	17970	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10170 SORRENTO VALLEY RD	STE 200	SAN DIEGO	CA	92121	1604	37	06073	32.88947089	-117.2089084	San Diego County
51118	Fee-for-Service	1780068643	1780068643	1	1	DELARAM, BAHAR K LMFT	8/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	STE 550	IRVINE	CA	92612	4694	30	06059	33.650775	-117.838296	Orange County
51235	Fee-for-Service	1598971038	1598971038	1	1	DYGERT, TIMO N MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	520 MEDICAL CENTER DRIVE	STE 200	MEDFORD	OR	97504	4314	00	None	42.318801	-122.831728	Jackson County
51332	Fee-for-Service	1265629000	1265629000	1	1	DEWAR, KAREN N MD	5/25/2010	207R00000X	NA	Other	026	PHYSICIANS	93536	45	Nephrology (Renal-Kidney)	0	In state provider	None	23928 LYONS AVE	STE 205	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
51344	Fee-for-Service	1245438787	1245438787	1	1	DEGUZMAN MEDICAL CORP	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
51366	Fee-for-Service	1508222647	1508222647	1	3	DIGNITY HEALTH MEDICAL FOUND	11/12/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	FL 3	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
51371	Fee-for-Service	1003822503	1003822503	1	1	DANG, PHUONG D MD	3/4/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41535	08	Family Practice	0	In state provider	None	145 INTERNATIONAL BLVD	None	OAKLAND	CA	94606	2233	01	06001	37.7981478	-122.2566386	Alameda County
51391	Fee-for-Service	1548336605	1548336605	1	2	DCOSTA, WALTER F DPM	7/26/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	NKLE CENTER SANTA ROSA	2281 CLEVELAND AVE	None	SANTA ROSA	CA	95403	2905	49	06097	38.461626	-122.728779	Sonoma County
51403	Fee-for-Service	1518359892	1518359892	1	1	DEL VILLAR, ALMI K NP	9/18/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
51404	Fee-for-Service	1487798062	1487798062	1	1	DE SENNA, ELAINE LCSW	4/26/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
51443	Fee-for-Service	1225087182	1225087182	1	1	DUNKELMAN, ANDREA R MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74127	02	General Surgery	0	In state provider	None	1001 NORTH TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
51496	Fee-for-Service	1497179691	1497179691	1	1	DAVE, MONA A MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128510	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
51524	Fee-for-Service	1710175641	1710175641	1	1	DINKINS, GRACIE-ANN MD INC	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	77962	None	None	0	In state provider	None	3628 E IMPERIAL HWY	STE 401	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
51533	Fee-for-Service	1457348617	1457348617	1	1	DYKES, H ROBERT OD	11/22/1980	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	854 EMERALD BAY RD	STE C	SOUTH LAKE TAHOE	CA	96150	6438	09	06017	38.91680713	-120.0091236	El Dorado County
51587	Fee-for-Service	1669557328	1669557328	1	1	DO, VIET M DO	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8443	08	Family Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
51604	Fee-for-Service	1265765259	1265765259	1	1	DOUGLAS, RYAN A LCSW	12/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
51617	Fee-for-Service	1356439657	1356439657	1	1	DROSMAN, STEVEN R MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29515	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3651 4TH AVE	STE 200	SAN DIEGO	CA	92103	4140	37	06073	32.74429738	-117.1615618	San Diego County
51633	Fee-for-Service	1245438787	1245438787	1	1	DEGUZMAN MEDICAL CORP	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
51650	Fee-for-Service	1063457620	1063457620	1	1	DOCS MEDICAL GROUP INC	7/2/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2145 COURT ST	None	REDDING	CA	96001	2531	45	06089	40.57727841	-122.3931992	Shasta County
51658	Fee-for-Service	1225540271	1225540271	1	1	DILLARD, MARIAH G LMFT	8/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
51668	Fee-for-Service	1720137615	1720137615	1	1	DUBICK, FRED H OD INC	1/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	STUDIO EYES OPTOMETRY	3808 W RIVERSIDE DR	STE 100	BURBANK	CA	91505	4339	19	06037	34.15252315	-118.3412174	Los Angeles County
51692	Fee-for-Service	1184796989	1184796989	1	1	DAO, TRAM N MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61386	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
51760	Fee-for-Service	1679816987	1679816987	1	1	DAVE, MIT P MD	12/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
51765	Fee-for-Service	1639116221	1639116221	1	1	DAVID J PORTER	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSOC	1501 S POTOMAC	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
51807	Fee-for-Service	1770522906	1770522906	1	1	DURANT HMA INC	9/8/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1800 W UNIVERSITY BLVD	None	DURANT	OK	74701	3006	00	None	34.007364	-96.393519	Bryan County
51811	Fee-for-Service	1518473552	1518473552	1	1	DIZON, CALEB NP	12/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
51829	Fee-for-Service	1649624636	1649624636	1	1	DIAO, KRISTEN MD	6/6/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153786	None	None	0	In state provider	None	1045 ATLANTIC AVE	STE 605	LONG BEACH	CA	90813	3408	19	06037	33.780267	-118.1850795	Los Angeles County
51848	Fee-for-Service	1790923779	1790923779	1	1	DESANTIS, MOLLY L MD	12/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106008	40	Pediatrics	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
51899	Fee-for-Service	1003879461	1003879461	1	1	DAVITA-RIVERSIDE LLC	8/1/2004	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	27602 CLINTON KEITH RD	None	MURRIETA	CA	92562	8513	33	06065	33.59835529	-117.1790318	Riverside County
51901	Fee-for-Service	1104049378	1104049378	1	1	DANIEL FRANCO MD, INC	12/6/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1800 WESTERN AVE	STE 401	SAN BERNARDINO	CA	92411	1355	36	06071	34.1315778	-117.3182453	San Bernardino County
51924	Fee-for-Service	1902642606	1902642606	1	1	DILAWARI, ERIKA CRNA	9/18/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
51981	Fee-for-Service	1013452234	1013452234	1	1	DR JULIE PHAN OD INC	4/2/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 HARRIMAN PL	None	SAN BERNARDINO	CA	92408	4203	36	06071	34.06663955	-117.262629	San Bernardino County
52003	Fee-for-Service	1346280245	1346280245	1	1	DO, THOMAS M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78702	41	Internal Medicine	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
52026	Fee-for-Service	1548224058	1548224058	1	1	DAMON, LLOYD E MD	10/1/1986	207RH0000X	NA	Hematology	026	PHYSICIANS	51715	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
52052	Fee-for-Service	1790175636	1790175636	1	1	DIAZ, HOLLY M T LMFT	9/18/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD ROAD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
52062	Fee-for-Service	1477625325	1477625325	1	1	DURHAM-O'DONNELL, JANE F	11/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81056	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
52068	Fee-for-Service	1295797322	1295797322	1	1	DAWN, SAMUEL KANG-NIEN	7/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61175	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
52077	Fee-for-Service	1164798153	1164798153	1	1	DESAI, DHAVAL D MD	3/19/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154499	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
52097	Fee-for-Service	1770522906	1770522906	1	1	DURANT HMA INC	9/8/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1800 W UNIVERSITY BLVD	None	DURANT	OK	74701	3006	00	None	34.007364	-96.393519	Bryan County
52103	Fee-for-Service	1922577154	1922577154	1	1	DONOVAN, ANNA E NP	1/19/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	135 CARMEN LN	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
52138	Fee-for-Service	1578524633	1578524633	1	1	DUCHANAN, BENNION D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1050 E SOUTH TEMPLE	None	SALT LAKE CTY	UT	84102	1507	00	None	40.76933651	-111.8610765	Salt Lake County
52143	Fee-for-Service	1366514713	1366514713	1	1	DOLARIAN, HERMINE PT	12/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1480 COLORADO BLVD	STE 130	LOS ANGELES	CA	90041	2373	19	06037	34.13925431	-118.1972852	Los Angeles County
52211	Fee-for-Service	1174113534	1174113534	1	5	DIAGNOSTIC PATHOLOGY LABORAT	3/3/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORY SERVICES, INC.	2000 SUTTER	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
52224	Fee-for-Service	1891984316	1891984316	1	1	DOSHI, NITA MD	11/7/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	92971	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
52232	Fee-for-Service	1801845235	1801845235	1	1	DO, THANH N LCSW	7/21/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
52266	Fee-for-Service	1508065947	1508065947	1	1	DORAN, SHAMSHA V MD	2/1/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	90583	13	Neurology (M.D. only)	0	In state provider	None	11303 W WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
52298	Fee-for-Service	1861570582	1861570582	1	1	DANG, ANH NHI H MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79471	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
52309	Fee-for-Service	1891720090	1891720090	1	1	DELBON ANESTHESIA	10/10/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
52342	Fee-for-Service	1053638171	1053638171	1	1	DOSHI, SEEMA R MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130472	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
52350	Fee-for-Service	1477625325	1477625325	1	1	DURHAM-O'DONNELL, JANE F	11/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81056	40	Pediatrics	0	In state provider	MD	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
52384	Fee-for-Service	1407050297	1407050297	1	1	DI ENNO, LISA R MD	1/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	162286	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
52385	Fee-for-Service	1144338971	1144338971	1	1	DEFILIPPO, RICHARD C LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	770 MAGNOLIA AVE	STE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
52439	Fee-for-Service	1588082135	1588082135	1	1	DEANGELO, SASCHA M MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150405	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
52444	Fee-for-Service	1043380199	1043380199	1	1	DANIELS, STEPHEN J MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42145	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
52451	Fee-for-Service	1720738057	1720738057	1	1	DREILING, JONATHAN T DO	4/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21604	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
52471	Fee-for-Service	1629268917	1629268917	1	1	DAGANZ0, JENIFER V PHD	2/8/2015	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	HEARING SCI OF STONESTOW	595 BUCKINGHAM WAY	STE 437	SAN FRANCISCO	CA	94132	1912	38	06075	37.73012679	-122.4767395	San Francisco County
52474	Fee-for-Service	1760561336	1760561336	1	1	DAVID H.VISKOCHIL M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
52510	Fee-for-Service	1891984316	1891984316	1	1	DOSHI, NITA MD	11/7/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	92971	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
52524	Fee-for-Service	1124085378	1124085378	1	1	DILISIO, RALPH E MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87397	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	585 W COLLEGE AVE	None	SANTA ROSA	CA	95401	5000	49	06097	38.445903	-122.735601	Sonoma County
52527	Fee-for-Service	1932132941	1932132941	1	1	DILEO, STEVEN J MD	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55921	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
52532	Fee-for-Service	1942299292	1942299292	1	1	DUKIN, OLEG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2209 GENESEE ST	None	UTICA	NY	13501	5930	00	None	43.08264	-75.266046	Oneida County
52549	Fee-for-Service	1295813798	1295813798	1	1	DIEHN, JENNIFER J MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84115	18	Ophthalmology	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
52555	Fee-for-Service	1255599130	1255599130	1	1	DESIMONE, DENNIS C DO	4/13/2020	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17849	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	782 MEDICAL CENTER DR E	STE 212	CLOVIS	CA	93611	6889	10	06019	36.84379626	-119.6609117	Fresno County
52617	Fee-for-Service	1669297685	1669297685	1	1	DAWA PHARMACY INC	1/14/2025	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20540 E ARROW HWY	D	COVINA	CA	91724	1208	19	06037	34.10659351	-117.853677	Los Angeles County
52621	Fee-for-Service	1306257456	1306257456	1	1	DISKIN, BRIAN E MD	12/13/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
52653	Fee-for-Service	1639189715	1639189715	1	1	DEAS, BRUCE MD	1/29/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	67934	None	None	0	In state provider	None	5176 HILL RD E	None	LAKEPORT	CA	95453	6300	17	06033	39.10557408	-122.9078316	Lake County
52655	Fee-for-Service	1023372349	1023372349	1	1	DE LA PARRA LANDA, ALEJANDRO	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143224	01	General Practice	0	In state provider	MD	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
52689	Fee-for-Service	1174614218	1174614218	1	1	DESAI, UMA S MD	9/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54279	01	General Practice	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
52693	Fee-for-Service	1053341669	1053341669	1	1	DIETRICH, DANIEL S MD	10/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	95731	30	Radiology	0	In state provider	None	546 E PINE ST	None	STOCKTON	CA	95204	5525	39	06077	37.97459526	-121.2889389	San Joaquin County
52721	Fee-for-Service	1295952810	1295952810	1	1	DICKERSON, KARENNA A MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146775	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
52730	Fee-for-Service	1780773960	1780773960	1	1	DHILLON, DAVINDER P S MD	3/9/2010	207RC0200X	NA	Other	026	PHYSICIANS	73500	41	Internal Medicine	0	In state provider	None	1162 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528873	-121.6208232	Sutter County
52764	Fee-for-Service	1699787911	1699787911	1	1	DAVID MICHAEL SAHLSTROM, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	251 5TH ST E	None	TRACY	MN	56175	1536	00	None	44.23239352	-95.60679229	Lyon County
52775	Fee-for-Service	1174731004	1174731004	1	1	DIEKER JR, STEPHEN R MD	6/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116949	05	Anesthesiology	0	In state provider	None	2752 HARRISON AVE	STE A	EUREKA	CA	95501	4738	12	06023	40.7831071	-124.139684	Humboldt County
52815	Fee-for-Service	1154971018	1154971018	1	1	DEL REFUGIO HEALTHCARE INC	8/31/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4800 S CENTRAL AVE	SUITE B	LOS ANGELES	CA	90011	5459	19	06037	33.999678	-118.2564515	Los Angeles County
52830	Fee-for-Service	1811061351	1811061351	1	1	DANIEL, DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86807	05	Anesthesiology	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
52839	Fee-for-Service	1255599130	1255599130	1	1	DESIMONE, DENNIS C DO	4/13/2020	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17849	15	Obstetrics (D.O. only)	0	In state provider	None	782 MEDICAL CENTER DR E	STE 212	CLOVIS	CA	93611	6889	10	06019	36.84379626	-119.6609117	Fresno County
52842	Fee-for-Service	1053354597	1053354597	1	1	DIAZ, RODNEY C MD	6/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74869	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
52883	Fee-for-Service	1972766657	1972766657	1	1	DEKERMENJIAN, RONY MD	12/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120917	13	Neurology (M.D. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	9998	33	06065	33.9760587	-117.3800672	Riverside County
52902	Fee-for-Service	1548336605	1548336605	1	3	DCOSTA, WALTER F DPM	7/26/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2281 CLEVELAND AVE	None	SANTA ROSA	CA	95403	2905	49	06097	38.461626	-122.728779	Sonoma County
52907	Fee-for-Service	1710447818	1710447818	1	1	DHANOA, JASKIRAT S MD	2/10/2023	207P00000X	NA	Other	026	PHYSICIANS	179224	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
52922	Fee-for-Service	1083256036	1083256036	1	1	DEVINE HOSPICE CARE INC	9/18/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20945 DEVONSHIRE BLVD	STE 201C	CHATSWORTH	CA	91311	2370	19	06037	34.25727552	-118.5901965	Los Angeles County
52936	Fee-for-Service	1386655066	1386655066	1	1	DOWLING, PATRICK T MD	5/10/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	33975	08	Family Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
52942	Fee-for-Service	1457857229	1457857229	1	1	DI, WAI TAN MD	9/24/2021	207P00000X	NA	Other	026	PHYSICIANS	174600	None	None	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
52949	Fee-for-Service	1902853344	1902853344	1	1	DAVIS, KELLE L	12/21/2005	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	330 W FELICITA AVE	STE A4	ESCONDIDO	CA	92025	6531	37	06073	33.10430078	-117.0738922	San Diego County
52967	Fee-for-Service	1194775874	1194775874	1	1	DE SOUZA, LUCIARA MD	12/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4203	30	06059	33.78029455	-117.864369	Orange County
52978	Fee-for-Service	1174614218	1174614218	1	1	DESAI, UMA S MD	9/9/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54279	08	Family Practice	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
53018	Fee-for-Service	1780773960	1780773960	1	1	DHILLON, DAVINDER P S MD	3/9/2010	207RC0200X	NA	Other	026	PHYSICIANS	73500	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1162 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14528873	-121.6208232	Sutter County
53088	Fee-for-Service	1245303106	1245303106	1	1	DUMITRESCU, OVIDIU I MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63744	41	Internal Medicine	0	In state provider	CPMC DAVIES CAMPUS	45 CASTRO ST	None	SAN FRANCISCO	CA	94114	1010	38	06075	37.76829732	-122.4357056	San Francisco County
53102	Fee-for-Service	1629065438	1629065438	1	1	DAVISON, JAMES MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8811 VILLAGE DRIVE	None	SAN ANTONIO	TX	78217	5415	00	None	29.52050008	-98.42777396	Bexar County
53127	Fee-for-Service	1518455013	1518455013	1	1	DEVALLE, NICOLE C MD	9/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	158195	08	Family Practice	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
53192	Fee-for-Service	1780630467	1780630467	1	1	DEA, MELVIN K MD	12/26/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	87461	18	Ophthalmology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
53200	Fee-for-Service	1366931339	1366931339	1	1	DR C SHOHAM PSYCHOLOGICAL	11/16/2018	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICES	9454 WILSHIRE BLVD	STE PH24	BEVERLY HILLS	CA	90212	2931	19	06037	34.06704553	-118.3986765	Los Angeles County
53206	Fee-for-Service	1811347453	1811347453	1	1	DE LA TORRE, BRENDA I LCSW	11/29/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
53208	Fee-for-Service	1073755898	1073755898	1	1	DARDENELLE, SONJA I MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154574	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
53213	Fee-for-Service	1083256036	1083256036	1	1	DEVINE HOSPICE CARE INC	9/18/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20945 DEVONSHIRE BLVD	STE 201C	CHATSWORTH	CA	91311	2370	19	06037	34.25727552	-118.5901965	Los Angeles County
53224	Fee-for-Service	1386655066	1386655066	1	1	DOWLING, PATRICK T MD	5/10/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	33975	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
53259	Fee-for-Service	1447516398	1447516398	1	1	DI TOMASSO, DOMINIC MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128668	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
53288	Fee-for-Service	1518998723	1518998723	1	3	DRS. MISHAL, PHAM & ASSOCIAT	4/9/2021	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES	8500 FLORENCE AVE.	None	DOWNEY	CA	90240	4056	19	06037	33.94970699	-118.1216339	Los Angeles County
53298	Fee-for-Service	1821176512	1821176512	1	1	DEEBLE, THOMAS A MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	43390	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7275 E SOUTHGATE DR	STE 401	SACRAMENTO	CA	95823	2632	34	06067	38.493576	-121.436559	Sacramento County
53306	Fee-for-Service	1073580577	1073580577	1	1	DAVULURI, PAVAN K MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55171	05	Anesthesiology	0	In state provider	None	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
53358	Fee-for-Service	1962500058	1962500058	1	1	DOO, BRYAN MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65648	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
53371	Fee-for-Service	1720108780	1720108780	1	1	DARSHAN, DAVID A	6/14/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
53381	Fee-for-Service	1245388172	1245388172	1	1	DAVIS, VERONICA CRNA	6/9/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53397	Fee-for-Service	1891351615	1891351615	1	1	DE RANIERI, MARCUS A DO	7/12/2022	163WX0003X	NA	Other	026	PHYSICIANS	19483	None	None	0	In state provider	None	600 MAIN ST	None	SOLEDAD	CA	93960	2533	27	06053	36.43281182	-121.3243597	Monterey County
53420	Fee-for-Service	1437457645	1437457645	1	1	DAISY HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1139 CIRBY WAY	None	ROSEVILLE	CA	95661	4421	31	06061	38.72951845	-121.275225	Placer County
53432	Fee-for-Service	1174030712	1174030712	1	1	DEOLASO, CHERRY M CNP	8/7/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7740 RANCHO SANTA FE RD	None	CARLSBAD	CA	92009	8685	37	06073	33.08100093	-117.2372485	San Diego County
53461	Fee-for-Service	1588800163	1588800163	1	1	DOYLE, MEGAN A LCSW	8/29/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
53467	Fee-for-Service	1023100039	1023100039	1	1	DOHRENWEND, PAUL B MD	9/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93014	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
53471	Fee-for-Service	1851354831	1851354831	1	1	DOUNIES, RUSSELL L MD	8/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	56621	02	General Surgery	0	In state provider	None	205 S WEST ST	STE C	VISALIA	CA	93291	6112	54	06107	36.329031	-119.296782	Tulare County
53474	Fee-for-Service	1619473204	1619473204	1	1	DAVID, JASON W MD	11/15/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
53477	Fee-for-Service	1821331034	1821331034	1	1	DEHAYBI, SARAH L MD	9/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147706	18	Ophthalmology	0	In state provider	None	1899 W MARCH LANE	None	STOCKTON	CA	95207	6402	39	06077	37.9873599	-121.3290151	San Joaquin County
53501	Fee-for-Service	1881951127	1881951127	1	1	DJAPRI, CHRISTINE M MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138533	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3440 W LOMITA BLVD	SUITE 346	TORRANCE	CA	90505	4820	19	06037	33.81328127	-118.3452927	Los Angeles County
53535	Fee-for-Service	1144601485	1144601485	1	1	DEGEORGE, TIMOTHY P	11/23/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
53574	Fee-for-Service	1841713195	1841713195	1	1	DEGROOT, JAMES M CRNA	2/27/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
53579	Fee-for-Service	1750580189	1750580189	1	1	DESAI, JAY R MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119605	30	Radiology	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
53597	Fee-for-Service	1801094834	1801094834	1	1	DESAI, NILIMA N MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	98193	01	General Practice	0	In state provider	None	2400 BALFOUR RD	STE 120	BRENTWOOD	CA	94513	4956	07	06013	37.92519383	-121.734461	Contra Costa County
53616	Fee-for-Service	1093863060	1093863060	1	1	DAMLE, VEENA P MD	11/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	36982	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
53621	Fee-for-Service	1154538692	1154538692	1	1	DR. CAREY LEE GUIDRY M.D.	5/9/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 SPRINGHILL DR	None	N LITTLE ROCK	AR	72117	2922	00	None	34.783704	-92.2230765	Pulaski County
53638	Fee-for-Service	1114122520	1114122520	1	1	DONOHUE, LEE T MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113680	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
53663	Fee-for-Service	1770921942	1770921942	1	1	DANG, JENNIFER A OD FAAO	7/28/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
53667	Fee-for-Service	1750312484	1750312484	1	1	DEVINENI, RAMA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5950 S COOPER RD	STE 4	CHANDLER	AZ	85249	2221	00	None	33.219963	-111.8071035	Maricopa County
53672	Fee-for-Service	1821215302	1821215302	1	1	DAVOUDI, SASSAN MD	12/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90942	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
53676	Fee-for-Service	1336469212	1336469212	1	1	DANCY-CABEAL, KRYSTA LMFT	6/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1648 DRUMMOND LN	None	LINCOLN	CA	95648	2935	31	06061	38.87900946	-121.312215	Placer County
53678	Fee-for-Service	1316971641	1316971641	2	1	DAVITA RIVERSIDE II, LLC	11/1/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11161 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3605	33	06065	33.90246598	-117.4783025	Riverside County
53688	Fee-for-Service	1255405858	1255405858	1	1	DULONG, MARK J MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	62896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
53692	Fee-for-Service	1780639385	1780639385	1	1	DAVIDSON, LEE MD	6/12/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
53778	Fee-for-Service	1871574350	1871574350	1	1	DORAISWAMY, ASOK MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82284	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
53815	Fee-for-Service	1033768924	1033768924	1	1	DAVIDIAN, TALIN V OD	2/4/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
53871	Fee-for-Service	1063551885	1063551885	1	1	DUONG, DUC H MD INC	10/1/2007	207T00000X	NA	General Surgery	026	PHYSICIANS	84028	14	Neurological Surgery	0	In state provider	None	1045 ATLANTIC AVE	STE 619	LONG BEACH	CA	90813	3425	19	06037	33.780267	-118.1850795	Los Angeles County
53893	Fee-for-Service	1568416147	1568416147	1	7	DESERT ADVANCED IMAGING MEDI	9/23/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	35800 BOB HOPE DRIVE	STE 150B	RANCHO MIRAGE	CA	92270	1722	33	06065	33.790527	-116.4058645	Riverside County
53901	Fee-for-Service	1124464300	1124464300	1	1	DODD, DYLAN MD	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131932	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53961	Fee-for-Service	1811922297	1811922297	1	1	DEANTONIO, CARLO MD	10/31/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71700	40	Pediatrics	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
54020	Fee-for-Service	1558759605	1558759605	1	1	DAVIS, CONSUELO V LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
54062	Fee-for-Service	1851950257	1851950257	1	1	DICKERSON, STEVEN D DPM	8/9/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2345 E 8TH ST	SUITE 105	NATIONAL CITY	CA	91950	2866	37	06073	32.68268563	-117.082682	San Diego County
54069	Fee-for-Service	1710039524	1710039524	1	1	DICENZO, DONNA M MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64590	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PERMANENTE MEDICAL GROUP	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
54082	Fee-for-Service	1134293038	1134293038	1	1	DEL PUEBLO MEDICAL GROUP	5/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	10200 MAIN ST	None	LAMONT	CA	93241	1700	15	06029	35.262594	-118.914516	Kern County
54096	Fee-for-Service	1144225426	1144225426	1	5	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ICAL GROUP INC	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
54143	Fee-for-Service	1295827780	1295827780	1	1	DEGC ENTERPRISES(US)IN	5/20/2013	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	14255 49TH ST NORTH	STE 301	CLEARWATER	FL	33762	2813	00	None	27.90171	-82.698075	Pinellas County
54206	Fee-for-Service	1245626613	1245626613	1	1	DARIO, JONATHAN MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153506	01	General Practice	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
54214	Fee-for-Service	1598384968	1598384968	1	1	DAVIS, RENEE C LMFT	9/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
54233	Fee-for-Service	1548490964	1548490964	1	1	DELOA, ANGELIKA MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	121429	08	Family Practice	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
54257	Fee-for-Service	1467945295	1467945295	1	1	DUDUMOV, NIKOLAY CRNA	12/12/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3630 EAST IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
54265	Fee-for-Service	1225528466	1225528466	1	1	DUONG, KHANH T MD	11/29/2021	207R00000X	NA	Other	026	PHYSICIANS	174153	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
54310	Fee-for-Service	1497852354	1497852354	1	1	DAVIS, DENISE E LMFT	11/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17772 IRVINE BLVD	STE 202	TUSTIN	CA	92780	3234	30	06059	33.74824746	-117.8220736	Orange County
54325	Fee-for-Service	1437583648	1437583648	1	1	DUGGAL, JASLEEN MD INC A	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113472	None	None	0	In state provider	PROFESSIONAL CORPORATION	3008 SILLECT AVENUE	SUITE 100	BAKERSFIELD	CA	93308	6360	15	06029	35.38608607	-119.0398799	Kern County
54331	Fee-for-Service	1932305034	1932305034	1	1	DAO, QUYEN MD	2/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85506	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
54338	Fee-for-Service	1972600856	1972600856	1	1	DINH, DINH VAN	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5768	01	General Practice	0	In state provider	None	14291 EUCLID ST	STE D112	GARDEN GROVE	CA	92843	4985	30	06059	33.755166	-117.937627	Orange County
54370	Fee-for-Service	1134293038	1134293038	1	1	DEL PUEBLO MEDICAL GROUP	5/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	10200 MAIN ST	None	LAMONT	CA	93241	1700	15	06029	35.262594	-118.914516	Kern County
54381	Fee-for-Service	1144225426	1144225426	1	5	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ICAL GROUP INC	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
54428	Fee-for-Service	1457895336	1457895336	1	1	DE CRAIG RANCH, LLC	8/26/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ICAN SAHARA CAMPUS	4980 W SAHARA AVE	None	LAS VEGAS	NV	89102	3462	00	None	36.14463148	-115.2088605	Clark County
54508	Fee-for-Service	1487732962	1487732962	1	1	DON, RICHARD J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39219	40	Pediatrics	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
54537	Fee-for-Service	1699503623	1699503623	1	1	DOROKHIN, SOFIYA AU	11/13/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
54572	Fee-for-Service	1356784573	1356784573	1	1	DIEP, JENNIFER E MD	2/4/2021	207PP0204X	NA	Other	026	PHYSICIANS	160987	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
54600	Fee-for-Service	1902513559	1902513559	1	1	DEVERICH, SERENA CNP	2/23/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
54623	Fee-for-Service	1275608374	1275608374	2	1	DEWAR, SENECA T MD	3/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33700	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	SUITE 124	SAN BERNARDINO	CA	92404	3854	36	06071	34.1358627	-117.2757898	San Bernardino County
54670	Fee-for-Service	1144225426	1144225426	1	5	DESERT TRAUMA SURGEONS INC	2/6/2024	2086S0102X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ICAL GROUP INC	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
54712	Fee-for-Service	1457895336	1457895336	1	1	DE CRAIG RANCH, LLC	8/26/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ICAN SAHARA CAMPUS	4980 W SAHARA AVE	None	LAS VEGAS	NV	89102	3462	00	None	36.14463148	-115.2088605	Clark County
54719	Fee-for-Service	1457457160	1457457160	1	1	DRUMMER, HARRIET L DO	11/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7014	18	Ophthalmology	0	In state provider	None	652 MAIN STREET	None	PLACERVILLE	CA	95667	5507	09	06017	38.72950087	-120.7940041	El Dorado County
54751	Fee-for-Service	1962116103	1962116103	1	1	DISABAR, SIMRAN NP	3/7/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
54791	Fee-for-Service	1417011289	1417011289	1	2	DOROUGH, DAN M MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60866	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	722 MEDICAL CENTER DR E	STE 101	CLOVIS	CA	93611	6810	10	06019	36.84107334	-119.6587409	Fresno County
54864	Fee-for-Service	1922049188	1922049188	1	1	DASTMALCHI, OWRANG DO	1/22/2019	208M00000X	NA	Other	026	PHYSICIANS	8369	41	Internal Medicine	0	In state provider	None	26991 CROWN VALLEY PKWY	100	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
54867	Fee-for-Service	1376547000	1376547000	1	1	DAM, MICHAEL MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75506	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
54889	Fee-for-Service	1538569793	1538569793	1	1	DIABLO MEDICAL & SLEEP	6/9/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC MEDICAL CORPORATI	2150 APPIAN WAY	SUITE 102	PINOLE	CA	94564	2583	07	06013	37.9958468	-122.3021554	Contra Costa County
54916	Fee-for-Service	1508555970	1508555970	1	1	DYNAMIC ABILITIES PEDIATRIC	8/28/2023	225XP0200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	950 BOARDWALK STE 204	None	SAN MARCOS	CA	92078	2600	37	06073	33.13639634	-117.1870622	San Diego County
54997	Fee-for-Service	1740200138	1740200138	1	1	DARDICK, LAWRENCE D MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	48334	01	General Practice	0	In state provider	None	2424 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5806	19	06037	34.03455172	-118.4792084	Los Angeles County
55008	Fee-for-Service	1548799117	1548799117	1	1	DUNN, ERIN C MD	7/8/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55009	Fee-for-Service	1457457160	1457457160	1	1	DRUMMER, HARRIET L DO	11/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7014	08	Family Practice	0	In state provider	None	652 MAIN STREET	None	PLACERVILLE	CA	95667	5507	09	06017	38.72950087	-120.7940041	El Dorado County
55089	Fee-for-Service	1255405825	1255405825	1	1	DEL CASTILLO, SILVIO A	4/3/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8074	08	Family Practice	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
55106	Fee-for-Service	1356557284	1356557284	1	1	DE JESUS, LILIA C MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121019	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55135	Fee-for-Service	1093743874	1093743874	1	1	DOOR CTY MEMORIAL HOSP	8/22/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 S 18TH AVE	None	STURGEON BAY	WI	54235	1401	00	None	44.83271939	-87.35147712	Door County
55154	Fee-for-Service	1376547000	1376547000	1	1	DAM, MICHAEL MD	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75506	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
55178	Fee-for-Service	1497863567	1497863567	1	1	DOYLE, RAMONA L MD	1/31/1992	207RP1001X	NA	Pulmonology	026	PHYSICIANS	68150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
55203	Fee-for-Service	1508555970	1508555970	1	1	DYNAMIC ABILITIES PEDIATRIC	8/28/2023	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	950 BOARDWALK STE 204	None	SAN MARCOS	CA	92078	2600	37	06073	33.13639634	-117.1870622	San Diego County
55218	Fee-for-Service	1205456092	1205456092	1	1	DUONG, DANIEL DO	12/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21099	None	None	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
55229	Fee-for-Service	1346701802	1346701802	1	1	DURAZO, RAMON A MD	2/11/2025	207R00000X	NA	Other	026	PHYSICIANS	179121	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
55320	Fee-for-Service	1962790014	1962790014	1	6	DIGNITY HEALTH MEDICAL FOUND	10/17/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3259 PIERCE STREET	None	SAN FRANCISCO	CA	94123	2705	38	06075	37.80019536	-122.4395129	San Francisco County
55362	Fee-for-Service	1154409035	1154409035	1	1	DOKICH, SRETENKA MD	8/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51447	40	Pediatrics	0	In state provider	None	17577 ARROW BLVD	None	FONTANA	CA	92335	4011	36	06071	34.09938951	-117.421272	San Bernardino County
55375	Fee-for-Service	1740475664	1740475664	1	1	DAMAJ, NOUHAD B MD	5/27/2008	193400000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	HORIZON VIEW MEDICAL CTR	6850 N DURANGO DR	STE 301	LAS VEGAS	NV	89149	4597	00	None	36.285876	-115.285266	Clark County
55388	Fee-for-Service	1538294103	1538294103	1	1	DIEHL, PAUL E MD AMC	11/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44437	41	Internal Medicine	0	In state provider	None	7320 WOODLAKE AVE	SUITE 270	WEST HILLS	CA	91307	1470	19	06037	34.20245266	-118.6321273	Los Angeles County
55393	Fee-for-Service	1356557284	1356557284	1	1	DE JESUS, LILIA C MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121019	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
55407	Fee-for-Service	1669955969	1669955969	1	1	DELATORRE, MARK A RRT	4/16/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
55427	Fee-for-Service	1760469209	1760469209	1	3	DIGESTIVE AND LIVER DISEASE	5/17/2022	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPECIALISTS A MEDICAL GR	14342 RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08608595	-117.9612248	Los Angeles County
55476	Fee-for-Service	1447257589	1447257589	1	1	DONG, PAUL R MD	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	72371	30	Radiology	0	In state provider	None	2801 L ST	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
55593	Fee-for-Service	1194864892	1194864892	1	1	DINI, SAEED, K MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52325	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
55628	Fee-for-Service	1093987281	1093987281	1	1	DANKO, REKA P MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
55633	Fee-for-Service	1588688824	1588688824	1	1	DESAI, SANDHYA MD	10/1/1995	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	49458	08	Family Practice	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
55729	Fee-for-Service	1043769474	1043769474	1	1	DEARING, CONNOR LCSW	5/16/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
55832	Fee-for-Service	1669784443	1669784443	1	1	DIAZ, GERALD M MD	6/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126359	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
55834	Fee-for-Service	1093948119	1093948119	1	1	DUVALL, ELIZABETH M PSYD	3/17/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1101 N PACIFIC AVE	SUITE 204	GLENDALE	CA	91202	3250	19	06037	34.16078708	-118.2644824	Los Angeles County
55837	Fee-for-Service	1750457909	1750457909	1	1	DOLEMAN, JEFFREY J	6/4/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
55862	Fee-for-Service	1679850671	1679850671	1	1	DAVIES, SUMMER R NP	7/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55873	Fee-for-Service	1831166651	1831166651	1	1	DALLAFIOR, DAVID E MD	6/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
55942	Fee-for-Service	1316024276	1316024276	1	1	DAVID, PAUL R MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60647	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
55948	Fee-for-Service	1003373721	1003373721	1	1	DANNY'S ANGELS LLC	11/25/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	81 SOLEDAD DR	None	MONTEREY	CA	93940	6037	27	06053	36.58566104	-121.9048682	Monterey County
55960	Fee-for-Service	1669823662	1669823662	1	1	DAVIS, JUSTIN L MD	7/30/2020	207P00000X	NA	Other	026	PHYSICIANS	18362	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
56010	Fee-for-Service	1003834789	1003834789	1	1	DESILVA, NIHAL MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135933	36	Psychiatry	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
56021	Fee-for-Service	1184986200	1184986200	1	1	DAI, RAN MD	2/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152215	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
56071	Fee-for-Service	1417275256	1417275256	1	1	DHAR, MRINAL MD	9/13/2017	208800000X	NA	Other	026	PHYSICIANS	144304	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
56092	Fee-for-Service	1770302135	1770302135	1	1	DOULAS PARTNER	10/3/2024	374J00000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	45	06089	0	0	None
56104	Fee-for-Service	1629162698	1629162698	1	1	DIMAUNAHAN, CLARE A MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	76204	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
56115	Fee-for-Service	1619196755	1619196755	1	1	DONALDSON, DAVID M MD	8/21/2019	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	163052	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
56125	Fee-for-Service	1790099752	1790099752	1	1	DAVIES, AKEMI N	5/6/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
56161	Fee-for-Service	1295102887	1295102887	1	2	DAWOODIAN, ALEX DPM	1/8/2025	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
56179	Fee-for-Service	1487230249	1487230249	1	1	DATUIN, ERIEL MD	10/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	29472 AVE DE LAS BANDERA	None	RANCHO SANTA MARG	CA	92688	2651	30	06059	33.620238	-117.610578	Orange County
56286	Fee-for-Service	1215943816	1215943816	1	1	DIETRICH, STEPHEN L MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50308	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
56356	Fee-for-Service	1265995187	1265995187	1	1	DEHGHANI, SEPEHR DO	8/11/2023	207L00000X	NA	Other	026	PHYSICIANS	20764	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
56374	Fee-for-Service	1881647188	1881647188	1	1	DELIWALA, TEJAS P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3 PLAZA DR	STE 13	TOMS RIVER	NJ	08757	3765	00	None	39.97008291	-74.24463617	Ocean County
56416	Fee-for-Service	1558337352	1558337352	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8635 W 3RD ST	STE 560W	LOS ANGELES	CA	90048	6110	19	06037	34.07361928	-118.3803143	Los Angeles County
56456	Fee-for-Service	1306460712	1306460712	1	1	DEAN, ERIN HART PT	3/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2838 OSWELL ST	None	BAKERSFIELD	CA	93306	2704	15	06029	35.39923633	-118.9499418	Kern County
56486	Fee-for-Service	1275707598	1275707598	1	1	DANG, UYEN N MD	10/19/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	103358	08	Family Practice	0	In state provider	None	23512 MADERO RD	None	MISSION VIEJO	CA	92691	2743	30	06059	33.62192373	-117.6765103	Orange County
56514	Fee-for-Service	1790892669	1790892669	1	1	DEW, ANN L DO	12/14/1990	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	5940	01	General Practice	0	In state provider	None	7140 INDIANA AVE	None	RIVERSIDE	CA	92502	2878	33	06065	33.93890182	-117.3977958	Riverside County
56586	Fee-for-Service	1134626187	1134626187	1	1	DHIR, YATIN N DO	7/12/2021	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	18868	None	None	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
56620	Fee-for-Service	1710407531	1710407531	1	1	DUBE, AMANDA R MD	7/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177532	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
56629	Fee-for-Service	1366442147	1366442147	1	1	DEVOE, ROBERT P MD	6/23/1989	207L00000X	NA	Other	026	PHYSICIANS	50205	05	Anesthesiology	0	In state provider	None	3939 J ST	STE 310	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
56652	Fee-for-Service	1205003233	1205003233	1	1	DOWNER, CHRISTOPHER D MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103785	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2210 E ILLINOIS AVE	STE 508	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
56655	Fee-for-Service	1386853026	1386853026	1	1	DANESHVAR, RAHI R MD	11/19/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	116728	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
56692	Fee-for-Service	1689033110	1689033110	1	1	DOLLARD, HANNA H	8/31/2015	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2550 23RD ST	BLDG 9, SUITE 119	SAN FRANCISCO	CA	94110	3504	38	06075	37.75436504	-122.4056861	San Francisco County
56702	Fee-for-Service	1154733079	1154733079	1	1	DHILLON, SARA MD	11/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168871	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
56729	Fee-for-Service	1992016463	1992016463	1	1	DAYSTAR HEARING AID CENTER	3/24/2010	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	INC	5290 LONG BEACH BLVD	None	LONG BEACH	CA	90805	5860	19	06037	33.85205986	-118.195772	Los Angeles County
56735	Fee-for-Service	1659430262	1659430262	1	1	DOR, KATHLEEN T MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75359	08	Family Practice	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
56758	Fee-for-Service	1285681056	1285681056	1	1	DUVERNAY, VIRGIL H MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	45858	41	Internal Medicine	0	In state provider	None	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
56824	Fee-for-Service	1851590012	1851590012	1	1	DEYHIM, ALI DPM	8/12/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2504 HARRISON AVE	A	EUREKA	CA	95501	3236	12	06023	40.785408	-124.139668	Humboldt County
56869	Fee-for-Service	1518377985	1518377985	1	1	DERKSEN, BRENNA J MD	6/27/2018	207P00000X	NA	Other	026	PHYSICIANS	140594	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
56903	Fee-for-Service	1518300060	1518300060	1	1	DEKOM, STEPHANIE A MD	7/29/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	132802	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
56911	Fee-for-Service	1609468362	1609468362	1	1	DODANGODA ARACHCHIGE, PRAMOD	10/6/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	A M	4045 LONE TREE WAY	D	ANTIOCH	CA	94531	6206	07	06013	37.976122	-121.8012402	Contra Costa County
56940	Fee-for-Service	1316635436	1316635436	1	1	DOZAL, CAROLINA	8/17/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
57010	Fee-for-Service	1396454120	1396454120	1	1	DAMEYER, JOSIE PHD	5/6/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13 BROADWAY	None	KENTFIELD	CA	94904	1506	21	06041	37.95465458	-122.5423461	Marin County
57051	Fee-for-Service	1871623280	1871623280	1	2	DIABETES CARE PHARMACY	12/16/2020	261QH0100X	NA	Other	102	DIABETES PREVENTION PROGRAM SUPPLIER	-	-	NOT APPLICABLE	0	In state provider	None	336 1/2 S GLENDORA AVE	STE C	WEST COVINA	CA	91790	3060	19	06037	34.06834181	-117.924157	Los Angeles County
57063	Fee-for-Service	1467680264	1467680264	1	1	DOI, CLARISSA A MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120758	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
57070	Fee-for-Service	1225402332	1225402332	1	1	DONNELLY, ELIZABETH A B CNM	12/27/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
57073	Fee-for-Service	1144312125	1144312125	1	1	DASS, SHARAD K MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70405	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
57127	Fee-for-Service	1518687763	1518687763	1	1	DOSOVITSKY, GILLY	12/9/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
57141	Fee-for-Service	1972782258	1972782258	1	1	DURDEN, CRYSTAL LMFT	7/8/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
57161	Fee-for-Service	1003902081	1003902081	1	1	DALUVOY, RAO V	12/1/2003	208600000X	NA	General Surgery	026	PHYSICIANS	32269	None	None	0	In state provider	SURGICAL CARE A PROF MED	805 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3033	36	06071	34.89343047	-117.0171832	San Bernardino County
57249	Fee-for-Service	1750739215	1750739215	1	1	DAAR, DAVID A MD	8/9/2023	2086S0122X	NA	General Surgery	026	PHYSICIANS	177410	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
57272	Fee-for-Service	1568993640	1568993640	1	1	DETHIER, DIVYA MD	10/16/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187388	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
57285	Fee-for-Service	1790998789	1790998789	1	1	DAVID C GRIFFIN JR MD	5/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5169 S COTTONWOOD ST	None	MURRAY	UT	84107	6767	00	None	40.658895	-111.891447	Salt Lake County
57364	Fee-for-Service	1891741518	1891741518	1	1	DUECK, RONALD MD	9/30/1982	207L00000X	NA	Other	026	PHYSICIANS	25120	05	Anesthesiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
57389	Fee-for-Service	1144688078	1144688078	1	1	DROUIN, JUDITH M MFT	2/22/2016	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	95 N BROOKSHIRE AVE	None	VENTURA	CA	93003	2401	56	06111	34.28033189	-119.2121915	Ventura County
57402	Fee-for-Service	1225094469	1225094469	1	1	DHANUKA, PROMILA MD INC	1/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95171	68	Hematology	0	In state provider	None	2510 AIRPARK DR	STE 103	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
57420	Fee-for-Service	1043267800	1043267800	1	1	DENG, QUANMEI MD	4/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146437	None	None	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
57424	Fee-for-Service	1013357813	1013357813	1	1	DAO, CHRISTINE N MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132692	01	General Practice	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
57541	Fee-for-Service	1871159137	1871159137	1	1	DONOHO, HALLE K OT	3/27/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1901 CARNEGIE AVE	SUITE 1-C	SANTA ANA	CA	92705	5504	30	06059	33.711615	-117.8416035	Orange County
57572	Fee-for-Service	1811449598	1811449598	1	1	DR. TIN S WONG DO MEDICAL CO	5/9/2017	261QH0100X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	RPORATION	711 W COLLEGE ST STE 208	None	LOS ANGELES	CA	90012	1093	19	06037	34.06541412	-118.2414102	Los Angeles County
57600	Fee-for-Service	1427412451	1427412451	1	1	DELIGERO, PATRICK H MD	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	151285	None	None	0	In state provider	None	117 E LIVE OAK AVE	STE 101	ARCADIA	CA	91006	5271	19	06037	34.10801594	-118.0269719	Los Angeles County
57657	Fee-for-Service	1295148328	1295148328	1	1	DIGDIGAN, LEEVANEIGH C MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136165	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
57680	Fee-for-Service	1801229794	1801229794	1	1	DOYLE, JACLYN S NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
57681	Fee-for-Service	1144427568	1144427568	1	1	DADGOSTAR, HAJIR, MD	9/1/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	90804	18	Ophthalmology	0	In state provider	None	16500 VENTURA BLVD	STE 250	ENCINO	CA	91436	2018	19	06037	34.15756758	-118.4926374	Los Angeles County
57689	Fee-for-Service	1225094469	1225094469	1	1	DHANUKA, PROMILA MD INC	1/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95171	78	Neoplastic Diseases/Oncology	0	In state provider	None	2510 AIRPARK DR	STE 103	REDDING	CA	96001	2461	45	06089	40.57119566	-122.4016582	Shasta County
57711	Fee-for-Service	1811164742	1811164742	1	1	DIAZ, ROBERTO MD	2/24/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	DIAZ MEDICAL GROUP	1828 EL CAMINO REAL	STE 601	BURLINGAME	CA	94010	3120	41	06081	37.59552262	-122.3838771	San Mateo County
57804	Fee-for-Service	1609188374	1609188374	1	1	DELLING, LETICIA J LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27201 TOURNEY RD	STE 225	VALENCIA	CA	91355	1804	19	06037	34.41741018	-118.5770409	Los Angeles County
57856	Fee-for-Service	1952756256	1952756256	1	2	DJENDEREDJIAN, LEVON MD	8/19/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172266	None	None	0	In state provider	None	1855 SAN MIGUEL DR	SUITE 28	WALNUT CREEK	CA	94596	5298	07	06013	37.89490348	-122.0529351	Contra Costa County
57914	Fee-for-Service	1992341721	1992341721	1	1	DILLINGHAM, MELESSA J	4/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
57921	Fee-for-Service	1649448069	1649448069	1	1	DENEAU, MELISSA MSW LCSW	1/17/2025	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25726 MORSE DR	None	CARMEL	CA	93923	8309	27	06053	36.55014801	-121.9091567	Monterey County
57958	Fee-for-Service	1679560478	1679560478	1	1	DELATORE, CHARLES U MD	5/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	72555	41	Internal Medicine	0	In state provider	None	595 BUCKINGHAM WY	STE 515	SAN FRANCISCO	CA	94132	1913	38	06075	37.73012679	-122.4767395	San Francisco County
58082	Fee-for-Service	1093860132	1093860132	1	1	DR JASON HEESE	12/29/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 PINE RIDGE BLVD	RM 1-919	WAUSAU	WI	54401	4102	00	None	44.966367	-89.667756	Marathon County
58090	Fee-for-Service	1801830096	1801830096	1	1	DO, DZUNG C MD	3/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90291	66	Emergency Medicine (Urgent Care)	0	In state provider	None	911 SUNSET DR	None	HOLLISTER	CA	95023	5602	35	06069	36.83504962	-121.3858245	San Benito County
58123	Fee-for-Service	1962721563	1962721563	1	1	DARRAH, NEHA J MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135980	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
58137	Fee-for-Service	1457528218	1457528218	1	1	DENDULURI, SANDEEP MD	10/2/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	133241	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
58139	Fee-for-Service	1770695561	1770695561	1	1	DERIEMER, DAVID A MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66082	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
58171	Fee-for-Service	1205223823	1205223823	1	1	DAVIS, KAELAN E MD	5/23/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147748	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
58255	Fee-for-Service	1528149747	1528149747	1	1	DR NATALIE DO DUONG OD	3/13/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2378 W LINCOLN AVE	None	ANAHEIM	CA	92801	5101	30	06059	33.83230044	-117.9664172	Orange County
58265	Fee-for-Service	1497497895	1497497895	1	1	DEVERAUX, CHRISTIAN E DO	10/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21815	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
58304	Fee-for-Service	1750323226	1750323226	1	1	DEMORDAUNT, QUINN A MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
58344	Fee-for-Service	1548354426	1548354426	1	1	DALY CITY PATHOLOGY MED	8/4/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
58368	Fee-for-Service	1568577955	1568577955	1	1	DANIEL R CONLIN & ROBERT	5/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	J ELSEN, MDS	2100 WEBSTER ST	STE 315	SAN FRANCISCO	CA	94115	2377	38	06075	37.7904826	-122.4324477	San Francisco County
58447	Fee-for-Service	1861751190	1861751190	1	1	DIAB, KHALED MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121108	08	Family Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
58499	Fee-for-Service	1265859250	1265859250	1	1	DISTLER, MARGARET G MD	5/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139343	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
58515	Fee-for-Service	1942572144	1942572144	1	1	DRESSER, LOUISA L MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125558	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PARKWAY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
58544	Fee-for-Service	1023120466	1023120466	1	1	DEVORE, ROBERT JR MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46354	05	Anesthesiology	0	In state provider	None	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	30	06059	33.746805	-117.834147	Orange County
58560	Fee-for-Service	1265692180	1265692180	1	1	DRONAMRAJU, DEEPTI V MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156114	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58598	Fee-for-Service	1083918445	1083918445	1	1	DACUMOS, MARICRIS B NP	10/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58620	Fee-for-Service	1932276706	1932276706	1	1	DONOGHUE, DEBORAH E NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	30400 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1300	30	06059	33.5224708	-117.6686181	Orange County
58635	Fee-for-Service	1992358105	1992358105	1	1	DORAME, WHITNEY A CRNA	3/16/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
58696	Fee-for-Service	1235369968	1235369968	1	1	DESAI, SHILPA H MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125863	03	Allergy	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
58722	Fee-for-Service	1063428621	1063428621	1	1	DEMAREST, GERALD MD	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
58726	Fee-for-Service	1750334884	1750334884	1	1	DOMINIC YEE, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10700 E GEDDES AVE	STE 200	ENGLEWOOD	CO	80112	3861	00	None	39.58449488	-104.8639802	Arapahoe County
58739	Fee-for-Service	1780860585	1780860585	1	1	D'AMICO, DANIEL M MD APC	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	18825	01	General Practice	0	In state provider	None	7551 TIMBERLAKE WAY	STE 200	SACRAMENTO	CA	95823	5420	34	06067	38.466225	-121.415958	Sacramento County
58758	Fee-for-Service	1356524599	1356524599	1	1	DE ANZA CLINIC	5/6/1996	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1001 BLAIR AVE	None	CALEXICO	CA	92231	2308	13	06025	32.678172	-115.4907771	Imperial County
58794	Fee-for-Service	1427505841	1427505841	1	1	DANG, CAROLINE N OD	9/7/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 NORTH BRAND BLVD	SUITE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
58795	Fee-for-Service	1508399528	1508399528	1	1	DHAMSANIA, VISHAN D MD	7/17/2020	2080P0204X	NA	Other	026	PHYSICIANS	157292	40	Pediatrics	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
58885	Fee-for-Service	1265698567	1265698567	1	1	DEOCAMPO, EDSIL A MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140261	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
58886	Fee-for-Service	1427167121	1427167121	1	1	DOONAN, BRYAN C MD	4/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78014	None	None	0	In state provider	None	360 SAN MIGUEL DR	SUITE 107	NEWPORT BEACH	CA	92660	7853	30	06059	33.61321911	-117.8722084	Orange County
58912	Fee-for-Service	1023290582	1023290582	1	1	DAMBACH, HEIDI M MD	5/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110625	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
58929	Fee-for-Service	1619050051	1619050051	1	1	DONNA JONES NP	8/19/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	219 BRYANT ST	None	BUFFALO	NY	14222	2006	00	None	42.909219	-78.87537	Erie County
58932	Fee-for-Service	1043772171	1043772171	1	1	DOSANJH, AMRIT K MD	7/14/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179020	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
58934	Fee-for-Service	1306808464	1306808464	1	1	DAHMS, ERIC B MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80316	41	Internal Medicine	0	In state provider	None	9466 BLACK MOUNTAIN RD	STE 100	SAN DIEGO	CA	92126	4550	37	06073	32.89448076	-117.123457	San Diego County
58964	Fee-for-Service	1275858953	1275858953	1	1	DEVITT, JESSICA A MD	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
58982	Fee-for-Service	1235369968	1235369968	1	1	DESAI, SHILPA H MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125863	66	Emergency Medicine (Urgent Care)	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
59017	Fee-for-Service	1629483565	1629483565	1	1	DERMODY, PATRICK M MD	6/6/2017	207P00000X	NA	Other	026	PHYSICIANS	139766	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
59027	Fee-for-Service	1780860585	1780860585	1	1	D'AMICO, DANIEL M MD APC	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	18825	20	Orthopedic Surgery	0	In state provider	None	7551 TIMBERLAKE WAY	STE 200	SACRAMENTO	CA	95823	5420	34	06067	38.466225	-121.415958	Sacramento County
59033	Fee-for-Service	1497411219	1497411219	1	1	DAVID, STEPHANIE LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
59045	Fee-for-Service	1417272683	1417272683	1	1	DOWNEY, PETER S MD	4/19/2023	208G00000X	NA	General Surgery	026	PHYSICIANS	146940	None	None	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
59046	Fee-for-Service	1356524599	1356524599	1	1	DE ANZA CLINIC	5/6/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1001 BLAIR AVE	None	CALEXICO	CA	92231	2308	13	06025	32.678172	-115.4907771	Imperial County
59070	Fee-for-Service	1760823629	1760823629	1	1	DODD-SULLIVAN, REBECCA M NP	10/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
59072	Fee-for-Service	1558449561	1558449561	1	1	DUGUAY, BRIAN M AU	5/15/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3443 VILLA LANE	SUITE 3	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
59172	Fee-for-Service	1265460463	1265460463	2	1	DOYLE, MICHAEL P MD	7/21/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71419	40	Pediatrics	0	In state provider	LAKE TAHOE PEDIATRICS	2074 LAKE TAHOE BLVD	STE 9	SOUTH LAKE TAHOE	CA	96150	6417	09	06017	38.91488542	-120.0019087	El Dorado County
59184	Fee-for-Service	1134310436	1134310436	1	1	DANIEL ADRIAN BROWN	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1323 W 6TH AVE	None	STILLWATER	OK	74074	4306	00	None	36.11584141	-97.07504326	Payne County
59192	Fee-for-Service	1487950523	1487950523	1	2	DIGNITY HEALTH MEDICAL	8/21/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	410 E YOSEMITE AVE	SUITE B	MERCED	CA	95340	8220	24	06047	37.33211247	-120.462489	Merced County
59243	Fee-for-Service	1194764472	1194764472	1	1	DONG, RONALD G MD	6/30/2006	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	87118	None	None	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
59255	Fee-for-Service	1962790014	1962790014	1	9	DIGNITY HEALTH MEDICAL FOUND	10/1/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4598 MISSION STREET	None	SAN FRANCISCO	CA	94112	2622	38	06075	37.72470903	-122.4348557	San Francisco County
59274	Fee-for-Service	1316038169	1316038169	1	2	DARDASHTI, MALIHE MD	12/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41092	01	General Practice	0	In state provider	SAN PEDRO ADAMS MEDICAL	2530 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	1520	19	06037	34.02177954	-118.2611562	Los Angeles County
59286	Fee-for-Service	1164719787	1164719787	1	1	DELANEY, CLIFFORD W LMFT	8/3/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119235	-	NOT APPLICABLE	0	In state provider	None	1365 AND 1385 N. JOHNSON	111, 112, 113, 102, AND	EL CAJON	CA	92020	1649	37	06073	32.813847	-116.970981	San Diego County
59333	Fee-for-Service	1174113534	1174113534	1	2	DIAGNOSTIC PATHOLOGY LABORAT	3/3/2021	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORY SERVICES, INC.	300 HOSPITAL DR.	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
59339	Fee-for-Service	1811076870	1811076870	1	1	DYNAMIC HOME CARE SVCS INC	4/15/1993	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14260 VENTURA BLVD	STE 301	SHERMAN OAKS	CA	91423	2734	19	06037	34.15013274	-118.4440789	Los Angeles County
59461	Fee-for-Service	1689784886	1689784886	1	1	DELA CRUZ, JUNE MD	10/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54445	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
59479	Fee-for-Service	1487950523	1487950523	1	2	DIGNITY HEALTH MEDICAL	8/21/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	410 E YOSEMITE AVE	SUITE B	MERCED	CA	95340	8220	24	06047	37.33211247	-120.462489	Merced County
59493	Fee-for-Service	1538537873	1538537873	2	1	DESERT CANYON INPATIENT SRV	1/18/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AMC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
59507	Fee-for-Service	1124061601	1124061601	1	1	DAWSON, NICOLE ANN MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65764	None	None	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
59510	Fee-for-Service	1083187892	1083187892	1	1	DONAHUE, NICHOLE J CRNA	6/19/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
59535	Fee-for-Service	1952370074	1952370074	1	1	DEL VALLE, JEANNETTE MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42660	66	Emergency Medicine (Urgent Care)	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
59542	Fee-for-Service	1194794628	1194794628	1	1	DURICK, THOMAS W MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50327	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
59562	Fee-for-Service	1316038169	1316038169	1	2	DARDASHTI, MALIHE MD	12/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41092	08	Family Practice	0	In state provider	SAN PEDRO ADAMS MEDICAL	2530 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	1520	19	06037	34.02177954	-118.2611562	Los Angeles County
59567	Fee-for-Service	1851301287	1851301287	1	1	DARLIN, DOUGLAS J MD	11/13/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67493	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
59568	Fee-for-Service	1811384001	1811384001	1	1	DO, KEVIN T MD	7/22/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	144782	None	None	0	In state provider	None	11180 WARNER AVE	STE 351	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
59613	Fee-for-Service	1427360999	1427360999	1	1	DEVIVO, RYAN F DO	11/12/2020	207P00000X	NA	Other	026	PHYSICIANS	17884	None	None	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
59619	Fee-for-Service	1639524283	1639524283	1	1	DAVID JENKINS	10/12/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1303 N MAIN ST	None	CEDAR CITY	UT	84721	9746	00	None	37.699596	-113.0664465	Iron County
59648	Fee-for-Service	1922077031	1922077031	1	1	DINH, ROBERT X MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70259	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
59663	Fee-for-Service	1881950749	1881950749	1	1	DEVULAPALLI, KAVI K MD	9/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	130764	None	None	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
59668	Fee-for-Service	1285706390	1285706390	1	1	DEHLINGER, MAIA M NP	5/18/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
59684	Fee-for-Service	1114993631	1114993631	1	1	DWORSKY, DAN E MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54041	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
59701	Fee-for-Service	1598109324	1598109324	1	1	DESOUZA, NEHA A MD	1/7/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	156886	68	Hematology	0	In state provider	None	20400 LAKE CHABOT RD	STE 102	CASTRO VALLEY	CA	94546	5314	01	06001	37.69628351	-122.0866765	Alameda County
59710	Fee-for-Service	1508068529	1508068529	1	1	DOMEIER, DIANE M	12/26/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1729 TULLY RD	STE 4	MODESTO	CA	95350	4082	50	06099	37.670027	-121.0122656	Stanislaus County
59730	Fee-for-Service	1598720963	1598720963	1	1	DEUSON, TRAVIS E MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69979	66	Emergency Medicine (Urgent Care)	0	In state provider	None	21840 NORMANDIE AVE	STE 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
59743	Fee-for-Service	1891462842	1891462842	1	1	DECKER, TONETTE K LMFT	11/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	C SOLUTIONS	14393 PARK AVE.	STE 200	VICTORVILLE	CA	92392	5010	36	06071	34.5123	-117.3248825	San Bernardino County
59752	Fee-for-Service	1689784886	1689784886	1	1	DELA CRUZ, JUNE MD	10/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54445	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
59758	Fee-for-Service	1437416229	1437416229	1	1	DIA, DANIA MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149721	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
59766	Fee-for-Service	1487950523	1487950523	1	2	DIGNITY HEALTH MEDICAL	8/21/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	410 E YOSEMITE AVE	SUITE B	MERCED	CA	95340	8220	24	06047	37.33211247	-120.462489	Merced County
59791	Fee-for-Service	1982867941	1982867941	1	1	DE NAGY, JOSEPH A DO	11/16/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18554	None	None	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	STE 200 225	LOS ANGELES	CA	90033	6720	19	06037	34.05112725	-118.2173921	Los Angeles County
59795	Fee-for-Service	1285490623	1285490623	1	1	DE LEON, CARMEN S CINTRON	3/13/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	24520 SUMMERFIELD DR	None	MORENO VALLEY	CA	92557	5129	33	06065	33.95986349	-117.2348055	Riverside County
59797	Fee-for-Service	1942337746	1942337746	1	1	DONALDSON, ARTHUR MD INC	3/1/1999	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	PO BOX 387	None	ANGELS CAMP	CA	95222	0387	05	06009	0	0	None
59802	Fee-for-Service	1174897771	1174897771	1	1	DEDICATED HOSPICE CARE INC	3/17/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10605 BALBOA BLVD	STE 300	GRANADA HILLS	CA	91344	6347	19	06037	34.263378	-118.5022965	Los Angeles County
59825	Fee-for-Service	1952370074	1952370074	1	1	DEL VALLE, JEANNETTE MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42660	41	Internal Medicine	0	In state provider	None	841 KUHN DR	STE 200	CHULA VISTA	CA	91914	3552	37	06073	32.65289649	-116.9665862	San Diego County
59839	Fee-for-Service	1881058659	1881058659	1	1	DE SENA, JOSEPH R MD	9/18/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153187	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
59858	Fee-for-Service	1851301287	1851301287	1	1	DARLIN, DOUGLAS J MD	11/13/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67493	34	Urology and Urological Surgery	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
59859	Fee-for-Service	1326034273	1326034273	1	1	DUSOL, MAURICE JR MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	20524	10	Gastroenterology (M.D. only)	0	In state provider	None	1201 W LA VETA AVE	STE 211	ORANGE	CA	92868	4207	30	06059	33.78034779	-117.8655767	Orange County
59866	Fee-for-Service	1780212092	1780212092	1	1	DE CASTRO, MARK C PT	1/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
59876	Fee-for-Service	1598775488	1598775488	1	1	DOLINAR-TUCHINSKY, AMY L MD	5/31/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	90096	40	Pediatrics	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
59893	Fee-for-Service	1861662553	1861662553	1	1	DANG, LAM D MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104109	08	Family Practice	0	In state provider	None	10141 WESTMINSTER AVE	STE E	GARDEN GROVE	CA	92843	4752	30	06059	33.75965047	-117.9517066	Orange County
59894	Fee-for-Service	1922112358	1922112358	1	1	DA SILVA, RUI A MD INC	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	58471-29 PALMS HWY	STE 203	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
59984	Fee-for-Service	1487239786	1487239786	1	1	DURAN, SOPHIA M CNP	12/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9700 DE SOTO	None	CHATSWORTH	CA	91311	4409	19	06037	34.246692	-118.588543	Los Angeles County
59995	Fee-for-Service	1316037906	1316037906	1	1	DULL, RANDAL O. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CTY	UT	84132	0100	00	None	40.77197161	-111.8352608	Salt Lake County
60026	Fee-for-Service	1891768826	1891768826	1	1	DANDAMUDI, SAROJA MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56061	41	Internal Medicine	0	In state provider	None	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3041	43	06085	37.35228637	-121.9754073	Santa Clara County
60071	Fee-for-Service	1962889063	1962889063	1	1	DEPETRIS, JENA MD	3/24/2020	111NR0200X	NA	Other	026	PHYSICIANS	167170	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
60082	Fee-for-Service	1285490623	1285490623	1	1	DE LEON, CARMEN S CINTRON	3/13/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24520 SUMMERFIELD DR	None	MORENO VALLEY	CA	92557	5129	33	06065	33.95986349	-117.2348055	Riverside County
60083	Fee-for-Service	1972725760	1972725760	1	1	DAY, GINA M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2005 LARKSPUR LANDING CI	None	LARKSPUR	CA	94939	1802	21	06041	37.94797232	-122.5085212	Marin County
60089	Fee-for-Service	1518427913	1518427913	1	1	DANG, TIMOTHY M	6/27/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	186246	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
60090	Fee-for-Service	1174897771	1174897771	1	1	DEDICATED HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10605 BALBOA BLVD	STE 300	GRANADA HILLS	CA	91344	6347	19	06037	34.263378	-118.5022965	Los Angeles County
60098	Fee-for-Service	1992810931	1992810931	1	1	DEEB, ZIAD L MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53557	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
60113	Fee-for-Service	1487717534	1487717534	1	1	DANSUNANKUL, AUYPORN MD	11/27/2013	207R00000X	NA	Other	026	PHYSICIANS	86648	41	Internal Medicine	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
60122	Fee-for-Service	1578151023	1578151023	1	1	DAMIANI, TAYLOR PSYD	6/18/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
60145	Fee-for-Service	1851301287	1851301287	1	1	DARLIN, DOUGLAS J MD	11/13/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67493	01	General Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
60153	Fee-for-Service	1215932462	1215932462	1	1	DUNCAN ,CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7950 FLOYD CURL DR	STE 620	SAN ANTONIO	TX	78229	0000	00	None	29.51244802	-98.57663128	Bexar County
60158	Fee-for-Service	1801859459	1801859459	1	1	DO, DAVID A MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78639	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
60170	Fee-for-Service	1770659336	1770659336	1	2	DIGNITY HEALTH	6/27/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
60206	Fee-for-Service	1780759027	1780759027	1	1	DONAVON R ALBERTSON, MD	11/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 BORTHWICK AVE	None	PORTSMOUTH	NH	03801	0000	00	None	43.06383567	-70.7900637	Rockingham County
60219	Fee-for-Service	1528090040	1528090040	1	1	DESCOTEAUX, STEVEN D MD	3/12/2021	207R00000X	NA	Other	086	MEDICAL DIRECTORS	168953	-	NOT APPLICABLE	0	In state provider	None	1352 COLUSA HWY	SUITE C	YUBA CITY	CA	95993	9147	51	06101	39.14177255	-121.635963	Sutter County
60381	Fee-for-Service	1508222647	1508222647	1	4	DIGNITY HEALTH MEDICAL FOUND	8/5/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	STE 100	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
60382	Fee-for-Service	1891954152	1891954152	1	1	DE AQUINO-CORLEY, KAREN	6/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105785	41	Internal Medicine	0	In state provider	GRACE V MD	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
60416	Fee-for-Service	1659333730	1659333730	1	1	DUGGAL, NEENA B MD	1/31/1996	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	42296	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
60421	Fee-for-Service	1053653873	1053653873	1	1	DIGNITY HEALTH MEDICAL	5/10/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	4240 HIGHLAND	None	HIGHLAND	CA	92346	2764	36	06071	34.13583752	-117.194355	San Bernardino County
60435	Fee-for-Service	1760772784	1760772784	1	1	DARROW, MORGAN A MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137601	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
60459	Fee-for-Service	1740593458	1740593458	1	1	DEODHAR, AJITA A MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116266	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
60502	Fee-for-Service	1346372273	1346372273	1	1	DIAZ-WINTERSET, LAURA PSY	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	20158	-	NOT APPLICABLE	0	In state provider	None	1303 WEST WALNUT PARKWAY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
60521	Fee-for-Service	1225528466	1225528466	1	2	DUONG, KHANH T MD	2/10/2022	207R00000X	NA	Other	026	PHYSICIANS	174153	None	None	0	In state provider	None	9635 MONTE VISTA AVE	208	MONTCLAIR	CA	91763	2235	36	06071	34.07975926	-117.6982207	San Bernardino County
60556	Fee-for-Service	1376838805	1376838805	2	1	DANN-MCNAMEE, MARY S LMFT	5/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1340 E ROUTE 66	SUITE 108	GLENDORA	CA	91740	3701	19	06037	34.12873255	-117.840681	Los Angeles County
60578	Fee-for-Service	1699852327	1699852327	1	1	DIALYSIS ACCESS CTR, INC	5/27/2003	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
60634	Fee-for-Service	1053653873	1053653873	1	10	DIGNITY HEALTH MEDICAL	8/11/2017	3336C0003X	NA	Pharmacies	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	401 E HIGHLAND AVE	STE 251	SAN BERNARDINO	CA	92404	3800	36	06071	34.1358627	-117.2757778	San Bernardino County
60668	Fee-for-Service	1508222647	1508222647	1	4	DIGNITY HEALTH MEDICAL FOUND	8/5/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	STE 100	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
60703	Fee-for-Service	1861021172	1861021172	1	1	DESAI, KEVAL N MD	4/10/2025	207R00000X	NA	Other	026	PHYSICIANS	188084	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60713	Fee-for-Service	1306914445	1306914445	1	1	DECHANT, PAUL F MD	10/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	53632	08	Family Practice	0	In state provider	None	9500 LIBERTY STREET	None	FREMONT	CA	94538	0000	01	06001	37.54879917	-121.9780646	Alameda County
60717	Fee-for-Service	1538245253	1538245253	1	1	DEMARTINI, WENDY B MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143565	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
60753	Fee-for-Service	1568683704	1568683704	1	1	DAVIES, SEENA MD	1/25/2011	207R00000X	NA	Other	026	PHYSICIANS	112716	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
60766	Fee-for-Service	1164613634	1164613634	1	1	DEVIES, LESLEE H DO	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10114	08	Family Practice	0	In state provider	None	400 N MCDOWELL BLVD	None	PETALUMA	CA	94954	2339	49	06097	38.25477	-122.63175	Sonoma County
60804	Fee-for-Service	1598387888	1598387888	1	1	DIAMOND ADULT & SENIOR	11/9/2021	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	CONCIERGE LLC	9350 WILSHIRE BLVD	SUITE 203	BEVERLY HILLS	CA	90212	3134	19	06037	34.06701801	-118.3955984	Los Angeles County
60820	Fee-for-Service	1053378414	1053378414	1	1	DSL DRUGS INC	12/6/1996	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	159 N GLENDORA AVE	None	GLENDORA	CA	91741	3342	19	06037	34.13759923	-117.8655007	Los Angeles County
60837	Fee-for-Service	1619176559	1619176559	1	1	DO, THAI V MD	7/6/2020	207R00000X	NA	Other	026	PHYSICIANS	53614	41	Internal Medicine	0	In state provider	None	1220 HEMLOCK WAY,	SUITE 102	SANTA ANA	CA	92707	3656	30	06059	33.70975375	-117.8842792	Orange County
60843	Fee-for-Service	1477612182	1477612182	1	1	DELFS, EMILY NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23781 MAQUINA AVE	None	MISSION VIEJO	CA	92691	2716	30	06059	33.61792093	-117.6778904	Orange County
60908	Fee-for-Service	1750381711	1750381711	1	1	DEANDA, MICHAEL D MD	5/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70940	08	Family Practice	0	In state provider	None	1770 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3027	19	06037	34.07637624	-117.7492622	Los Angeles County
60958	Fee-for-Service	1508222647	1508222647	1	4	DIGNITY HEALTH MEDICAL FOUND	8/5/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18460 ROSCOE BLVD	STE 100	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
60970	Fee-for-Service	1982126058	1982126058	1	1	DUNPHEY, BRIAN X LMFT	8/23/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 DESERT LAKES CIRCLE	None	PALM SPRINGS	CA	92264	5524	33	06065	33.79827597	-116.5081264	Riverside County
60978	Fee-for-Service	1982098125	1982098125	1	1	DIKE, PEACE N MD	8/5/2022	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	180181	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
61020	Fee-for-Service	1821529579	1821529579	1	1	DOLISCA, SARAH-BIANCA MD	11/4/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
61029	Fee-for-Service	1457379372	1457379372	1	1	DAMANI, SAMIR B MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88989	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
61051	Fee-for-Service	1730536566	1730536566	1	1	DENNIS, KRISTIN L	6/28/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	735 PINE ST	None	PASO ROBLES	CA	93446	2857	40	06079	35.62232732	-120.6885158	San Luis Obispo County
61078	Fee-for-Service	1235178658	1235178658	1	1	DHALIWAL, HARMANJEET MD	1/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83373	05	Anesthesiology	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
61122	Fee-for-Service	1174085344	1174085344	1	1	DUNN, GUINN ELLEN MD	8/26/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61135	Fee-for-Service	1447391412	1447391412	1	1	DENGEL, MICHAEL K MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99864	13	Neurology (M.D. only)	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
61198	Fee-for-Service	1023185022	1023185022	1	1	DRAZIN, ELAINE M MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65929	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
61272	Fee-for-Service	1013120120	1013120120	1	1	DESHMUKH, MONICA S MD	5/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100264	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
61287	Fee-for-Service	1588352041	1588352041	1	1	DHARMESH SHETH MD MEDICAL IN	10/25/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	C	1045 ATLANTIC AVE	STE 608	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
61292	Fee-for-Service	1790527299	1790527299	1	1	DEOMAMPO, PAULA MONICA M	2/25/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
61298	Fee-for-Service	1912180266	1912180266	1	1	DO, THUY D DO	3/21/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
61302	Fee-for-Service	1144841172	1144841172	1	1	DIAZ, KING N CNP	7/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2550 HOLLYWOOD	STE 100	BURBANK	CA	91505	1055	19	06037	34.195086	-118.348892	Los Angeles County
61356	Fee-for-Service	1881772952	1881772952	1	1	DAVIS, ROBERT R MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	46532	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
61490	Fee-for-Service	1629156732	1629156732	1	1	DICKSTEIN, EVGENIYA MD	12/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73469	41	Internal Medicine	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
61492	Fee-for-Service	1215397492	1215397492	1	1	DUN, HOLLY N CCC-SP	12/22/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
61528	Fee-for-Service	1265490668	1265490668	1	1	DRAUGHON, LAURIE F MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	58044	41	Internal Medicine	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
61572	Fee-for-Service	1861832420	1861832420	1	1	DE GUZMAN, CARLO E	2/5/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
61646	Fee-for-Service	1700177136	1700177136	1	1	DUNN-PIRIO, ANASTASIE M MD	9/14/2018	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	157861	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
61689	Fee-for-Service	1982719597	1982719597	1	1	DO, THOA T	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43520	None	None	0	In state provider	None	14350 BROOKHURST ST	None	GARDEN GROVE	CA	92843	4608	30	06059	33.753825	-117.954801	Orange County
61706	Fee-for-Service	1649864604	1649864604	1	1	DAM, TRI N NP	2/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
61718	Fee-for-Service	1639467467	1639467467	1	1	DIEP, ETHAN S Q OD	5/26/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
61742	Fee-for-Service	1083222087	1083222087	1	1	DUFF, VALENTINE D RCP	7/26/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
61752	Fee-for-Service	1053430165	1053430165	1	1	DILLON, CECILE PHD	1/31/1993	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20932 BROOKHURST ST	STE 210	HUNTINGTON BEACH	CA	92646	6643	30	06059	33.65834344	-117.9535794	Orange County
61758	Fee-for-Service	1194179275	1194179275	1	1	DESANTO, DONALD J MD	8/22/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	151274	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
61789	Fee-for-Service	1053744664	1053744664	1	1	DELLA FAVE, ALBERT MD	3/25/2025	207P00000X	NA	Other	026	PHYSICIANS	169092	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
61791	Fee-for-Service	1841566817	1841566817	1	1	DONNELLY-TAYLOR, CLARE A MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131147	01	General Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
61799	Fee-for-Service	1396759759	1396759759	2	1	DONOFRIO, DIANNA J	3/15/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18095 US HIGHWAY 18	SUITE C	APPLE VALLEY	CA	92307	2189	36	06071	34.54025876	-117.2693057	San Bernardino County
61809	Fee-for-Service	1760901383	1760901383	1	1	DUNNAGAN, LINDSEY K LMFT	5/17/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	1	Border provider	None	187 WARM SPRINGS	SUITE B157	LAS VEGAS	NV	89119	4110	00	None	36.05690954	-115.164216	Clark County
61816	Fee-for-Service	1215959796	1215959796	1	1	DANG, TRACH P MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51333	40	Pediatrics	0	In state provider	None	2114 SENTER RD	STE 24	SAN JOSE	CA	95112	2608	43	06085	37.31161529	-121.8513661	Santa Clara County
61822	Fee-for-Service	1659083756	1659083756	1	1	DAVIES-BALCH, SHANTAY RENEE	6/30/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	10	06019	0	0	None
61825	Fee-for-Service	1326517475	1326517475	1	1	DAYBREAK COUNSELING CENTER	1/30/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4182 N VIKING WAY	202 & 203	LONG BEACH	CA	90808	1476	19	06037	33.83328678	-118.1259324	Los Angeles County
61862	Fee-for-Service	1831590439	1831590439	1	1	DANAN, ILAN J MD	3/1/2018	2084S0010X	NA	Neurology	026	PHYSICIANS	133500	13	Neurology (M.D. only)	0	In state provider	None	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
61994	Fee-for-Service	1053593277	1053593277	1	1	DE JESUS, HECTOR M MD INC	6/11/2009	207R00000X	NA	Other	026	PHYSICIANS	60223	41	Internal Medicine	0	In state provider	None	2323 16TH ST	STE 300	BAKERSFIELD	CA	93301	3420	15	06029	35.37238027	-119.0288508	Kern County
61997	Fee-for-Service	1902870298	1902870298	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ESCONDIDO DIALYSIS	203 E 2ND AVE	None	ESCONDIDO	CA	92025	4212	37	06073	33.1215091	-117.0792586	San Diego County
61999	Fee-for-Service	1710542642	1710542642	1	1	DELANO HOME HEALTH CARE INC	10/13/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	20501 VENTURA BLVD	STE 280	WOODLAND HILLS	CA	91364	6414	19	06037	34.16800818	-118.5797688	Los Angeles County
62008	Fee-for-Service	1881011278	1881011278	1	1	DIXON, REBECCA A CRNA	10/20/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
62059	Fee-for-Service	1831145283	1831145283	1	1	DAVID, GERARD R MD	12/3/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	162830	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
62063	Fee-for-Service	1003234097	1003234097	1	1	DREW MOSS	3/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1420 N 10TH ST	None	SPEARFISH	SD	57783	1532	00	None	44.49911462	-103.8556611	Lawrence County
62070	Fee-for-Service	1811973514	1811973514	1	1	DUMESIC, DANIEL A MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	42468	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	STE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
62082	Fee-for-Service	1770963266	1770963266	1	1	DHALIWAL, GURJOT S MD	12/9/2019	207R00000X	NA	Other	026	PHYSICIANS	153097	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
62088	Fee-for-Service	1427203140	1427203140	1	1	DE LA CRUZ, JOANNA MAE C PT	5/14/2020	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	403 W ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
62098	Fee-for-Service	1568539575	1568539575	1	1	DESILETS, JON D MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61387	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
62113	Fee-for-Service	1326517475	1326517475	1	1	DAYBREAK COUNSELING CENTER	1/30/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4182 N VIKING WAY	202 & 203	LONG BEACH	CA	90808	1476	19	06037	33.83328678	-118.1259324	Los Angeles County
62127	Fee-for-Service	1710256763	1710256763	1	1	DAILEY, LENA J CRNA	9/9/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
62161	Fee-for-Service	1750872503	1750872503	1	1	DANFORD-JOHN, KENDRA	8/29/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3527 W FLORIDA AVE	None	HEMET	CA	92545	3564	33	06065	33.745347	-117.0091125	Riverside County
62186	Fee-for-Service	1598780322	1598780322	1	1	DUZMAN, EFRAIM MD	9/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38972	18	Ophthalmology	0	In state provider	None	4605 BARRANCA PKWY	STE 100	IRVINE	CA	92604	1726	30	06059	33.67863338	-117.7997794	Orange County
62248	Fee-for-Service	1568416147	1568416147	1	5	DESERT ADVANCED IMAGING MEDI	10/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
62251	Fee-for-Service	1235206178	1235206178	1	1	DYKSTRA, LEE G MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	32009	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
62310	Fee-for-Service	1235243775	1235243775	1	1	DUFFY, BRYN J MD	7/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110571	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
62317	Fee-for-Service	1811949548	1811949548	1	1	DESERT VALLEY MEDICAL	7/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	12276 HESPERIA RD	STE 123	VICTORVILLE	CA	92395	5838	36	06071	34.47424926	-117.2915621	San Bernardino County
62328	Fee-for-Service	1295799815	1295799815	1	1	DRLJEVIC, ELVIRA S MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104672	26	Psychiatry (child)	0	In state provider	None	1792 TRIBUTE ROAD	STE 350	SACRAMENTO	CA	95815	4322	34	06067	38.598219	-121.445964	Sacramento County
62329	Fee-for-Service	1881747046	1881747046	1	1	DREW, DANNY E MD	11/27/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98440	08	Family Practice	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
62354	Fee-for-Service	1851014765	1851014765	1	1	DIABUAH, EUNICE E	11/3/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	405 W WINCHESTER DRIVE	None	RIALTO	CA	92376	3304	36	06071	34.1253687	-117.3773312	San Bernardino County
62429	Fee-for-Service	1427481233	1427481233	1	1	DAVENPORT, TERRIAL S LCSW	6/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1545 WEBSTER ST	SUITE A	FAIRFIELD	CA	94533	4917	48	06095	38.25753941	-122.0475412	Solano County
62443	Fee-for-Service	1306928221	1306928221	1	1	DANG, YADAVINDER MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	38596	40	Pediatrics	0	In state provider	None	5451 LA PALMA AVE	STE 15	LA PALMA	CA	90623	1758	30	06059	33.84643146	-118.038843	Orange County
62447	Fee-for-Service	1376989392	1376989392	1	1	DE WINTER, KARA L MD	5/5/2023	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168209	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
62456	Fee-for-Service	1053653873	1053653873	1	4	DIGNITY HEALTH MEDICAL	7/14/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	7291 BOULDER AVE	STE 2-C	HIGHLAND	CA	92346	6900	36	06071	34.12169346	-117.1953693	San Bernardino County
62468	Fee-for-Service	1457575169	1457575169	1	1	DANOVITCH, ITAI MD	8/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99119	36	Psychiatry	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
62497	Fee-for-Service	1124496021	1124496021	1	1	DO, KHAI MD INC	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42932	41	Internal Medicine	0	In state provider	None	9880 CENTRAL AVE	None	MONTCLAIR	CA	91763	2817	36	06071	34.074504	-117.6896585	San Bernardino County
62511	Fee-for-Service	1861478042	1861478042	1	1	DAHLIN, BRIAN C MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91652	30	Radiology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
62538	Fee-for-Service	1235206178	1235206178	1	1	DYKSTRA, LEE G MD	7/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	32009	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
62541	Fee-for-Service	1144235821	1144235821	1	1	DHALIWAL, GURPREET S MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69707	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
62556	Fee-for-Service	1528422086	1528422086	1	1	DCI LABORATORY LLC	5/11/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2917 FOSTER CREIGHTON DR	None	NASHVILLE	TN	37204	3705	00	None	36.10959301	-86.75371072	Davidson County
62591	Fee-for-Service	1235336660	1235336660	1	1	DIAZ, SERGIO H LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
62626	Fee-for-Service	1689619454	1689619454	1	1	DANESHRAD, SHAWN S MD A	3/11/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70241	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL CORPORATION	8920 WILSHIRE BLVD	STE 420	BEVERLY HILLS	CA	90211	2004	19	06037	34.06703599	-118.3863456	Los Angeles County
62640	Fee-for-Service	1841433299	1841433299	1	1	DELT MEDICAL SUPPLY INC	12/21/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DELT MEDICAL SUPPLY INC	14918 1/2 BURBANK BLVD	None	SHERMAN OAKS	CA	91411	3677	19	06037	34.17208548	-118.4580945	Los Angeles County
62641	Fee-for-Service	1851014765	1851014765	1	1	DIABUAH, EUNICE E	11/3/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	405 W WINCHESTER DRIVE	None	RIALTO	CA	92376	3304	36	06071	34.1253687	-117.3773312	San Bernardino County
62656	Fee-for-Service	1457387250	1457387250	1	1	DREEBEN, SHARON M MD	4/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	67534	20	Orthopedic Surgery	0	In state provider	None	9339 GENESEE AVENUE	SUITE 150	SAN DIEGO	CA	92121	2144	37	06073	32.87610483	-117.2139185	San Diego County
62680	Fee-for-Service	1912466061	1912466061	1	1	DING, CHIEN-KUANG C MD	3/17/2023	207ZP0101X	NA	Other	026	PHYSICIANS	178440	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
62694	Fee-for-Service	1003028580	1003028580	1	1	DEL ALBA CAMPOMANES, ALEJAND	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99120	18	Ophthalmology	0	In state provider	RA MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2721	38	06075	37.76386986	-122.4568084	San Francisco County
62714	Fee-for-Service	1194742064	1194742064	1	1	DAUGHERTY, TAMI J MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74786	68	Hematology	0	In state provider	None	2340 CLAY ST	FL 1-57	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
62731	Fee-for-Service	1306928221	1306928221	1	1	DANG, YADAVINDER MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	38596	18	Ophthalmology	0	In state provider	None	5451 LA PALMA AVE	STE 15	LA PALMA	CA	90623	1758	30	06059	33.84643146	-118.038843	Orange County
62737	Fee-for-Service	1184393555	1184393555	1	1	DANIEL J COSTIGAN DO INC	9/29/2021	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2175 ROSALINE	STE A	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
62743	Fee-for-Service	1013303239	1013303239	1	1	DWORSKY, JILL MD	10/31/2023	208C00000X	NA	General Surgery	026	PHYSICIANS	146285	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
62751	Fee-for-Service	1548422108	1548422108	1	1	DO, JACLYNN MD INC	7/9/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78520	None	None	0	In state provider	None	8070 WESTMINSTER BLVD	STE A	WESTMINSTER	CA	92683	3033	30	06059	33.75926549	-117.98829	Orange County
62850	Fee-for-Service	1962746081	1962746081	1	1	DAO, SAMANTHA T MD	2/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	134999	05	Anesthesiology	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
62888	Fee-for-Service	1174919799	1174919799	1	1	DEVRIES, JOHN MD	2/28/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
62913	Fee-for-Service	1689619454	1689619454	1	1	DANESHRAD, SHAWN S MD A	3/11/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70241	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	8920 WILSHIRE BLVD	STE 420	BEVERLY HILLS	CA	90211	2004	19	06037	34.06703599	-118.3863456	Los Angeles County
62980	Fee-for-Service	1841342953	1841342953	1	1	DAHLMAN, CHARLES J OD	1/26/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1033 3RD STREET	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
62985	Fee-for-Service	1265599096	1265599096	1	1	DAVID G. BURICA MD	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 STATE ST	None	MCCALL	ID	83638	3704	00	None	44.90904704	-116.1097318	Valley County
63012	Fee-for-Service	1114244126	1114244126	1	1	DESERT PAIN SPECIALISTS, INC	3/3/2020	174400000X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	72780 COUNTRY CLUB DR	STE C300	RANCHO MIRAGE	CA	92270	4150	33	06065	33.75795596	-116.392246	Riverside County
63018	Fee-for-Service	1245237643	1245237643	1	1	DURA MEDIC, LLC	7/25/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	DURA MEDIC, LLC	3601 S CONGRESS AVE.	STE B400B	AUSTIN	TX	78704	7268	00	None	30.22729889	-97.76157381	Travis County
63038	Fee-for-Service	1053653873	1053653873	1	8	DIGNITY HEALTH MEDICAL	7/2/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2150 N WATERMAN AVE	STE 202	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
63138	Fee-for-Service	1194865543	1194865543	1	1	DURAZO, ANTONIO JR MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	48642	08	Family Practice	0	In state provider	MORINDA MEDICAL GROUP	841 W MORTON AVE	None	PORTERVILLE	CA	93257	3184	54	06107	36.07325151	-119.0359035	Tulare County
63160	Fee-for-Service	1710953773	1710953773	1	1	DESAI, NAYAN P MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79077	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
63166	Fee-for-Service	1598861882	1598861882	1	1	DASWANI, ADARSH MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82774	45	Nephrology (Renal-Kidney)	0	In state provider	None	3300 E SOUTH ST	STE 110	LAKEWOOD	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
63182	Fee-for-Service	1861094815	1861094815	1	1	DEMARINIS, CHRISTINA L CNP	3/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
63200	Fee-for-Service	1811969991	1811969991	1	1	DOUGLASS, ALAN B MD	8/13/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	75547	67	Endocrinology	0	In state provider	None	625 W CITRACADO PKWY	108	ESCONDIDO	CA	92025	6428	37	06073	33.09166731	-117.0784699	San Diego County
63223	Fee-for-Service	1902877301	1902877301	1	1	DARAWAL, ASSAD U MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	51602	41	Internal Medicine	0	In state provider	None	81893 DR CARREON BLVD	STE 1	INDIO	CA	92201	5592	33	06065	33.7073755	-116.2355895	Riverside County
63288	Fee-for-Service	1528504883	1528504883	1	1	DIETLIN, LACEY N	6/20/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
63309	Fee-for-Service	1366450264	1366450264	2	1	DODD, JEFFREY S MD	12/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81163	20	Orthopedic Surgery	0	In state provider	None	10051 LAKE AVENUE	SUITE 3	TRUCKEE	CA	96161	4870	29	06057	39.32550268	-120.2025066	Nevada County
63326	Fee-for-Service	1053653873	1053653873	1	8	DIGNITY HEALTH MEDICAL	7/2/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2150 N WATERMAN AVE	STE 202	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
63329	Fee-for-Service	1144308263	1144308263	1	1	DEVERS, ALLISON MD	5/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54405	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
63362	Fee-for-Service	1801978853	1801978853	1	1	DR.THERESA CULLEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5301 E GRANT RD	None	TUCSON	AZ	85712	0000	00	None	32.252391	-110.8790055	Pima County
63389	Fee-for-Service	1184839615	1184839615	1	1	DOSS, ASHWIN S MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140420	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
63408	Fee-for-Service	1124087838	1124087838	1	1	DEIN, JOHN	12/31/1989	208G00000X	NA	General Surgery	026	PHYSICIANS	52082	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J ST	STE 270	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
63429	Fee-for-Service	1659753911	1659753911	1	1	DUSCH, MARIE N MD	8/1/2021	2086S0105X	NA	General Surgery	026	PHYSICIANS	144633	None	None	0	In state provider	None	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	40	06079	35.29243951	-120.668652	San Luis Obispo County
63432	Fee-for-Service	1720583321	1720583321	1	1	DIONISOPOULOS, SHONTAL B DPM	5/6/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
63438	Fee-for-Service	1922352467	1922352467	1	1	DE ANDRADE, REGIANE S MD	3/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121499	None	None	0	In state provider	None	11190 WARNER AVE	STE 115	FOUNTAIN VALLEY	CA	92708	4028	30	06059	33.714	-117.9333585	Orange County
63458	Fee-for-Service	1598861882	1598861882	1	1	DASWANI, ADARSH MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82774	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 110	LAKEWOOD	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
63475	Fee-for-Service	1831130939	1831130939	1	1	DOYLE, JOHN M MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	73367	22	Pathology (M.D. only)	0	In state provider	None	16300 ROSCOE BLVD	STE 1A	VAN NUYS	CA	91406	1258	19	06037	34.22128033	-118.4884471	Los Angeles County
63505	Fee-for-Service	1265496996	1265496996	1	1	DIANE MARY TWICKLER	4/22/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
63541	Fee-for-Service	1568994630	1568994630	1	1	DANG, BRIAN MD	2/27/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158045	None	None	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
63581	Fee-for-Service	1588828164	1588828164	1	1	DAVIS, CIARA A LCSW	7/8/2022	171M00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
63610	Fee-for-Service	1104082155	1104082155	1	1	DORSEY-HIGDON, CARRIE NP	3/12/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
63642	Fee-for-Service	1548595127	1548595127	1	1	DHARIA, AJAY S MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114612	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
63656	Fee-for-Service	1093862294	1093862294	1	1	DUBOIS, ELIZABETH RN	6/3/2007	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	292 SMITH RD	None	WATSONVILLE	CA	95076	9727	44	06087	36.98912259	-121.7523628	Santa Cruz County
63657	Fee-for-Service	1942664842	1942664842	1	1	DURAN, PEDRO A MD	2/3/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150481	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
63662	Fee-for-Service	1356469266	1356469266	1	1	DRIVER, CATHERINE B MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86522	83	Rheumatology	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 100	MISSION VIEJO	CA	92691	6389	30	06059	33.56286021	-117.6673449	Orange County
63666	Fee-for-Service	1922476589	1922476589	1	1	DANG, NHI H	3/27/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
63690	Fee-for-Service	1689837338	1689837338	1	1	DELTORO-DIAZ, CHRISTINA MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110108	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
63695	Fee-for-Service	1699235739	1699235739	1	1	DEMBAR, ALEXANDRA R MD	9/4/2023	207R00000X	NA	Other	026	PHYSICIANS	186373	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
63703	Fee-for-Service	1376869180	1376869180	1	1	DING, DAVID Y MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134215	20	Orthopedic Surgery	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
63725	Fee-for-Service	1588858062	1588858062	1	1	DEANER, SHERRY D	2/28/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
63750	Fee-for-Service	1689038424	1689038424	1	1	DERMENDJIAN, HAROUT	11/15/2017	390200000X	NA	Other	026	PHYSICIANS	151068	30	Radiology	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
63757	Fee-for-Service	1740607944	1740607944	1	1	DEMPSEY, TIMOTHY M MD	3/1/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	139347	None	None	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
63823	Fee-for-Service	1891796082	1891796082	1	2	DAVID KAY	9/28/2023	2085R0204X	NA	Other	026	PHYSICIANS	185655	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
63893	Fee-for-Service	1861411084	1861411084	1	1	DESHIELDS, LAURENCE M DO	5/2/2024	208M00000X	NA	Other	026	PHYSICIANS	175802	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
63902	Fee-for-Service	1851580385	1851580385	1	1	DUEBBERT, JEANNE M LMFT	5/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
63931	Fee-for-Service	1548595127	1548595127	1	1	DHARIA, AJAY S MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114612	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
63942	Fee-for-Service	1164610754	1164610754	1	1	DE LE TORRE, GUILLERMO	3/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
63955	Fee-for-Service	1992729099	1992729099	1	1	DONZIS, PAUL B MD INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	42774	18	Ophthalmology	0	In state provider	None	4644 LINCOLN BLVD	STE 102	MARINA DEL REY	CA	90292	6374	19	06037	33.98210351	-118.4405172	Los Angeles County
63979	Fee-for-Service	1598229437	1598229437	1	1	DEVONSHIRE HEALTHCARE INC	1/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1201 34TH ST	None	SAN DIEGO	CA	92102	2416	37	06073	32.718168	-117.1210315	San Diego County
63985	Fee-for-Service	1689990509	1689990509	1	1	DIAS, DENNIS A MD	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10761	40	Pediatrics	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	94503	1719	49	06097	38.482839	-122.7357945	Sonoma County
63996	Fee-for-Service	1538604442	1538604442	1	1	DUVVURI, MADHAVI V MD	4/4/2025	2085N0700X	NA	MRI Provider	026	PHYSICIANS	182454	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
64010	Fee-for-Service	1194840421	1194840421	1	2	DIGNITY HEALTH	4/26/2022	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
64019	Fee-for-Service	1134515851	1134515851	1	1	DODSON, DANIEL S MD	8/1/2021	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	172961	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
64029	Fee-for-Service	1659753218	1659753218	1	1	DUCHMAN, BRYCE J MD	7/11/2022	207LC0200X	NA	Other	026	PHYSICIANS	176837	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
64049	Fee-for-Service	1639845456	1639845456	1	1	DAVINE, LINDA LMFT	8/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
64050	Fee-for-Service	1871612929	1871612929	1	2	DARDASHTI, HONEY B LMFT	5/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2716 S VERMONT AVE	UNIT 9	LOS ANGELES	CA	90007	2671	19	06037	34.029891	-118.2915225	Los Angeles County
64060	Fee-for-Service	1144608555	1144608555	1	1	DADIOS, MARC D MD	9/23/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146121	None	None	0	In state provider	None	18133 VENTURA BLVD	200 2ND FLOOR	TARZANA	CA	91356	3616	19	06037	34.1657808	-118.5283188	Los Angeles County
64074	Fee-for-Service	1104922806	1104922806	1	1	DHAWAN, VINOD K MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34165	77	Infectious Disease	0	In state provider	None	1902 ROYALTY DR	STE 200	POMONA	CA	91767	3059	19	06037	34.07791925	-117.746146	Los Angeles County
64108	Fee-for-Service	1265639140	1265639140	1	1	DAS, PIYUSH MD	5/25/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	170803	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
64204	Fee-for-Service	1710142708	1710142708	1	1	DILLON, BENEDICT S MD	2/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111118	41	Internal Medicine	0	In state provider	None	949 PALM AVE	None	IMPERIAL BEACH	CA	91932	1503	37	06073	32.58380109	-117.1133687	San Diego County
64227	Fee-for-Service	1407996804	1407996804	1	1	DARGE, KASSA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N 20TH ST	STE 210	PHILADELPHIA	PA	19103	1454	00	None	39.95590217	-75.17277518	Philadelphia County
64277	Fee-for-Service	1568416147	1568416147	1	4	DESERT ADVANCED IMAGING MEDI	1/12/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL CENTER	1180 N INDIAN CANYON DR	STE E155	PALM SPRINGS	CA	92262	4835	33	06065	33.839505	-116.5455735	Riverside County
64284	Fee-for-Service	1538604442	1538604442	1	1	DUVVURI, MADHAVI V MD	4/4/2025	2085N0700X	NA	MRI Provider	026	PHYSICIANS	182454	13	Neurology (M.D. only)	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
64292	Fee-for-Service	1659589844	1659589844	1	1	DOCTORS OF DERMATOLOGY INC	6/8/2015	193400000X	NA	Other	026	PHYSICIANS	8307	None	None	0	In state provider	None	27141 HIDAWAY AVENUE	SUITE 104	SANTA CLARITA	CA	91351	4150	19	06037	34.41483	-118.469039	Los Angeles County
64309	Fee-for-Service	1770070302	1770070302	1	1	DIEHL, JESSICA A MD	6/12/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	186660	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
64335	Fee-for-Service	1487629382	1487629382	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5429 W CYPRESS AVE	None	VISALIA	CA	93277	8341	54	06107	36.324423	-119.3517855	Tulare County
64362	Fee-for-Service	1104922806	1104922806	1	1	DHAWAN, VINOD K MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34165	01	General Practice	0	In state provider	None	1902 ROYALTY DR	STE 200	POMONA	CA	91767	3059	19	06037	34.07791925	-117.746146	Los Angeles County
64391	Fee-for-Service	1780741090	1780741090	1	1	DA ZHEN TRAVEL AGENCY	6/15/2015	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE	17331 E VALLEY BLVD	None	LA PUENTE	CA	91744	0000	19	06037	34.011387	-117.9264465	Los Angeles County
64486	Fee-for-Service	1912240946	1912240946	1	1	DIAZ, ROBERT MD	10/29/2018	207RS0010X	NA	Other	026	PHYSICIANS	148247	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
64504	Fee-for-Service	1063536993	1063536993	1	1	DELA CRUZ, ROBERT G MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104275	41	Internal Medicine	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
64545	Fee-for-Service	1518998723	1518998723	1	4	DRS. MISHAL, PHAM & ASSOCIAT	4/14/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	14359 PIONEER BLVD.	SUITE A	NORWALK	CA	90650	4850	19	06037	33.90057	-118.0826075	Los Angeles County
64549	Fee-for-Service	1730527698	1730527698	1	1	DAUTREMONT, BRITTNEY A DO	12/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1441 CONSTITUTION BLVD	BLDG 400 STE 100	SALINAS	CA	93906	3136	27	06053	36.696987	-121.633164	Monterey County
64555	Fee-for-Service	1902183098	1902183098	1	1	DEBORAH A HIGER	4/18/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	725 PINE STREET	None	MOUNT SHASTA	CA	96067	2133	47	06093	41.31593884	-122.3193143	Siskiyou County
64583	Fee-for-Service	1477587673	1477587673	1	1	DELASALAS, MERCEDESANN T MD	5/14/2024	207R00000X	NA	Other	026	PHYSICIANS	50934	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
64623	Fee-for-Service	1437207222	1437207222	1	1	DAWSON, GAIL MD	12/26/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67779	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
64624	Fee-for-Service	1710221403	1710221403	1	1	DIETRICH, EDWIN H MD	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129815	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
64636	Fee-for-Service	1336393784	1336393784	1	1	DEBOPAM SAMANTHA	7/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
64650	Fee-for-Service	1104922806	1104922806	1	1	DHAWAN, VINOD K MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34165	41	Internal Medicine	0	In state provider	None	1902 ROYALTY DR	STE 200	POMONA	CA	91767	3059	19	06037	34.07791925	-117.746146	Los Angeles County
64686	Fee-for-Service	1588706550	1588706550	1	1	DEVLAMING, WILLIAM H MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33859	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	1355 EAST ST	STE 120	REDDING	CA	96001	0801	45	06089	40.58628506	-122.3887911	Shasta County
64726	Fee-for-Service	1447617519	1447617519	1	2	DANIEL, RHYAN N PSYD	9/30/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	107 W FAIRVIEW BLVD	None	INGLEWOOD	CA	90302	1202	19	06037	33.97924422	-118.3583448	Los Angeles County
64739	Fee-for-Service	1639916505	1639916505	1	1	DARLA GALE COUNSELING, MARRI	7/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AGE AND FAMILY THERAPIST	6135 KING RD	SUITE D	LOOMIS	CA	95650	8877	31	06061	38.8251327	-121.1892156	Placer County
64743	Fee-for-Service	1164092862	1164092862	1	1	DIONISIO, VERONICA CNP	2/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	130 N GRAND AVE	None	GLENDORA	CA	91741	2434	19	06037	34.137045	-117.87057	Los Angeles County
64784	Fee-for-Service	1730848920	1730848920	1	2	DOUBLESTARS TRANSPORTATION	5/5/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	STE 114	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
64818	Fee-for-Service	1790938777	1790938777	1	1	D'CUNHA, BEVERLY A AU	2/14/2025	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	19801 VANOWEN ST	SUITE H	WINNETKA	CA	91306	3962	19	06037	34.19383649	-118.5645375	Los Angeles County
64819	Fee-for-Service	1164032447	1164032447	1	1	DOUGLAS, MUSTAFA F MD	8/3/2023	208M00000X	NA	Other	026	PHYSICIANS	185288	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
64837	Fee-for-Service	1568416147	1568416147	1	10	DESERT ADVANCED IMAGING MEDI	12/8/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL CENTER	57840 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	3047	36	06071	34.12683378	-116.4025899	San Bernardino County
64839	Fee-for-Service	1902183098	1902183098	1	1	DEBORAH A HIGER	4/18/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	725 PINE STREET	None	MOUNT SHASTA	CA	96067	2133	47	06093	41.31593884	-122.3193143	Siskiyou County
64875	Fee-for-Service	1053072678	1053072678	1	1	DELICATE CARE HOME HEALTH	5/28/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2221 W OLIVE AVE	UNIT H	BURBANK	CA	91506	2609	19	06037	34.16315855	-118.3275742	Los Angeles County
64909	Fee-for-Service	1437207222	1437207222	1	1	DAWSON, GAIL MD	12/26/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67779	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
64989	Fee-for-Service	1982130795	1982130795	1	1	DYCHIOCO, JUSTIN A MD	8/7/2020	208M00000X	NA	Other	026	PHYSICIANS	164593	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
65024	Fee-for-Service	1457457160	1457457160	1	2	DRUMMER, HARRIET L DO	7/28/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	7014	-	NOT APPLICABLE	0	In state provider	None	2844 COLOMA ST	None	PLACERVILLE	CA	95667	4406	09	06017	38.73241271	-120.8065775	El Dorado County
65085	Fee-for-Service	1043502677	1043502677	1	1	DAWSON, MELISSA L DO	9/20/2018	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16459	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1405 MAGNOLIA AVE	SUITE A	CHICO	CA	95926	3310	04	06007	39.74046859	-121.8497839	Butte County
65095	Fee-for-Service	1871665828	1871665828	1	2	DURRANT, JULIA C MD	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
65100	Fee-for-Service	1851098750	1851098750	1	1	DELMONTE, TONI	3/24/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
65121	Fee-for-Service	1639486566	1639486566	1	1	DWUMFUOH, TAKYI LMFT	6/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1652 W TEXAS STREET	SUITE 144	FAIRFIELD	CA	94533	6066	48	06095	38.24929745	-122.0578065	Solano County
65122	Fee-for-Service	1801963020	1801963020	1	1	DELGADO, ELIANA D MD	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	51484	20	Orthopedic Surgery	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
65128	Fee-for-Service	1902183098	1902183098	1	1	DEBORAH A HIGER	8/27/2012	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	725 PINE STREET	None	MOUNT SHASTA	CA	96067	2133	47	06093	41.31593884	-122.3193143	Siskiyou County
65156	Fee-for-Service	1760574446	1760574446	1	1	DULBECCO, FIONA L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64381	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2340 CLAY ST	STE 525	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
65178	Fee-for-Service	1467487769	1467487769	1	1	DOUGLAS, KAYE ANNE P MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88867	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	ONE HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
65217	Fee-for-Service	1487114211	1487114211	1	1	DONG, ELAINE Y MD	8/28/2023	2085B0100X	NA	MRI Provider	026	PHYSICIANS	182377	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
65229	Fee-for-Service	1033604889	1033604889	1	1	DICKEN, BROOKE E LCSW	1/9/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
65272	Fee-for-Service	1851328108	1851328108	1	1	DRACHENBERG, ANA M MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74874	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	STE 3	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
65303	Fee-for-Service	1922596089	1922596089	1	1	DELUCIA, MARY E LMFT	7/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5800 HANNUM AVE	105	CULVER CITY	CA	90230	6553	19	06037	33.98724995	-118.3858338	Los Angeles County
65316	Fee-for-Service	1952446304	1952446304	1	1	DUONG, HAO QUANG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42116	01	General Practice	0	In state provider	None	173 N MORRISON AVE	STE I	SAN JOSE	CA	95126	2712	43	06085	37.33258801	-121.9084887	Santa Clara County
65377	Fee-for-Service	1366167215	1366167215	1	1	DOUGLASS, TREVOR S PT	10/19/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3191 MISSION INN AVE	B	RIVERSIDE	CA	92507	4187	33	06065	33.98015514	-117.3677324	Riverside County
65390	Fee-for-Service	1144317306	1144317306	1	2	DONN & DOFF INC.	2/10/2024	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	THETICS	830 PINE STREET	None	MOUNT SHASTA	CA	96067	2137	47	06093	41.31730651	-122.3208659	Siskiyou County
65417	Fee-for-Service	1902183098	1902183098	1	1	DEBORAH A HIGER	4/18/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	725 PINE STREET	None	MOUNT SHASTA	CA	96067	2133	47	06093	41.31593884	-122.3193143	Siskiyou County
65434	Fee-for-Service	1336139609	1336139609	1	1	DIAZ, VICTOR M	9/24/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
65438	Fee-for-Service	1265131734	1265131734	1	1	DOUBLE LOTUS ACUPUNCTURE PRO	1/23/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NTEGRATIVE MEDICINE	152 MILL STREET	SUITE G	GRASS VALLEY	CA	95945	4771	29	06057	39.21759945	-121.0631115	Nevada County
65445	Fee-for-Service	1760574446	1760574446	1	1	DULBECCO, FIONA L MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64381	41	Internal Medicine	0	In state provider	None	2340 CLAY ST	STE 525	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
65447	Fee-for-Service	1982960514	1982960514	1	1	DEYRO, HEIDI J MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133814	40	Pediatrics	0	In state provider	None	505 E ROMIE LN	STE K	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
65453	Fee-for-Service	1285788620	1285788620	1	1	DNM PHARMACY INC	12/3/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6221 WILSHIRE BLVD	STE 100	LOS ANGELES	CA	90048	5209	19	06037	34.06329534	-118.3640031	Los Angeles County
65470	Fee-for-Service	1134207962	1134207962	1	1	DOKHANI, F SHABESTARI	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	45896	01	General Practice	0	In state provider	None	213 W BEAMER ST	None	WOODLAND	CA	95695	2510	57	06113	38.68483629	-121.7937301	Yolo County
65514	Fee-for-Service	1225031693	1225031693	1	1	DAVIS, MICHAEL S MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41457	41	Internal Medicine	0	In state provider	None	200 COTTAGE AVE	STE 203	MANTECA	CA	95336	4935	39	06077	37.79956104	-121.1982472	San Joaquin County
65519	Fee-for-Service	1508851064	1508851064	1	1	DECASTRO, DULCE R MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	44674	22	Pathology (M.D. only)	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
65523	Fee-for-Service	1659349850	1659349850	1	1	DAVID THOMPSON DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2400 N ROCKTON AVE	None	ROCKFORD	IL	61103	3655	00	None	42.29890121	-89.09680826	Winnebago County
65525	Fee-for-Service	1699156539	1699156539	1	1	DE VERA, MARY ANN Z NP	7/12/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
65550	Fee-for-Service	1275898868	1275898868	1	1	DRAKE, LORI C DPM	8/18/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
65556	Fee-for-Service	1386998524	1386998524	1	1	DALTON, EMILY PSYD	6/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
65559	Fee-for-Service	1699726976	1699726976	1	1	DAVILA, EDMUNDO R MD	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37410	01	General Practice	0	In state provider	RUIZ DAVILA, E MD INC	4087 PERALTA BLVD	None	FREMONT	CA	94536	4849	01	06001	37.55736284	-122.0074555	Alameda County
65561	Fee-for-Service	1851328108	1851328108	1	1	DRACHENBERG, ANA M MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74874	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	STE 3	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
65580	Fee-for-Service	1255511903	1255511903	1	1	DOLINER, ADIR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1401 MEDICAL PKWY	None	CEDAR PARK	TX	78613	7763	00	None	30.532428	-97.8121845	Williamson County
65602	Fee-for-Service	1952446304	1952446304	1	1	DUONG, HAO QUANG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42116	36	Psychiatry	0	In state provider	None	173 N MORRISON AVE	STE I	SAN JOSE	CA	95126	2712	43	06085	37.33258801	-121.9084887	Santa Clara County
65662	Fee-for-Service	1861464000	1861464000	1	1	DOLORICO, ARLENE M MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65842	18	Ophthalmology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
65715	Fee-for-Service	1528046612	1528046612	1	1	DRAKE, DAVID G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	166 4TH ST E	None	ST PAUL	MN	55101	1421	00	None	44.94748068	-93.08830943	Ramsey County
65719	Fee-for-Service	1689962607	1689962607	1	1	DHAR, ROMIKA MD	4/24/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	131809	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
65734	Fee-for-Service	1609022359	1609022359	1	1	DEVINCENTIS, TAMMY CNP	12/19/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
65755	Fee-for-Service	1396004032	1396004032	1	1	DELA CRUZ, MARICEL ROMELIA B	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	16838	66	Emergency Medicine (Urgent Care)	0	In state provider	DO	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
65761	Fee-for-Service	1760571145	1760571145	1	1	DAWKINS, PATRICK A MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86127	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27225 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63194474	-122.0897225	Alameda County
65766	Fee-for-Service	1760427926	1760427926	1	1	DURHAM, BRITT A MD	3/31/1989	193400000X	NA	Other	026	PHYSICIANS	61109	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
65801	Fee-for-Service	1225031693	1225031693	1	1	DAVIS, MICHAEL S MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41457	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 COTTAGE AVE	STE 203	MANTECA	CA	95336	4935	39	06077	37.79956104	-121.1982472	San Joaquin County
65820	Fee-for-Service	1730300617	1730300617	1	1	DAVID STEINBERG MD INC	12/27/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83337	08	Family Practice	0	In state provider	None	1513 S GRAND AVE	STE 320	LOS ANGELES	CA	90015	3021	19	06037	34.03596303	-118.266212	Los Angeles County
65843	Fee-for-Service	1225344484	1225344484	1	1	DECOLONGON, JENNIFER MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127594	01	General Practice	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
65846	Fee-for-Service	1699726976	1699726976	1	1	DAVILA, EDMUNDO R MD	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37410	08	Family Practice	0	In state provider	RUIZ DAVILA, E MD INC	4087 PERALTA BLVD	None	FREMONT	CA	94536	4849	01	06001	37.55736284	-122.0074555	Alameda County
65864	Fee-for-Service	1457304925	1457304925	1	1	DOPKO, JOSHUA M MD	2/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
65870	Fee-for-Service	1679509269	1679509269	1	1	DACANAY, LEONARDO MD	1/1/2012	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1936 UNIVERSITY AVE	STE 112	BERKELEY	CA	94704	1003	01	06001	37.87159283	-122.2722026	Alameda County
65931	Fee-for-Service	1790759744	1790759744	1	1	DVA HEALTHCARE RENAL	8/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	2738 W IMPERIAL HWY	None	INGLEWOOD	CA	90303	3111	19	06037	33.9308427	-118.3235088	Los Angeles County
65968	Fee-for-Service	1710035597	1710035597	1	1	DUBOWY, KAREN S MD	10/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68718	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
65999	Fee-for-Service	1053340745	1053340745	1	1	DESAI, DHANLAXMI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	970 E WASHINGTON ST	STE 2E	MEDINA	OH	44256	2181	00	None	41.13909692	-81.83919622	Medina County
66004	Fee-for-Service	1831168459	1831168459	1	1	DAO, SOPHIE KIEU-LIEN	1/31/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY INC	991 MONTAGUE EXPRESSWAY	SUITE 111	MILPITAS	CA	95035	6809	43	06085	37.41304686	-121.8852862	Santa Clara County
66014	Fee-for-Service	1992736599	1992736599	1	5	DOCTORS HOSPITAL OF MANTECA	2/13/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	1134 NORMAN DR	None	MANTECA	CA	95336	5963	39	06077	37.79418644	-121.2005742	San Joaquin County
66019	Fee-for-Service	1437719408	1437719408	1	1	DAUD, MUHAMMAD A MD	11/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190282	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
66036	Fee-for-Service	1881936128	1881936128	1	1	DELAGRAMMATICAS, DIMITRI E M	8/17/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	161981	20	Orthopedic Surgery	0	In state provider	D	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	40	06079	35.29243951	-120.668652	San Luis Obispo County
66067	Fee-for-Service	1053653873	1053653873	1	7	DIGNITY HEALTH MEDICAL	5/12/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	FOUNDATION	17051 SIERRA LAKES PKWY	STE 101	FONTANA	CA	92336	1274	36	06071	34.13797332	-117.4324372	San Bernardino County
66092	Fee-for-Service	1780779041	1780779041	1	1	DONSON, DAVID A MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53955	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3528	19	06037	33.89242734	-118.2947128	Los Angeles County
66117	Fee-for-Service	1053653873	1053653873	1	6	DIGNITY HEALTH MEDICAL	1/15/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	401 E HIGHLAND AVE	STE 450A	SAN BERNARDINO	CA	92404	3836	36	06071	34.1358627	-117.2757778	San Bernardino County
66127	Fee-for-Service	1811920424	1811920424	1	1	DIX, KAREN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40807	01	General Practice	0	In state provider	None	20401 AVALON BLVD	STE C	CARSON	CA	90746	3226	19	06037	33.84655123	-118.2648105	Los Angeles County
66130	Fee-for-Service	1225344484	1225344484	1	1	DECOLONGON, JENNIFER MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127594	08	Family Practice	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
66135	Fee-for-Service	1699726976	1699726976	1	1	DAVILA, EDMUNDO R MD	11/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	37410	-	NOT APPLICABLE	0	In state provider	RUIZ DAVILA, E MD INC	4087 PERALTA BLVD	None	FREMONT	CA	94536	4849	01	06001	37.55736284	-122.0074555	Alameda County
66191	Fee-for-Service	1467962746	1467962746	1	1	DAVIS, SUCCURA M NP	8/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3733 SAN DIMAS ST	STE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
66238	Fee-for-Service	1629276068	1629276068	1	1	DINOVO, AMY M LCSW	7/11/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
66308	Fee-for-Service	1043674120	1043674120	1	1	DASGUPTA, MINNIE N MD	5/23/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150937	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
66355	Fee-for-Service	1053653873	1053653873	1	7	DIGNITY HEALTH MEDICAL	5/12/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	17051 SIERRA LAKES PKWY	STE 101	FONTANA	CA	92336	1274	36	06071	34.13797332	-117.4324372	San Bernardino County
66410	Fee-for-Service	1356509699	1356509699	1	1	DRESEL VELASQUEZ, KATHRYN C	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105955	15	Obstetrics (D.O. only)	0	In state provider	MD	515 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42796855	-119.7246047	Santa Barbara County
66414	Fee-for-Service	1144668575	1144668575	1	1	DEMING, PHILLIP R LMFT	6/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
66422	Fee-for-Service	1467017061	1467017061	1	1	DIGNITY HOME HEALTH CARE	2/25/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1589 W SHAW AVE	SUITE 10	FRESNO	CA	93711	3500	10	06019	36.8081908	-119.821524	Fresno County
66442	Fee-for-Service	1407997158	1407997158	1	1	DAVIDOFF, MARC LMFT	1/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
66469	Fee-for-Service	1952486052	1952486052	1	1	DAVIDSON, DEBORAH A PT	2/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	2100 MAIN ST	STE 250	HUNTINGTON BEACH	CA	92648	2495	30	06059	33.68051369	-118.0015429	Orange County
66493	Fee-for-Service	1841293156	1841293156	1	1	DEATHERAGE, MARK F MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	MARK F DEATHERAGE MD	1600 NW 6TH ST	None	GRANTS PASS	OR	97526	1094	00	None	42.45662001	-123.3226346	Josephine County
66549	Fee-for-Service	1548407638	1548407638	1	1	DUMITRU, DANA G DO	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10090	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
66589	Fee-for-Service	1295082857	1295082857	2	1	DHP OF TWIN CITIES MEDICAL G	9/18/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	ROUP INC	1100 LAS TABLAS ROAD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
66590	Fee-for-Service	1245469923	1245469923	1	1	DE LA ZERDA, DAVID J MD	2/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109197	41	Internal Medicine	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
66602	Fee-for-Service	1194776021	1194776021	1	1	DUGGAL, HARPREET S MD	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	91798	36	Psychiatry	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
66681	Fee-for-Service	1477146488	1477146488	1	1	DAVIS, LAUREN E PT	3/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2603 PATTERSON RD	STE 8	RIVERBANK	CA	95367	3407	50	06099	37.73272653	-120.949119	Stanislaus County
66699	Fee-for-Service	1356509699	1356509699	1	1	DRESEL VELASQUEZ, KATHRYN C	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105955	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	515 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42796855	-119.7246047	Santa Barbara County
66700	Fee-for-Service	1275804080	1275804080	1	1	DODDAMREDDY, PRADEEP K MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121969	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
66722	Fee-for-Service	1902301211	1902301211	1	1	DEARBORN, THOMAS M LMFT	3/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7090 MIRATECH DR	None	SAN DIEGO	CA	92121	3109	37	06073	32.89821825	-117.1711874	San Diego County
66723	Fee-for-Service	1205883865	1205883865	1	1	DR MARCUS EAST	3/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	655 MEDICAL CENTER DR NE	None	SALEM	OR	97301	2751	00	None	44.941122	-123.007959	Marion County
66769	Fee-for-Service	1801566138	1801566138	1	1	DV QUALITY HOME HEALTH CARE,	11/22/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	936 WEST AVE J-4	UNIT 202	LANCASTER	CA	93534	4246	19	06037	34.6893897	-118.1468548	Los Angeles County
66778	Fee-for-Service	1841293156	1841293156	1	1	DEATHERAGE, MARK F MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	MARK F DEATHERAGE MD	1600 NW 6TH ST	None	GRANTS PASS	OR	97526	1094	00	None	42.45662001	-123.3226346	Josephine County
66814	Fee-for-Service	1164526224	1164526224	1	1	DAS, MALAY R MD	7/1/1979	207R00000X	NA	Other	026	PHYSICIANS	34000	45	Nephrology (Renal-Kidney)	0	In state provider	DAS MEDICAL GROUP INC	4477 W 118TH ST	STE 409	HAWTHORNE	CA	90250	2259	19	06037	33.92734752	-118.354221	Los Angeles County
66858	Fee-for-Service	1811211626	1811211626	1	1	DETZ, ALISSA A MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110966	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
66913	Fee-for-Service	1437117421	1437117421	1	1	DASGUPTA, RAJKUMAR R MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124658	None	None	0	In state provider	None	1520 SAN PABLO STREET	SUITE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
66920	Fee-for-Service	1962114587	1962114587	1	1	DINGDING, LEILA P CRNA	1/31/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 CHESTER AVE.	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
66921	Fee-for-Service	1588697619	1588697619	1	1	DESAI, VAISHALI B MD	12/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118401	41	Internal Medicine	0	In state provider	None	1783 CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
66958	Fee-for-Service	1952020315	1952020315	1	1	DESERT VALLEY MEDICAL GROUP	9/7/2022	207RG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12998 HESPERIA RD	101	VICTORVILLE	CA	92395	8316	36	06071	34.48789715	-117.2906992	San Bernardino County
66963	Fee-for-Service	1942316807	1942316807	1	1	DEO, RAHUL C MD	2/16/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	115307	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66971	Fee-for-Service	1194968784	1194968784	1	1	DALAL, ROOSHIN B MD	11/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116801	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
67075	Fee-for-Service	1245235951	1245235951	1	1	DANIEL DROTTS	2/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 WAYNE MEMORIAL DR	None	GOLDSBORO	NC	27534	9494	00	None	35.398593	-77.952294	Wayne County
67124	Fee-for-Service	1922635457	1922635457	1	1	DILBAROVA, RIMA MD	7/31/2023	2279E0002X	NA	Other	026	PHYSICIANS	185630	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
67147	Fee-for-Service	1861410581	1861410581	1	1	DIGNITY HEALTH MEDICAL	3/20/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
67176	Fee-for-Service	1972614758	1972614758	1	1	DO, THUTRANG DO	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8885	None	None	0	In state provider	DO MEDICAL, INC	15735 HAWTHORNE BLVD	STE 111	LAWNDALE	CA	90260	2664	19	06037	33.887664	-118.3527595	Los Angeles County
67243	Fee-for-Service	1326764739	1326764739	1	1	DR. DEE HEALTH CENTER, INC	2/13/2023	2083A0300X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	18800 MAIN ST	STE 101	HUNTINGTON BEACH	CA	92648	1707	30	06059	33.68890364	-117.9949974	Orange County
67258	Fee-for-Service	1881692291	1881692291	1	1	DEL CASTILLO, FULGENCIO B MD	8/22/2022	2080P0006X	NA	Psychiatry	026	PHYSICIANS	177174	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
67324	Fee-for-Service	1609014463	1609014463	1	1	DIGIULIO, CARLA CRNA	7/29/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
67347	Fee-for-Service	1831944875	1831944875	1	1	DIPENDRA GAUTAM PHYSICAL THE	11/8/2024	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	Y	7942 N MAPLE AVE	SUITE 102	FRESNO	CA	93720	0293	10	06019	36.851454	-119.747724	Fresno County
67361	Fee-for-Service	1598877516	1598877516	1	1	DENVER NEPHROLOGISTS PC	2/10/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
67377	Fee-for-Service	1881852739	1881852739	1	1	DESIKAN, SONIA MD	1/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116755	40	Pediatrics	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
67385	Fee-for-Service	1528475969	1528475969	1	1	DARGAH-ZADA, NIGAR MD	11/20/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	1801 WILSHIRE BLVD	100	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
67391	Fee-for-Service	1891371589	1891371589	1	1	DAVIS, SARAH C DO	7/31/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21002	08	Family Practice	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
67423	Fee-for-Service	1053596361	1053596361	1	1	DANG PHARMACY GROUP INC	7/23/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SAN GABRIEL MEDICAL PHAR	1250 S SUNSET AVE	STE 207	WEST COVINA	CA	91790	3962	19	06037	34.0610671	-117.9463685	Los Angeles County
67450	Fee-for-Service	1528078631	1528078631	1	1	DAYAHAN, CESARIO D MD	7/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82521	05	Anesthesiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
67480	Fee-for-Service	1356542237	1356542237	1	1	DOH, RAYMOND J	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63108	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
67540	Fee-for-Service	1275808115	1275808115	1	2	DUONG D NGUYEN, INC	10/3/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY	5051 CANYON CREST DR	102	RIVERSIDE	CA	92507	6035	33	06065	33.9589602	-117.3311519	Riverside County
67560	Fee-for-Service	1265934632	1265934632	1	1	DANUBE RIVER HOLDINGS LLC	3/20/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6041 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4816	34	06067	38.611431	-121.329522	Sacramento County
67582	Fee-for-Service	1336181411	1336181411	1	1	DE HOYOS, JUAN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87714	36	Psychiatry	0	In state provider	None	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	44	06087	36.99276804	-122.0178271	Santa Cruz County
67609	Fee-for-Service	1861410581	1861410581	1	3	DIGNITY HEALTH MEDICAL	8/3/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
67610	Fee-for-Service	1164789103	1164789103	1	1	DOAN, CHAU X MD	5/25/2021	207L00000X	NA	Other	026	PHYSICIANS	171275	None	None	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	8580	30	06059	33.56008604	-117.6657795	Orange County
67648	Fee-for-Service	1841325966	1841325966	1	1	DEES, SEAN M PT	3/24/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	420 B ST	None	YUBA CITY	CA	95991	5070	51	06101	39.13415904	-121.6121453	Sutter County
67651	Fee-for-Service	1306573381	1306573381	1	1	DR. PEI CHI CHAIN, OD, OPTOM	1/18/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7835 HIGHLAND VILLAGE PL	STE D106	SAN DIEGO	CA	92129	5185	37	06073	32.96222703	-117.1547737	San Diego County
67693	Fee-for-Service	1194354357	1194354357	1	1	DE GUZMAN, LIANE	9/5/2023	208M00000X	NA	Other	026	PHYSICIANS	20461	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
67737	Fee-for-Service	1366707523	1366707523	1	1	DUMITRESCU, TEODORA MD	9/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133903	41	Internal Medicine	0	In state provider	None	2340 CLAY STREET	2ND FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
67759	Fee-for-Service	1831623453	1831623453	1	1	DOS PALOS APEX HEALTH CENTER	4/5/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INC	1549 GOLDEN GATE AVE	None	DOS PALOS	CA	93620	2339	24	06047	36.985059	-120.627763	Merced County
67770	Fee-for-Service	1851933980	1851933980	1	1	DE GUZMAN, MUTYA JOYCE NP	9/16/2023	2278C0205X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
67776	Fee-for-Service	1962083030	1962083030	1	1	DESAI, CHINAR PT	12/5/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
67785	Fee-for-Service	1376727974	1376727974	1	1	DANG, ALAN B MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116008	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
67817	Fee-for-Service	1659525061	1659525061	1	1	DUKE FACILITIES INC	8/10/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6142 GREENFIELD LN	None	STOCKTON	CA	95207	3110	39	06077	38.01118661	-121.3000821	San Joaquin County
67819	Fee-for-Service	1851634190	1851634190	1	1	DOHERTY, LEANA M MD	5/14/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
67863	Fee-for-Service	1073878096	1073878096	1	1	DUONG, CAROLYN H OD	1/13/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
67893	Fee-for-Service	1700956885	1700956885	2	1	DIVYA RX SERVICES	1/31/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 N EL CIELO WAY	STE D405	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
67918	Fee-for-Service	1750836524	1750836524	1	1	DINSMORES INPATIENT SERVICES	11/1/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AMC	2700 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
67919	Fee-for-Service	1659702785	1659702785	1	1	DIFABIO, ADRIENNE B PHD	1/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
67923	Fee-for-Service	1952418162	1952418162	1	1	DENTON, JAMES R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
67930	Fee-for-Service	1174705107	1174705107	1	1	DO, ALICE N DO	2/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9018	07	Dermatology	0	In state provider	None	2235 HAYES ST	5TH FLOOR	SAN FRANCISCO	CA	94117	1082	38	06075	37.77302045	-122.4529717	San Francisco County
68049	Fee-for-Service	1831623453	1831623453	1	1	DOS PALOS APEX HEALTH CENTER	4/5/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INC	1549 GOLDEN GATE AVE	None	DOS PALOS	CA	93620	2339	24	06047	36.985059	-120.627763	Merced County
68056	Fee-for-Service	1205463775	1205463775	1	1	DAIL, CODY S MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176184	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
68075	Fee-for-Service	1497884928	1497884928	1	1	DAVID, MIRIAM MD	7/14/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172562	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
68114	Fee-for-Service	1881728426	1881728426	1	1	DELUNA, ANDRES L MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93352	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
68115	Fee-for-Service	1578345203	1578345203	1	1	DAUGHERTY, SANDRA PT	11/30/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
68138	Fee-for-Service	1598128217	1598128217	1	1	DIAZ, OLGA Y MD	8/7/2020	207P00000X	NA	Other	026	PHYSICIANS	156210	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
68157	Fee-for-Service	1770528721	1770528721	1	1	DEEM, CLARK W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4717 S 19TH ST	None	TACOMA	WA	98405	1167	00	None	47.24292351	-122.500746	Pierce County
68178	Fee-for-Service	1033549936	1033549936	1	1	DIVINE GRACE HOSPICE, INC	7/27/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4766 PARK GRANADA	STE 112	CALABASAS	CA	91302	3347	19	06037	34.15398634	-118.6423535	Los Angeles County
68208	Fee-for-Service	1487670329	1487670329	1	1	DAVIS, KIM T CNM	10/18/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
68214	Fee-for-Service	1407846157	1407846157	1	1	DEZA, JUAN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45058	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3230 WARING CT	STE D	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
68276	Fee-for-Service	1902099708	1902099708	1	1	DOZIER, EMANUEL V MD	3/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	75322	41	Internal Medicine	0	In state provider	None	2129 17TH ST	None	BAKERSFIELD	CA	93301	3704	15	06029	35.37431354	-119.026782	Kern County
68310	Fee-for-Service	1669523759	1669523759	1	2	DURGA MEDICAL CORPORATION	10/25/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	225 N LAURSEN ST	None	HEMET	CA	92543	4437	33	06065	33.749955	-116.9608485	Riverside County
68353	Fee-for-Service	1689291486	1689291486	1	1	DMOWSKA, JULIA MD	3/21/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
68393	Fee-for-Service	1669854568	1669854568	1	1	DAVIS, LAILA N PSYD	11/9/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
68452	Fee-for-Service	1740522408	1740522408	1	1	DANG, CHUONG D MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133239	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
68465	Fee-for-Service	1033549936	1033549936	1	1	DIVINE GRACE HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4766 PARK GRANADA	STE 112	CALABASAS	CA	91302	3347	19	06037	34.15398634	-118.6423535	Los Angeles County
68479	Fee-for-Service	1265894257	1265894257	1	1	DELSHAD, SEAN MD	5/3/2019	207R00000X	NA	Other	026	PHYSICIANS	153480	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
68500	Fee-for-Service	1407846157	1407846157	1	1	DEZA, JUAN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45058	41	Internal Medicine	0	In state provider	None	3230 WARING CT	STE D	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
68501	Fee-for-Service	1831352673	1831352673	1	1	DOAN, PHUONGDOAN L MD DO	6/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9926	None	None	0	In state provider	None	12815 HEACOCK ST	None	MORENO VALLEY	CA	92553	3116	33	06065	33.934842	-117.2438195	Riverside County
68537	Fee-for-Service	1780051375	1780051375	1	1	DO, PATRICIA LMFT	1/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8177 MONTEVINA DR	None	SACRAMENTO	CA	95829	1519	34	06067	38.461581	-121.3608195	Sacramento County
68538	Fee-for-Service	1912013418	1912013418	1	1	DAVIDSON, JESSICA MD	5/31/1992	207R00000X	NA	Other	026	PHYSICIANS	70472	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
68551	Fee-for-Service	1487715017	1487715017	1	1	DAUM, LISETTE M PT	7/17/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
68554	Fee-for-Service	1598746182	1598746182	1	1	DAVID KLEIS II, INC	7/26/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PALM GROVE HEALTHCARE	1665 E 8TH ST	None	BEAUMONT	CA	92223	2512	33	06065	33.93262174	-116.948731	Riverside County
68574	Fee-for-Service	1649243775	1649243775	1	1	DYLLA, MARY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61743	41	Internal Medicine	0	In state provider	None	1120 POPE ST	None	SAINT HELENA	CA	94574	1278	28	06055	38.50361674	-122.4664123	Napa County
68623	Fee-for-Service	1316038169	1316038169	1	1	DARDASHTI, MALIHE MD	8/13/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41092	None	None	0	In state provider	None	8500 WILSHIRE BLVD	STE 625	BEVERLY HILLS	CA	90211	3120	19	06037	34.06521956	-118.3764689	Los Angeles County
68628	Fee-for-Service	1144678525	1144678525	1	1	DE ALBA, JASMINE I LCSW	4/19/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
68652	Fee-for-Service	1790217230	1790217230	1	1	DHADVAI, SANDEEP MD	5/5/2020	390200000X	NA	Other	026	PHYSICIANS	159026	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
68693	Fee-for-Service	1801192109	1801192109	1	1	DIWAN, MURTAZA A MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149821	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
68696	Fee-for-Service	1992124606	1992124606	1	1	DECULING, EROL NP	3/18/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	321 TURNER	None	LODI	CA	95240	0517	39	06077	38.14571389	-121.2776835	San Joaquin County
68721	Fee-for-Service	1043264781	1043264781	1	1	DEVEREAUX, ROBERT A MD	4/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	31475	01	General Practice	0	In state provider	None	11100 WARNER AVE	STE 100	FOUNTAIN VLY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
68753	Fee-for-Service	1710938964	1710938964	1	1	DEL CARMEN, RENATO S MD	3/6/1996	207L00000X	NA	Other	026	PHYSICIANS	47837	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
68760	Fee-for-Service	1902259179	1902259179	1	1	DAVIS, ALLYSHA LCSW	10/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
68769	Fee-for-Service	1194799544	1194799544	1	1	DVA HEALTHCARE RENAL	10/7/1988	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	405 DOVER PKWY	None	DELANO	CA	93215	3714	15	06029	35.7555975	-119.2496517	Kern County
68795	Fee-for-Service	1407846157	1407846157	1	1	DEZA, JUAN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45058	01	General Practice	0	In state provider	None	3230 WARING CT	STE D	OCEANSIDE	CA	92056	4509	37	06073	33.18776771	-117.2893136	San Diego County
68799	Fee-for-Service	1225457955	1225457955	1	1	DOERING, ANDREW J MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1600 MEDICAL PKWY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
68812	Fee-for-Service	1093716979	1093716979	1	1	DEKALB MEDICAL CENTER, INC	4/19/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2701 N. DECATUR ROAD	None	DECATUR	GA	30033	5918	00	None	33.79223923	-84.28241267	DeKalb County
68840	Fee-for-Service	1346634896	1346634896	1	1	DEOT, DEEPA MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146953	01	General Practice	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
68848	Fee-for-Service	1194840421	1194840421	1	1	DIGNITY HEALTH	1/1/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
68858	Fee-for-Service	1144343146	1144343146	1	1	DAVIDSON, JOSHUA M MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88990	03	Allergy	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
68873	Fee-for-Service	1518351972	1518351972	1	1	DANIYAN, ADEGBEMISOLA A MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143743	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
68889	Fee-for-Service	1679700488	1679700488	1	1	DROR, ROY LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
68895	Fee-for-Service	1992736599	1992736599	1	1	DOCTORS HOSPITAL OF MANTECA	6/1/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
68915	Fee-for-Service	1790815876	1790815876	1	1	DRAKE, GLEN S LMFT	6/15/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY RD	STE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
68924	Fee-for-Service	1396009734	1396009734	1	1	DEEPA NAGARAJA	12/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3426 LAKE AVE	STE 120	PUEBLO	CO	81004	3878	00	None	38.21506782	-104.6257952	Pueblo County
68935	Fee-for-Service	1376861815	1376861815	1	1	DYNAMICS ORTHOTICS AND	5/27/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PROSTHETICS INC	11550 INDIAN HILLS ROAD	211	MISSION HILLS	CA	90502	2051	19	06037	34.28024575	-118.4588775	Los Angeles County
68964	Fee-for-Service	1174531859	1174531859	1	11	DIGNITY HEALTH MEDICAL FOUND	6/28/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	-SEQUOIA INC.	2900 WHIPPLE AVE	STE 210	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
68972	Fee-for-Service	1508356304	1508356304	1	1	DANN, ALLYSSA MD	7/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163762	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
68986	Fee-for-Service	1013934975	1013934975	1	1	DOUGLAS HUSHKA MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
69000	Fee-for-Service	1508200940	1508200940	1	1	DASTJERDI, MOHAMMAD MD	8/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137935	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
69010	Fee-for-Service	1093700528	1093700528	1	1	DUNN, JAMES S JR MD	5/28/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84568	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	229 W CHERRY AVE	None	PORTERVILLE	CA	93257	3401	54	06107	36.06917549	-119.0215574	Tulare County
69061	Fee-for-Service	1326314816	1326314816	1	1	DE LUCA, DARROW D MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125153	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
69091	Fee-for-Service	1093716979	1093716979	1	1	DEKALB MEDICAL CENTER, INC	4/19/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2701 N. DECATUR ROAD	None	DECATUR	GA	30033	5918	00	None	33.79223923	-84.28241267	DeKalb County
69118	Fee-for-Service	1700800307	1700800307	1	1	DRIANO, ANDREA N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
69126	Fee-for-Service	1316193600	1316193600	1	1	DEVAKI, UMA DO	9/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10305	08	Family Practice	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
69138	Fee-for-Service	1194840421	1194840421	1	1	DIGNITY HEALTH	1/1/2002	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
69190	Fee-for-Service	1003805938	1003805938	1	1	DIBBLE, ROBERT B PHD	7/9/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	375 E LINE ST	None	BISHOP	CA	93514	3566	14	06027	37.36149848	-118.389735	Inyo County
69291	Fee-for-Service	1154819274	1154819274	1	1	DENG, DORIS Z MD	7/31/2024	390200000X	NA	Other	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
69342	Fee-for-Service	1942473467	1942473467	1	2	DYER, BRIDGET A MD	5/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117438	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
69349	Fee-for-Service	1639176167	1639176167	1	1	DOSHI, SHEPHAL K MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64891	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	333 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4501	19	06037	33.9670722	-118.3439911	Los Angeles County
69413	Fee-for-Service	1760601694	1760601694	1	1	DYER, EDWARD A MD	12/11/2023	207RC0200X	NA	Other	026	PHYSICIANS	187456	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
69427	Fee-for-Service	1457612574	1457612574	1	1	DECKMAN, NOELLE J PHD	6/23/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
69453	Fee-for-Service	1639430523	1639430523	1	1	DELGADO, JOSE A LMFT	8/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
69471	Fee-for-Service	1760582472	1760582472	1	1	DENISTON, MARIA S	11/28/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
69476	Fee-for-Service	1679762702	1679762702	1	1	DEVORE, GREGGORY R MD	1/30/2008	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 330	PASADENA	CA	91105	3187	19	06037	34.13101049	-118.151532	Los Angeles County
69499	Fee-for-Service	1073557179	1073557179	1	1	DOUNG, VICTORIA D DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	PRIMARY PAIN RELIEF CNTR	13037 EUCLID ST	None	GARDEN GROVE	CA	92843	1333	30	06059	33.77287939	-117.9380083	Orange County
69537	Fee-for-Service	1518999309	1518999309	1	1	DON, SHERMAN MD	1/1/1979	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	13732	None	None	0	In state provider	None	17732 BEACH BLVD	SUITE C	HUNTINGTON BEACH	CA	92647	6881	30	06059	33.705054	-117.9890625	Orange County
69544	Fee-for-Service	1114597564	1114597564	1	1	DONOHUE, JEANINE T PT	6/19/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
69550	Fee-for-Service	1205993813	1205993813	1	1	DOUCET, JAY J MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69243	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
69559	Fee-for-Service	1528653623	1528653623	1	1	DHAMANI, HAFIZA NP	8/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
69564	Fee-for-Service	1902839962	1902839962	1	3	DUMOLIN SERVICE CORP	10/14/1996	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5028 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1214	49	06097	38.50534992	-122.758861	Sonoma County
69577	Fee-for-Service	1750081261	1750081261	1	1	DELPINO, DARIONNE LMFT	7/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
69582	Fee-for-Service	1417035122	1417035122	1	1	DASEN, KEVIN R MD	12/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70957	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
69635	Fee-for-Service	1891867545	1891867545	1	1	DA COSTA, ANABELA C MD	11/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89165	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
69653	Fee-for-Service	1366507162	1366507162	1	1	DZIERSKI, DAVID L	1/9/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	81 CERNON STREET	None	VACAVILLE	CA	95688	2803	48	06095	38.36102104	-121.9906107	Solano County
69673	Fee-for-Service	1801202783	1801202783	1	1	DHANOA, NARPINDER S MD	4/1/2019	207R00000X	NA	Other	026	PHYSICIANS	148832	41	Internal Medicine	0	In state provider	None	2710 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
69717	Fee-for-Service	1134230121	1134230121	1	1	DOCTOR DIABETIC SUPPLY LLC	10/4/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	3660 ENTERPRISE WY	None	MIRAMAR	FL	33025	6616	00	None	25.97690675	-80.28877802	Broward County
69745	Fee-for-Service	1356831689	1356831689	1	1	DAWSON, SHAMMEER LCSW	4/11/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
69774	Fee-for-Service	1851089783	1851089783	1	1	DHALIWAL, RIYA CD	5/17/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
69782	Fee-for-Service	1063402477	1063402477	1	1	DEVIA, ALVARO H MD	3/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	6554 S MCCARRAN BLVD	STE B	RENO	NV	89509	6149	00	None	39.47663442	-119.7992969	Washoe County
69875	Fee-for-Service	1275601387	1275601387	1	1	DAVIS, HOLLY	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
69885	Fee-for-Service	1144666108	1144666108	1	1	DASH, DEBADUTTA MD	12/23/2020	207P00000X	NA	Other	026	PHYSICIANS	168558	None	None	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
69887	Fee-for-Service	1033615984	1033615984	1	1	DUFFICY, WILLIAM MD	1/24/2023	390200000X	NA	Other	026	PHYSICIANS	180816	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
69896	Fee-for-Service	1700068152	1700068152	1	1	DIECKHOFF, JOHN C MD	6/2/2010	207R00000X	NA	Other	026	PHYSICIANS	103281	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	8589	30	06059	33.62421676	-117.9309656	Orange County
69897	Fee-for-Service	1871778720	1871778720	1	1	DING, ALEXANDER MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124660	30	Radiology	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
69926	Fee-for-Service	1235942616	1235942616	1	1	DAHLEM, ASHLEY A	3/14/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
69969	Fee-for-Service	1407108905	1407108905	1	1	DONOHUE, LAURA T	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
69994	Fee-for-Service	1972998847	1972998847	1	1	DATE, CAITLIN	2/15/2018	390200000X	NA	Other	026	PHYSICIANS	147188	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
69996	Fee-for-Service	1568875938	1568875938	1	1	DOSANJH, ANEIL S MD	8/14/2019	208M00000X	NA	Other	026	PHYSICIANS	155096	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
70015	Fee-for-Service	1578598595	1578598595	1	1	DELTA SIERRA MED GRP INC	8/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
70020	Fee-for-Service	1881225795	1881225795	1	1	DANIEL RESIDENTIAL CARE HOME	4/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	4295 AMAPOLA WAY	None	SACRAMENTO	CA	95823	5049	34	06067	38.468754	-121.4540145	Sacramento County
70058	Fee-for-Service	1205125663	1205125663	1	1	DIABETIC DME SUPPLIES LLC	7/1/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	77 MACK WALTERS RD	STE 301B	SHELBYVILLE	KY	40065	1793	00	None	38.21048161	-85.24016534	Shelby County
70066	Fee-for-Service	1760462105	1760462105	1	1	DUPREZ, GERALD R	2/28/1993	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9140 HAVEN AVE	STE 120	RANCHO CUCAMONGA	CA	91730	5414	36	06071	34.087491	-117.5758895	San Bernardino County
70076	Fee-for-Service	1922175876	1922175876	1	1	DAVIS, EARTHA D MD	12/1/1995	207P00000X	NA	Other	026	PHYSICIANS	81395	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
70102	Fee-for-Service	1417089962	1417089962	1	1	DIAGNOSTIC IMAGING MED	4/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	SPLIT BILLING	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
70187	Fee-for-Service	1659434132	1659434132	1	1	DALAL, JYOTI H PT	3/31/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
70192	Fee-for-Service	1801922521	1801922521	1	1	DOAN VAN, NICOLAS N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68391	41	Internal Medicine	0	In state provider	None	11100 WARNER AVE	STE 150B	FOUNTAIN VALLEY	CA	92708	7510	30	06059	33.716291	-117.9355051	Orange County
70213	Fee-for-Service	1154956415	1154956415	1	1	DWARAKANATH, ANIRUDH MD	11/19/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
70222	Fee-for-Service	1801837331	1801837331	1	1	DENENHOLZ, DAVID A MD	1/7/1999	174400000X	NA	Other	026	PHYSICIANS	37998	07	Dermatology	0	In state provider	None	960 E GREEN ST	STE 330	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
70244	Fee-for-Service	1992736599	1992736599	1	3	DOCTORS HOSPITAL OF MANTECA	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
70249	Fee-for-Service	1659032506	1659032506	1	1	DIAMOND PREVENTIVE CARE INC	8/22/2023	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	3321 TYLER AVE	None	EL MONTE	CA	91731	3101	19	06037	34.069086	-118.0360285	Los Angeles County
70269	Fee-for-Service	1841481074	1841481074	1	1	DIAZ ARJONILLA, MARUJA D	8/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97144	40	Pediatrics	0	In state provider	MD	1020 29TH STREET	STE 270	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
70301	Fee-for-Service	1477021442	1477021442	1	1	DEDEAUX, JOSEPH D PT	6/14/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	9999	30	06059	33.85429451	-117.8446551	Orange County
70302	Fee-for-Service	1578598595	1578598595	1	1	DELTA SIERRA MED GRP INC	8/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
70304	Fee-for-Service	1447284286	1447284286	1	1	DAY, FRANK C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
70324	Fee-for-Service	1326465501	1326465501	1	1	DYER, ALEXANDRA M MD	7/23/2017	207P00000X	NA	Other	026	PHYSICIANS	139313	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 OLD RIVER ROAD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
70334	Fee-for-Service	1952309163	1952309163	1	1	DYSTER, JOHN G MD	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89262	01	General Practice	0	In state provider	None	10 WOODLAND ROAD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
70369	Fee-for-Service	1578837076	1578837076	1	1	DIRKSEN, JENNIFER	3/1/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	8263 BELLA VISTA DR	None	RANCHO CUCAMONGA	CA	91701	1331	36	06071	34.16109199	-117.6266955	San Bernardino County
70437	Fee-for-Service	1740221514	1740221514	1	1	DIERKS, OLE MD	7/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93901	45	Nephrology (Renal-Kidney)	0	In state provider	None	20055 LAKE CHABOT RD	STE 230	CASTRO VALLEY	CA	94546	5333	01	06001	37.69836512	-122.0873587	Alameda County
70447	Fee-for-Service	1952507923	1952507923	1	1	DUGGIRALA, SRIKANT K MD	1/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116387	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	315 N 3RD AVE	SUITE 207	COVINA	CA	91723	1917	19	06037	34.08873786	-117.8923869	Los Angeles County
70466	Fee-for-Service	1306297601	1306297601	1	1	DAVIDSON, KELLIE	8/23/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33187 SKYVIEW RD	None	WINCHESTER	CA	92596	4524	33	06065	33.60665252	-117.0803788	Riverside County
70480	Fee-for-Service	1801922521	1801922521	1	1	DOAN VAN, NICOLAS N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	68391	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11100 WARNER AVE	STE 150B	FOUNTAIN VALLEY	CA	92708	7510	30	06059	33.716291	-117.9355051	Orange County
70500	Fee-for-Service	1558933374	1558933374	1	1	DAISY LI, DO, INC.	11/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1525 N EL DORADO ST	STE 1	STOCKTON	CA	95204	5932	39	06077	37.96821044	-121.2941422	San Joaquin County
70517	Fee-for-Service	1336463777	1336463777	1	2	DAY, SUSAN B PHD	12/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	103 S FOREST RD	None	SONORA	CA	95370	4895	55	06109	37.98049475	-120.3898999	Tuolumne County
70559	Fee-for-Service	1649247719	1649247719	1	1	DEVENDRA, ROMILA	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50665	01	General Practice	0	In state provider	None	14901 RINALDI ST	STE 205	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
70566	Fee-for-Service	1366127151	1366127151	1	1	DONES, ASHA LEIGH CCC-SLP	5/9/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
70588	Fee-for-Service	1578598595	1578598595	1	1	DELTA SIERRA MED GRP INC	8/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
70607	Fee-for-Service	1427258417	1427258417	1	1	DAVIS, AMY W MD	9/7/2020	207ZP0213X	NA	Other	026	PHYSICIANS	169350	22	Pathology (M.D. only)	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
70647	Fee-for-Service	1417057316	1417057316	1	1	DOUST, AFSHIN Y MD	5/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134958	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
70654	Fee-for-Service	1487851705	1487851705	1	1	DIWADKAR, GOURI B MD	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112955	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
70655	Fee-for-Service	1578837076	1578837076	1	1	DIRKSEN, JENNIFER	3/1/2015	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	8263 BELLA VISTA DR	None	RANCHO CUCAMONGA	CA	91701	1331	36	06071	34.16109199	-117.6266955	San Bernardino County
70677	Fee-for-Service	1386223402	1386223402	1	1	DARIUS A SCHNEIDER MD APC	4/24/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	ALISTS MEDICAL GROUP	8851 CENTER DRIVE	SUITE 404	LA MESA	CA	91942	0000	37	06073	32.78189749	-117.0075062	San Diego County
70695	Fee-for-Service	1962667204	1962667204	1	1	DANG, NEHA MD	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151242	83	Rheumatology	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
70696	Fee-for-Service	1770014110	1770014110	1	1	DORIA MEDINA SANCHEZ, JORGE	1/25/2024	207R00000X	NA	Other	026	PHYSICIANS	169360	None	None	0	In state provider	A MD	1245 WILSHIRE BLVD	STE 514	LOS ANGELES	CA	90017	4805	19	06037	34.05362775	-118.2661889	Los Angeles County
70713	Fee-for-Service	1750549739	1750549739	1	1	DAVIS, CATHERINE A MD	5/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107835	40	Pediatrics	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
70742	Fee-for-Service	1396816146	1396816146	1	1	DOHIL, RANJAN MD	2/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	73858	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
70756	Fee-for-Service	1306297601	1306297601	1	1	DAVIDSON, KELLIE	8/23/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33187 SKYVIEW RD	None	WINCHESTER	CA	92596	4524	33	06065	33.60665252	-117.0803788	Riverside County
70786	Fee-for-Service	1639242746	1639242746	1	2	DEPENDABLE HOME HEALTH INC	9/15/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16922 AIRPORT BLVD	BLDG 1, STE 17	MOJAVE	CA	93501	1655	15	06029	35.05253591	-118.157783	Kern County
70851	Fee-for-Service	1386763845	1386763845	1	1	DONALD ALAN THORNTON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
70926	Fee-for-Service	1174027395	1174027395	1	1	DUONG, TAN MD	12/30/2020	207R00000X	NA	Other	026	PHYSICIANS	169952	None	None	0	In state provider	None	7260 E SOUTHGATE DR	STE D	SACRAMENTO	CA	95823	2609	34	06067	38.493999	-121.438395	Sacramento County
70933	Fee-for-Service	1861582033	1861582033	1	1	DEMIAN, ROMANY F MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	52286	None	None	0	In state provider	SAN JUAN MED CLINIC INC	971 W 7TH ST	STE B	OXNARD	CA	93030	6757	56	06111	34.19516388	-119.1889217	Ventura County
71003	Fee-for-Service	1710461371	1710461371	1	1	DELA CRUZ, ERIN J MD	5/30/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	178632	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
71016	Fee-for-Service	1639513823	1639513823	1	1	DUNCAN, ANN K MD	9/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135992	01	General Practice	0	In state provider	None	2575 E BIDWELL STREET	STE 100	FOLSOM	CA	95630	6445	34	06067	38.658888	-121.1303835	Sacramento County
71030	Fee-for-Service	1396816146	1396816146	1	1	DOHIL, RANJAN MD	2/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	73858	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71032	Fee-for-Service	1912225459	1912225459	1	1	DYNAMICS ORTHOTICS AND	5/27/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PROSTHETICS INC	1001 W CARSON ST	SUITE L	TORRANCE	CA	90502	2051	19	06037	33.83160647	-118.2928635	Los Angeles County
71066	Fee-for-Service	1578903936	1578903936	1	1	DURAN, EDWARD MD	10/9/2023	207R00000X	NA	Other	026	PHYSICIANS	191070	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71074	Fee-for-Service	1578724555	1578724555	1	1	DUGAN, MARK C MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
71131	Fee-for-Service	1922690288	1922690288	1	1	DOVE TREE MANOR INC	5/18/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3991 DOVE TREE AVE	None	RIALTO	CA	92377	3584	36	06071	34.17226771	-117.4270097	San Bernardino County
71189	Fee-for-Service	1356758403	1356758403	1	1	DHAMI, JASPREET MD	1/22/2025	207R00000X	NA	Other	026	PHYSICIANS	168172	03	Allergy	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
71220	Fee-for-Service	1861467607	1861467607	1	1	DVA HLTCARE RENAL CARE	7/30/1980	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	VICTOR VALLEY DIALYSIS	16049 KAMANA RD	None	APPLE VALLEY	CA	92307	1331	36	06071	34.54288622	-117.2712611	San Bernardino County
71226	Fee-for-Service	1528019163	1528019163	1	1	DHINDSA, AMAN MD	4/5/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74215	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
71238	Fee-for-Service	1689092470	1689092470	1	1	DAIRO, BRANDON O MD	9/13/2022	208VP0014X	NA	Other	026	PHYSICIANS	143253	None	None	0	In state provider	None	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
71329	Fee-for-Service	1508492406	1508492406	1	1	DREWRY, OLIVER MD	9/16/2024	207L00000X	NA	Other	026	PHYSICIANS	188601	05	Anesthesiology	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
71331	Fee-for-Service	1134489107	1134489107	1	1	DHILLON, UJAGGER S MD INC	4/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36464	10	Gastroenterology (M.D. only)	0	In state provider	A PRO CORP	7405 N FRESNO ST	None	FRESNO	CA	93720	2457	10	06019	36.8450311	-119.7839039	Fresno County
71347	Fee-for-Service	1467984120	1467984120	1	1	DI GERONIMO, RYAN MD	9/8/2023	111NR0200X	NA	Other	026	PHYSICIANS	158951	None	None	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
71363	Fee-for-Service	1578724555	1578724555	1	1	DUGAN, MARK C MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
71379	Fee-for-Service	1831213701	1831213701	1	1	DABESTANI, ALI MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34447	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23961 CALLE DE LA MAGDAL	None	LAGUNA HILLS	CA	92653	3616	30	06059	33.60999658	-117.7126577	Orange County
71414	Fee-for-Service	1487756110	1487756110	1	1	DEVINE, SANDRA W LCSW	12/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PROFESSIONAL CENTER	STE 322	NOVATO	CA	94947	4334	21	06041	38.09622946	-122.5776347	Marin County
71415	Fee-for-Service	1851821268	1851821268	1	1	DING, JIA JENNIFER MD	7/31/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
71426	Fee-for-Service	1649339201	1649339201	1	1	DICKTER, JANA K MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79210	77	Infectious Disease	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
71427	Fee-for-Service	1609947662	1609947662	1	1	DOEHRING, PAUL C MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	50379	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
71428	Fee-for-Service	1427634724	1427634724	1	1	DAVIS, TIFFANY N OT	7/28/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3760 CONVOY STREET	100	SAN DIEGO	CA	92111	3743	37	06073	32.81197521	-117.1531278	San Diego County
71477	Fee-for-Service	1356758403	1356758403	1	1	DHAMI, JASPREET MD	1/22/2025	207R00000X	NA	Other	026	PHYSICIANS	168172	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
71602	Fee-for-Service	1497833586	1497833586	1	1	DOBROW, ALFRED L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39067	18	Ophthalmology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
71635	Fee-for-Service	1427324326	1427324326	1	1	DANG, DEBBIE Y MD	9/9/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	128509	20	Orthopedic Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
71667	Fee-for-Service	1831213701	1831213701	1	1	DABESTANI, ALI MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34447	41	Internal Medicine	0	In state provider	None	23961 CALLE DE LA MAGDAL	None	LAGUNA HILLS	CA	92653	3616	30	06059	33.60999658	-117.7126577	Orange County
71672	Fee-for-Service	1679826556	1679826556	1	1	DORN, UMA P PHD	11/12/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
71688	Fee-for-Service	1639431836	1639431836	1	1	DOLOUEI, REZA T MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143808	01	General Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
71710	Fee-for-Service	1578192498	1578192498	1	1	DUNN, PHILLIP DO	9/3/2024	390200000X	NA	Other	026	PHYSICIANS	22754	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
71711	Fee-for-Service	1649339201	1649339201	1	1	DICKTER, JANA K MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79210	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
71712	Fee-for-Service	1609947662	1609947662	1	1	DOEHRING, PAUL C MD	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	50379	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
71769	Fee-for-Service	1952396103	1952396103	1	1	DENNIS, TAMARA S MD	1/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92702	08	Family Practice	0	In state provider	None	3306 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239845	-124.1360414	Humboldt County
71999	Fee-for-Service	1053653873	1053653873	1	3	DIGNITY HEALTH MEDICAL	7/14/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FOUNDATION	1800 MEDICAL CENTER DR	STE 104	SAN BERNARDINO	CA	92404	1233	36	06071	34.131816	-117.322587	San Bernardino County
72017	Fee-for-Service	1134681992	1134681992	1	1	DAHAN, JONATHAN A MD	4/18/2023	207L00000X	NA	Other	026	PHYSICIANS	181817	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
72054	Fee-for-Service	1932378833	1932378833	1	1	DE GUZMAN, HYACINTH R MD	7/31/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97836	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
72084	Fee-for-Service	1346746245	1346746245	1	1	DESMOND, ANGELA MD	6/28/2024	390200000X	NA	Other	026	PHYSICIANS	164069	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
72085	Fee-for-Service	1922238575	1922238575	1	1	DI GIACOMO, GINA A LMFT	7/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1335 S EUCLID ST	None	ANAHEIM	CA	92802	2008	30	06059	33.814575	-117.9414565	Orange County
72108	Fee-for-Service	1609040740	1609040740	1	2	DAN HOME HEALTH CARE INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9836 WHITE OAK AVENUE	SUITE 209	NORTHRIDGE	CA	91325	4844	19	06037	34.24955635	-118.5198811	Los Angeles County
72110	Fee-for-Service	1760472997	1760472997	1	1	DIXON, PHILIP L OD	6/1/1980	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1056 G ST	None	REEDLEY	CA	93654	2936	10	06019	36.59650174	-119.450984	Fresno County
72121	Fee-for-Service	1962579722	1962579722	1	1	DAKAN, EARL T CRNA	4/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
72126	Fee-for-Service	1174514582	1174514582	1	1	DURKIN, WILLIAM T JR MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	57870	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
72199	Fee-for-Service	1154359099	1154359099	1	1	DEBORAH BURSEY	2/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
72269	Fee-for-Service	1063917888	1063917888	1	1	DOS SANTOS, BRITTANY A MD	10/10/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	166614	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
72272	Fee-for-Service	1447966916	1447966916	1	1	DIVYA V PATEL MD INC	4/26/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	16003 TUSCOLA RD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
72291	Fee-for-Service	1245366558	1245366558	1	1	DUONG, TUAN A MD	3/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82670	41	Internal Medicine	0	In state provider	FOG CITY MED CLINIC	1489 WEBSTER ST	STE 200	SAN FRANCISCO	CA	94115	3760	38	06075	37.78408269	-122.4311967	San Francisco County
72310	Fee-for-Service	1750773883	1750773883	1	1	DANNYS HOME HEALTH CARE INC	1/25/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1539 SAWTELLE BLVD	SUITE PH 22	LOS ANGELES	CA	90025	3267	19	06037	34.04743879	-118.4492806	Los Angeles County
72334	Fee-for-Service	1023325792	1023325792	1	1	DOMINGO, KATRINA A PHD	7/1/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
72341	Fee-for-Service	1053638429	1053638429	1	1	DROUBI, DIANA MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124736	07	Dermatology	0	In state provider	None	910 MAPLE STREET	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
72355	Fee-for-Service	1538679105	1538679105	1	1	DEAN, DAVID L CCC-SLP	6/21/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2910 INLAND EMPIRE BLVD	SUITE 114	ONTARIO	CA	91764	4896	36	06071	34.06986	-117.589617	San Bernardino County
72370	Fee-for-Service	1023182045	1023182045	1	1	DAITCH, DIANA L LMFT	6/29/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47260	-	NOT APPLICABLE	0	In state provider	None	6244 EL CAJON BLVD	STE 15, 16, 17, & 18	SAN DIEGO	CA	92115	3918	37	06073	32.76342577	-117.0636924	San Diego County
72412	Fee-for-Service	1023285400	1023285400	1	1	DING, PHILIP D MD	1/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150131	02	General Surgery	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
72449	Fee-for-Service	1689683112	1689683112	1	1	DOHERTY, DEBORAH L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	43130	25	Physical Medicine and Rehabilitation	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
72450	Fee-for-Service	1629852843	1629852843	1	1	DAMASK FAMILY COUNSELING AND	8/21/2023	106H00000X	NA	Mental Health Outpatient Services	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
72470	Fee-for-Service	1760633523	1760633523	1	1	DEBRUIN, JODY PHD	4/8/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9700 EL CAMINO REAL	SUITE 300	ATASCADERO	CA	93422	5581	40	06079	35.46523281	-120.647999	San Luis Obispo County
72508	Fee-for-Service	1760534762	1760534762	2	1	DAVIDSON, MAURICE DO	7/14/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	4212	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
72517	Fee-for-Service	1720794456	1720794456	1	1	DEREK HO MD PC	8/8/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	TICS	115 S 1ST AVE	None	ARCADIA	CA	91006	3606	19	06037	34.13833544	-118.0283334	Los Angeles County
72570	Fee-for-Service	1093195315	1093195315	1	1	DURRANI, HAMZA MD	5/16/2023	208600000X	NA	General Surgery	026	PHYSICIANS	184162	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
72620	Fee-for-Service	1770729360	1770729360	1	1	DESAI, SONAL S MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154756	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
72680	Fee-for-Service	1164505020	1164505020	1	1	DANO, DELFIN L MD	10/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53019	None	None	0	In state provider	None	1850 N RIVERSIDE AVE	STE 210	RIALTO	CA	92376	8082	36	06071	34.132905	-117.3704675	San Bernardino County
72707	Fee-for-Service	1437332244	1437332244	1	1	DUGGAL, JASLEEN K MD	4/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113472	67	Endocrinology	0	In state provider	None	3801 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	5731	15	06029	35.39450879	-119.0082635	Kern County
72722	Fee-for-Service	1942396429	1942396429	1	1	DAVIS, RICHARD H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	22954	03	Allergy	0	In state provider	None	1429 COLLEGE AVENUE	STE E	MODESTO	CA	95350	4057	50	06099	37.6654086	-121.0076479	Stanislaus County
72733	Fee-for-Service	1689683112	1689683112	1	1	DOHERTY, DEBORAH L MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	43130	01	General Practice	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
72736	Fee-for-Service	1891867412	1891867412	1	1	DANESHMAND, SHAHRAM MD	4/26/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63844	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
72739	Fee-for-Service	1215362629	1215362629	1	1	DUONG, NGOC-TRUC T MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126702	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
72744	Fee-for-Service	1679995344	1679995344	1	1	DRAEGER, CHRISTY RAE	3/17/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	189 NOVEL	None	IRVINE	CA	92618	1791	30	06059	33.68969664	-117.7391403	Orange County
72797	Fee-for-Service	1417973942	1417973942	1	1	DIDECH, DEAN M MD	2/1/1984	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35698	40	Pediatrics	0	In state provider	None	45 S 17TH ST	None	SAN JOSE	CA	95112	2032	43	06085	37.34311801	-121.8738218	Santa Clara County
72919	Fee-for-Service	1467836288	1467836288	1	1	DEHGHANI, HOSSEIN MD INC	8/25/2015	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	113434	None	None	0	In state provider	None	1511 W GLENOAKS BLVD	None	GLENDALE	CA	91201	1912	19	06037	34.16869826	-118.2861627	Los Angeles County
72962	Fee-for-Service	1568869543	1568869543	1	1	DECASTRO, BRIANDA LMFT	11/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
72963	Fee-for-Service	1487695466	1487695466	1	1	DIAZ, GLENN F T MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	73348	01	General Practice	0	In state provider	None	17500 FOOTHILL BLVD	STE A-2	FONTANA	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino County
72975	Fee-for-Service	1033434923	1033434923	1	2	DUNCAN, PARKER A MD	6/1/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	118268	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
72982	Fee-for-Service	1396281630	1396281630	1	1	DESERT COVE DESERT HOT SPRIN	7/15/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13660 MOUNTAIN VIEW RD	None	DESERT HOT SPRING	CA	92240	6454	33	06065	33.94885679	-116.475	Riverside County
73001	Fee-for-Service	1992748214	1992748214	1	2	DUNFORD, JAMES V MD	12/6/2018	207P00000X	NA	Other	086	MEDICAL DIRECTORS	34860	-	NOT APPLICABLE	0	In state provider	None	550 FESLER STREET	SUITE G1 G2	EL CAJON	CA	92020	1901	37	06073	32.8088283	-116.9686057	San Diego County
73010	Fee-for-Service	1992106454	1992106454	1	1	DANIAL, MARK T PT	2/18/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
73025	Fee-for-Service	1891867412	1891867412	1	1	DANESHMAND, SHAHRAM MD	4/26/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63844	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
73032	Fee-for-Service	1639136617	1639136617	1	1	DERMARK, JEFFREY VAN. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
73033	Fee-for-Service	1679995344	1679995344	1	1	DRAEGER, CHRISTY RAE	3/17/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	189 NOVEL	None	IRVINE	CA	92618	1791	30	06059	33.68969664	-117.7391403	Orange County
73055	Fee-for-Service	1003893751	1003893751	1	1	DENNEY, BRUCE W MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	STE 13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
73092	Fee-for-Service	1821122367	1821122367	1	1	DIXON, ROSA M LMFT	8/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	935 GEARY STREET	602	SAN FRANCISCO	CA	94109	7096	38	06075	37.78600561	-122.4186866	San Francisco County
73104	Fee-for-Service	1578717187	1578717187	1	1	DAVIS, MICHAEL C MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110088	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
73114	Fee-for-Service	1487790697	1487790697	2	1	DIGNITY HEALTH	5/12/2020	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SERVICES	124 S COLLEGE DR.	SUITE C	SANTA MARIA	CA	93454	5325	42	06083	34.951968	-120.4247835	Santa Barbara County
73118	Fee-for-Service	1861503815	1861503815	1	1	DEHOVITZ, ROSS MD	1/1/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56876	40	Pediatrics	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
73132	Fee-for-Service	1750331179	1750331179	1	1	DJALILIAN, HAMID R MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85665	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
73160	Fee-for-Service	1275809840	1275809840	1	1	DIALYSIS NEWCO INC	4/1/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1181 BROADWAY	STE 5	CHULA VISTA	CA	91911	2749	37	06073	32.60752502	-117.0801794	San Diego County
73166	Fee-for-Service	1548647274	1548647274	1	1	DHALIWAL-BINNING, KARAMJIT K	8/13/2019	208M00000X	NA	Other	026	PHYSICIANS	152942	41	Internal Medicine	0	In state provider	MD	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
73173	Fee-for-Service	1164721163	1164721163	1	1	DANIALIFAR, TANAZ F MD	8/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115306	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
73177	Fee-for-Service	1861533325	1861533325	1	1	DAPHNE EDMONSTON HEMMINGS, M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
73184	Fee-for-Service	1689769911	1689769911	1	1	DIGNITY HEALTH	5/30/1996	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
73216	Fee-for-Service	1417109067	1417109067	1	1	DHOOT, JASHDEEP S MD	1/13/2023	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	111117	None	None	0	In state provider	None	2898 LINDEN AVE	None	LONG BEACH	CA	90806	1627	19	06037	33.809688	-118.1868115	Los Angeles County
73321	Fee-for-Service	1124106901	1124106901	1	1	DEBARE, ROBERT S MD	1/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70958	01	General Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
73333	Fee-for-Service	1356147615	1356147615	1	1	DAVILA TRINIDAD, MAYRA L	3/31/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
73370	Fee-for-Service	1619165842	1619165842	1	1	DIXON, JEDEDIAH R MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109534	30	Radiology	0	In state provider	None	1720 CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
73371	Fee-for-Service	1417130196	1417130196	1	1	DUNCAN, DEENA T MFT	6/20/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86701	-	NOT APPLICABLE	0	In state provider	None	11500 PARAMOUNT BLVD	None	DOWNEY	CA	90241	2405	19	06037	33.94027357	-118.139714	Los Angeles County
73404	Fee-for-Service	1568485415	1568485415	1	1	DEO, EKNATH MD	11/21/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	26505	41	Internal Medicine	0	In state provider	None	2690 PACIFIC AVE	STE 260	LONG BEACH	CA	90806	2661	19	06037	33.805854	-118.1936805	Los Angeles County
73407	Fee-for-Service	1629591128	1629591128	1	1	DR. JUDITH LEE OPTOMETRY, IN	4/30/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	C	4200 E 4TH ST	None	ONTARIO	CA	91764	5250	36	06071	34.075701	-117.5618295	San Bernardino County
73418	Fee-for-Service	1255347753	1255347753	1	1	DANSKY, DAVID MD	2/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64084	None	None	0	In state provider	None	23625 HOLMAN HIGHWAY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
73429	Fee-for-Service	1730150830	1730150830	1	1	DAVIS, DANIEL K MD	11/19/2018	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	61920	20	Orthopedic Surgery	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
73433	Fee-for-Service	1972647170	1972647170	1	1	DOMAGALSKI, JASON E MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129763	08	Family Practice	0	In state provider	None	555 TACHEVAH DR	3W105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
73446	Fee-for-Service	1033689948	1033689948	1	2	DIACARTA, INC	5/23/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	4385 HOPYARD RD	SUITE 100	PLEASANTON	CA	94588	2758	01	06001	37.68767007	-121.9036212	Alameda County
73458	Fee-for-Service	1619143203	1619143203	1	1	DUFUR, MICHAEL	10/21/2008	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 ALHAMBRA BLVD	#200	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
73473	Fee-for-Service	1689769911	1689769911	1	1	DIGNITY HEALTH	5/30/1996	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
73489	Fee-for-Service	1649838244	1649838244	1	1	DUSAJ, JUSTIN DO	10/18/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20492	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
73511	Fee-for-Service	1962908137	1962908137	1	1	DABABO, NOUR MD	6/10/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	184919	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
73536	Fee-for-Service	1013769801	1013769801	1	1	DELAPLANE-YUSEM, NAOMI S	5/29/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
73549	Fee-for-Service	1649213653	1649213653	1	1	DE LA LLANA, SYLVIA A MD	2/1/1998	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	42011	01	General Practice	0	In state provider	None	7226 SEPULVEDA BLVD	STE 101	VAN NUYS	CA	91405	2062	19	06037	34.20198	-118.4661725	Los Angeles County
73576	Fee-for-Service	1548532344	1548532344	1	1	D'AMBRUOSO, SARAH F NP	9/14/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2336 SANTA MONICA BLVD	SUITE 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
73577	Fee-for-Service	1063559805	1063559805	1	1	DUFFIELD, CURTIS R MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97873	30	Radiology	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
73593	Fee-for-Service	1881631711	1881631711	1	3	DERMATOLOGY SPECIALISTS INC	6/30/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	INC.	530 LOMAS SANTA FE DR	STE M	SOLANA BEACH	CA	92075	1346	37	06073	32.99511173	-117.2659419	San Diego County
73598	Fee-for-Service	1881241776	1881241776	1	1	DELTA CENTER FAMILY THERAPY	10/5/2019	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	INC	343 E MAIN ST	STE 701	STOCKTON	CA	95202	2977	39	06077	37.95334019	-121.2862084	San Joaquin County
73626	Fee-for-Service	1336255694	1336255694	1	1	DOMAGUING JR, MACARIO L	1/4/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37893	08	Family Practice	0	In state provider	MD INC	130 W ROUTE 66	STE 214	GLENDORA	CA	91740	6251	19	06037	34.12865951	-117.8651745	Los Angeles County
73638	Fee-for-Service	1306880836	1306880836	1	1	DIAZ, JOSE J MD	9/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64744	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
73647	Fee-for-Service	1457421901	1457421901	1	1	DOUGLASS, DIANA K MD	9/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86041	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
73673	Fee-for-Service	1982880928	1982880928	1	1	DUONG, SON T MD	11/5/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	73996	02	General Surgery	0	In state provider	None	11190 WARNER AVE	408	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
73685	Fee-for-Service	1750307013	1750307013	1	1	DARLA HESS MD	8/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MEMORIAL DR	None	OIL CITY	PA	16301	1341	00	None	41.44114846	-79.70703218	Venango County
73703	Fee-for-Service	1851333033	1851333033	1	1	DIOKNO, ROSANA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
73744	Fee-for-Service	1437173457	1437173457	1	1	DAVIS, DANIEL R MFT	6/15/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1588 HOMESTEAD RD	MB 10, SUITE B	SANTA CLARA	CA	95050	4771	43	06085	37.34637328	-121.9509049	Santa Clara County
73815	Fee-for-Service	1023383213	1023383213	1	1	DENTON, CHRISTOPHER C MD	9/18/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141711	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
73856	Fee-for-Service	1831442763	1831442763	1	1	DE QUIROS, IVY LEE CNP	2/1/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
73898	Fee-for-Service	1275552390	1275552390	1	2	DO, EMILY H OD	1/1/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2114 SENTER RD	STE 6	SAN JOSE	CA	95112	2608	43	06085	37.31161529	-121.8513661	Santa Clara County
73912	Fee-for-Service	1740052588	1740052588	1	1	DUCUSIN, IVAN	11/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	180 OTAY LAKES ROAD	SUITE 105	BONITA	CA	91902	2443	37	06073	32.65928608	-117.0304661	San Diego County
73926	Fee-for-Service	1306880836	1306880836	1	1	DIAZ, JOSE J MD	9/1/1998	207P00000X	NA	Other	026	PHYSICIANS	64744	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
73943	Fee-for-Service	1962810275	1962810275	1	1	DEBUS, MICHELLE M LMFT	11/23/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	6166 VESPER AVE	None	VAN NUYS	CA	91411	2851	19	06037	34.182189	-118.450893	Los Angeles County
73949	Fee-for-Service	1801197934	1801197934	1	1	DIGIUSEPPE, MICHAEL A DPM	8/5/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
73966	Fee-for-Service	1851097232	1851097232	1	1	DASS, ROMMEL PT	3/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
74020	Fee-for-Service	1023166949	1023166949	1	1	DRAPER, BRAD K CRNA	6/10/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	624 E ELDER ST	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
74021	Fee-for-Service	1598725434	1598725434	1	1	DAVID STRYKER	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 WALTER ST NE	STE 104	ALBUQUERQUE	NM	87102	2541	00	None	35.08716551	-106.6401923	Bernalillo County
74024	Fee-for-Service	1629318241	1629318241	1	1	DUDAS, RADU MD	1/1/2018	207P00000X	NA	Other	026	PHYSICIANS	145196	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
74032	Fee-for-Service	1649215260	1649215260	1	1	DYER, JEFF J MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85883	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
74075	Fee-for-Service	1962094474	1962094474	1	1	DUDDING, JALEE CNP	2/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18080 IMPERIAL HWY	None	YORBA LINDA	CA	92886	3436	30	06059	33.89287302	-117.8194305	Orange County
74076	Fee-for-Service	1619943834	1619943834	1	1	DODSON, DAVID C MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88777	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
74103	Fee-for-Service	1023383213	1023383213	1	1	DENTON, CHRISTOPHER C MD	9/18/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	141711	40	Pediatrics	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
74142	Fee-for-Service	1669741757	1669741757	1	1	DEMETRION, HELEN K CCC-SLP	11/30/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
74159	Fee-for-Service	1326605346	1326605346	1	1	DHAKAL, SUSMITA	10/11/2022	207R00000X	NA	Other	026	PHYSICIANS	178827	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74178	Fee-for-Service	1376297226	1376297226	1	1	DEVRIES, NICHOLAS G CNP	3/29/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7740 RANCHO SANTA FE RD	None	CARLSBAD	CA	92009	8685	37	06073	33.08100093	-117.2372485	San Diego County
74190	Fee-for-Service	1619017670	1619017670	1	1	DOUGLAS, KIMBERLY A MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71095	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
74329	Fee-for-Service	1215317847	1215317847	1	1	DOUGLAWI, ANTOIN	7/13/2020	208800000X	NA	Other	026	PHYSICIANS	168501	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
74377	Fee-for-Service	1366437584	1366437584	1	1	DENIS Y LIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	275 VARNUM AVE	STE 203	LOWELL	MA	01854	2109	00	None	42.646932	-71.340453	Middlesex County
74441	Fee-for-Service	1831521681	1831521681	1	1	DALLAL, VERONICA NP	12/12/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
74452	Fee-for-Service	1831366046	1831366046	1	1	DASILVA, KAREN B MD	3/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103783	13	Neurology (M.D. only)	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
74485	Fee-for-Service	1003802869	1003802869	1	1	DURRA, OMAR A MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78304	05	Anesthesiology	0	In state provider	None	3530 WILSHIRE BLVD	STE 350	LOS ANGELES	CA	90010	2335	19	06037	34.06171652	-118.301427	Los Angeles County
74496	Fee-for-Service	1114917754	1114917754	1	1	DITTO, KARA E MD	6/27/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	169234	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
74501	Fee-for-Service	1093918724	1093918724	1	1	DEVER, JOHN B MD	5/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114858	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
74526	Fee-for-Service	1962677146	1962677146	1	1	DEVARAJ, REENA MD	5/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118890	01	General Practice	0	In state provider	None	1525 W FLORIDA AVE	STE D	HEMET	CA	92543	4423	33	06065	33.7473507	-116.9878543	Riverside County
74546	Fee-for-Service	1811071806	1811071806	1	1	DEANE, JOHN MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	38018	01	General Practice	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
74616	Fee-for-Service	1013180579	1013180579	1	1	DE JONG, KATHERINE R MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102874	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
74675	Fee-for-Service	1154307296	1154307296	1	1	DISNEY, LEW MD	2/1/1997	174400000X	NA	Other	026	PHYSICIANS	49362	14	Neurological Surgery	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
74681	Fee-for-Service	1861998049	1861998049	1	1	DANG, ERIC H MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	164738	None	None	0	In state provider	None	1117 E DEVONSHIRE AVENUE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
74686	Fee-for-Service	1932326808	1932326808	1	1	DHIR, VASHITA MD	8/5/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	91248	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
74715	Fee-for-Service	1336501030	1336501030	1	1	DINH, ALEX R MD	6/22/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	161465	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
74748	Fee-for-Service	1780862375	1780862375	1	1	DUARTE, JULIO P MD	5/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93430	05	Anesthesiology	0	In state provider	None	24451 HEALTH CENTER DR	SUITE 104	LAGUNA HILLS	CA	92653	3651	30	06059	33.60848903	-117.7079742	Orange County
74775	Fee-for-Service	1477704856	1477704856	1	1	DE CLERCK, BRITTNEY K MD	11/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102391	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
74789	Fee-for-Service	1144497678	1144497678	1	10	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	FOUNDATION	1321 COTTONWOOD ST	STE 205	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
74835	Fee-for-Service	1245536234	1245536234	1	1	DELA MERCED, JACQUELINE S MD	4/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106528	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 200 225	LOS ANGELES	CA	90033	2497	19	06037	34.05112725	-118.2173921	Los Angeles County
74838	Fee-for-Service	1093895195	1093895195	1	1	DANGODARA, AMISH A MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78904	01	General Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
74844	Fee-for-Service	1407910821	1407910821	1	1	DARROW, MARC LMFT	6/28/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
74864	Fee-for-Service	1649589870	1649589870	1	1	DOUS, SAFWAT MD	8/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118010	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
74884	Fee-for-Service	1740308683	1740308683	1	1	DHALLA ORTHOPEDIC	12/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	CENTER INC	4343 MARKET ST	STE A	RIVERSIDE	CA	92501	3567	33	06065	33.97734857	-117.3791849	Riverside County
74885	Fee-for-Service	1710907639	1710907639	1	1	DEVASKAR, SHERIN U MD	7/1/1998	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	32624	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	# 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
74906	Fee-for-Service	1508222647	1508222647	1	1	DIGNITY HEALTH MEDICAL FOUND	3/1/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18406 ROSCOE	STE A	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
74945	Fee-for-Service	1669702544	1669702544	1	1	DASAN SCHMITT	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10401 W THUNDERBIRD BLVD	None	SUN CITY	AZ	85351	3004	00	None	33.603885	-112.2831765	Maricopa County
74967	Fee-for-Service	1336670116	1336670116	1	1	DOO, JOSEPHINE MD	11/14/2024	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161501	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
75030	Fee-for-Service	1659339745	1659339745	1	1	DESAI, SMITA A DO	12/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9425	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
75078	Fee-for-Service	1083809966	1083809966	1	1	DADFARMAY, SINA MD	8/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120705	None	None	0	In state provider	None	1680 E 120TH STREET	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
75080	Fee-for-Service	1144497678	1144497678	1	10	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1321 COTTONWOOD ST	STE 205	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
75114	Fee-for-Service	1003876038	1003876038	1	1	DASGHAIB, HOLLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65488	None	None	0	In state provider	None	2119 S MYRTLE AVE	None	MONROVIA	CA	91016	4838	19	06037	34.126191	-118.001656	Los Angeles County
75128	Fee-for-Service	1093895195	1093895195	1	1	DANGODARA, AMISH A MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78904	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
75195	Fee-for-Service	1508222647	1508222647	1	1	DIGNITY HEALTH MEDICAL FOUND	3/1/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18406 ROSCOE	STE A	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
75225	Fee-for-Service	1295786010	1295786010	1	1	DADSON, JESSE J MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
75260	Fee-for-Service	1427556950	1427556950	1	1	DEASON, BAILEY A	9/28/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
75297	Fee-for-Service	1760671267	1760671267	1	1	DR. NANCY WANG, O.D., INC.	10/27/2021	261QP2300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 N EUCLID AVENUE	SUITE A	UPLAND	CA	91786	6031	36	06071	34.097508	-117.6509735	San Bernardino County
75389	Fee-for-Service	1700109220	1700109220	1	1	DANIEL, DEBRA R LCSW	1/12/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5000 CALIFORNIA AVE	208	BAKERSFIELD	CA	93309	0711	15	06029	35.36362594	-119.0576588	Kern County
75476	Fee-for-Service	1518096924	1518096924	1	1	DONG, LAWRENCE G MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	65617	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
75484	Fee-for-Service	1508222647	1508222647	1	1	DIGNITY HEALTH MEDICAL FOUND	3/1/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-NORTHRIDGE FAMILY MEDIC	18406 ROSCOE	STE A	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
75521	Fee-for-Service	1588712533	1588712533	1	1	DABREO, JOHN MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42728	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
75532	Fee-for-Service	1598309502	1598309502	1	1	DONALD R. WOLFF	1/30/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	345 5TH ST	#20	HOLLISTER	CA	95023	3844	35	06069	36.85144793	-121.4029697	San Benito County
75564	Fee-for-Service	1821096157	1821096157	1	1	DICESARE, PAUL E MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62347	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
75584	Fee-for-Service	1851397210	1851397210	1	1	DY, ROBERT DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
75601	Fee-for-Service	1619108164	1619108164	1	1	DEVINENI, VENKAT MD INC	8/17/2015	261QM2500X	NA	Other	026	PHYSICIANS	54340	None	None	0	In state provider	None	17259 JASMINE ST	STE B	VICTORVILLE	CA	92395	7787	36	06071	34.47490447	-117.2855835	San Bernardino County
75614	Fee-for-Service	1578831996	1578831996	1	1	DE LA PENA, NICOLAS R MD INC	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61619	77	Infectious Disease	0	In state provider	None	3389 G ST	STE A	MERCED	CA	95340	0964	24	06047	37.32623805	-120.4692747	Merced County
75626	Fee-for-Service	1447887807	1447887807	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	10942 RAMONA BLVD	SUITE A	EL MONTE	CA	91731	2644	19	06037	34.07199583	-118.0369162	Los Angeles County
75665	Fee-for-Service	1265939243	1265939243	1	1	DERIFIELD, KELLIE A LMFT	9/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	218 W MAIN ST	104	TUSTIN	CA	92780	7709	30	06059	33.74205624	-117.8254112	Orange County
75673	Fee-for-Service	1336155795	1336155795	1	1	DRAZEK, TIM J MD	3/31/1994	207P00000X	NA	Other	026	PHYSICIANS	79918	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
75676	Fee-for-Service	1457759102	1457759102	1	1	DANIEL, EMILY MD	7/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151533	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
75694	Fee-for-Service	1063629830	1063629830	1	1	DEAN G ANDERSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	150 WEST 100 NORTH	None	VERNAL	UT	84078	2036	00	None	40.45713947	-109.531368	Uintah County
75727	Fee-for-Service	1043502677	1043502677	1	3	DAWSON, MELISSA L DO	9/20/2018	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16459	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
75875	Fee-for-Service	1689616138	1689616138	1	1	DUNLEVY, DANIEL B MD	9/1/2001	207P00000X	NA	Other	026	PHYSICIANS	61359	25	Physical Medicine and Rehabilitation	0	In state provider	None	3701 J ST	STE 201	SACRAMENTO	CA	95816	5542	34	06067	38.571237	-121.4566245	Sacramento County
75888	Fee-for-Service	1306543426	1306543426	1	1	DESERT COTTAGES LLC	3/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	83-617 HIMILAYA DRIVE	None	INDIO	CA	92203	4019	33	06065	33.74336612	-116.205097	Riverside County
75889	Fee-for-Service	1427212935	1427212935	1	1	DESMOND, ALLISON	12/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
75903	Fee-for-Service	1578831996	1578831996	1	1	DE LA PENA, NICOLAS R MD INC	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	61619	41	Internal Medicine	0	In state provider	None	3389 G ST	STE A	MERCED	CA	95340	0964	24	06047	37.32623805	-120.4692747	Merced County
75916	Fee-for-Service	1447887807	1447887807	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10942 RAMONA BLVD	SUITE A	EL MONTE	CA	91731	2644	19	06037	34.07199583	-118.0369162	Los Angeles County
75939	Fee-for-Service	1568796092	1568796092	1	1	DUONG, LE M OD	3/24/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W VALLEY BLVD	SITE 115	SAN GABRIEL	CA	91776	3784	19	06037	34.07958215	-118.1021957	Los Angeles County
75940	Fee-for-Service	1770506206	1770506206	1	1	DINH, CHRISTINE H MD	3/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53100	08	Family Practice	0	In state provider	None	2630 SAN GABRIEL BLVD	STE 105	ROSEMEAD	CA	91770	5204	19	06037	34.059978	-118.0905515	Los Angeles County
75996	Fee-for-Service	1801054705	1801054705	1	1	DARA, JASMEEN S MD	6/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148232	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
76015	Fee-for-Service	1083145692	1083145692	1	1	DYSTER, TIMOTHY G	7/14/2020	208M00000X	NA	Other	026	PHYSICIANS	161656	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76028	Fee-for-Service	1689008427	1689008427	1	1	DAVIES, SHANNON M	3/26/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	6601	19	06037	34.1719401	-118.5881418	Los Angeles County
76055	Fee-for-Service	1992971378	1992971378	1	1	DOKUBO, EMILY K MD	2/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103668	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
76059	Fee-for-Service	1780181552	1780181552	1	1	DUMITRIU, ALISON L MD	8/17/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	164085	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
76078	Fee-for-Service	1093919656	1093919656	1	1	DIZON, SAMMY A MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101792	01	General Practice	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
76089	Fee-for-Service	1750494928	1750494928	1	1	DRYE, BARBARA D MD	4/16/2020	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	66083	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
76107	Fee-for-Service	1649451550	1649451550	1	1	DEL TORO VARGAS, LUCIANO	11/8/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	102007	None	None	0	In state provider	None	1336 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.69908763	-121.6352503	Monterey County
76165	Fee-for-Service	1891192696	1891192696	1	1	DABU, JOAN K MD	9/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150418	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
76199	Fee-for-Service	1760878326	1760878326	1	1	DIEBOLD, STEPHANIE MD	9/9/2019	207P00000X	NA	Other	026	PHYSICIANS	160336	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
76221	Fee-for-Service	1508890922	1508890922	1	2	DHARAWAT, RAMESH N MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	49723	01	General Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
76239	Fee-for-Service	1164459921	1164459921	1	1	DUNCAN, GREGORY J MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44032	20	Orthopedic Surgery	0	In state provider	None	1200 MARSHALL ST	None	CRESCENT CITY	CA	95531	8922	08	06015	41.76759105	-124.20039	Del Norte County
76261	Fee-for-Service	1205092970	1205092970	1	1	DORI LALANNE PTR GEN PTR	10/25/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	35-800 BOB HOPE DR	#245	RANCHO MIRAGE	CA	92270	1740	33	06065	33.78398109	-116.4059049	Riverside County
76263	Fee-for-Service	1548367402	1548367402	1	1	DEL ROSARIO, RAUL MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56061	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
76301	Fee-for-Service	1538568407	1538568407	1	1	DAVIDSON, BROOKE N PSYD	1/30/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 ASHTON AVE	None	MENLO PARK	CA	94025	6501	41	06081	37.43205327	-122.2036961	San Mateo County
76331	Fee-for-Service	1710143490	1710143490	1	1	DEBOER, BETHANY M DO	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11035	08	Family Practice	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
76344	Fee-for-Service	1639470024	1639470024	1	1	DE VERA, JONATHAN M	8/16/2017	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
76357	Fee-for-Service	1871933895	1871933895	1	1	DIEP, APRIL L DO	12/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
76386	Fee-for-Service	1699975276	1699975276	1	1	DILLON, BRANDON B LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
76443	Fee-for-Service	1386029619	1386029619	1	1	DUNN, TIFFANY LCSW	9/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
76444	Fee-for-Service	1366683377	1366683377	1	1	DENLEY, ERIC C MD	7/23/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	121927	01	General Practice	0	In state provider	None	43847 HEATON AVE	STE D	LANCASTER	CA	93534	4936	19	06037	34.67959105	-118.1457605	Los Angeles County
76501	Fee-for-Service	1336269695	1336269695	1	1	DONALDSON, MICHELLE A LMFT	8/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1490 CLAREMONT BLVD	STE 204	CLAREMONT	CA	91711	3519	19	06037	34.11108358	-117.7019894	Los Angeles County
76530	Fee-for-Service	1164459921	1164459921	1	1	DUNCAN, GREGORY J MD	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44032	46	Hand Surgery	0	In state provider	None	1200 MARSHALL ST	None	CRESCENT CITY	CA	95531	8922	08	06015	41.76759105	-124.20039	Del Norte County
76539	Fee-for-Service	1356549455	1356549455	1	1	DIALYSIS CENTER OF	10/15/2008	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ONTARIO, LLC	2850 INLAND EMPIRE BLVD	STE C	ONTARIO	CA	91764	4659	36	06071	34.069932	-117.5913135	San Bernardino County
76567	Fee-for-Service	1316301849	1316301849	1	1	DIAZ, CHRISTIANE S LMFT	6/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
76621	Fee-for-Service	1346244050	1346244050	1	2	DAMEN, AYMAN MD	9/7/2021	213EG0000X	NA	Other	026	PHYSICIANS	48085	None	None	0	In state provider	None	150 N LINCOLN WAY	None	GALT	CA	95632	1721	34	06067	38.256615	-121.3007445	Sacramento County
76623	Fee-for-Service	1346871647	1346871647	1	1	DOCTOR G MD PC	10/21/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	905 S GLENOAKS BLVD	None	BURBANK	CA	91502	1529	19	06037	34.17717203	-118.2982398	Los Angeles County
76633	Fee-for-Service	1861557712	1861557712	1	1	DOAN, TU D OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7462 N FIGUEROA STREET	SUITE 100	LOS ANGELES	CA	90041	1716	19	06037	34.13966532	-118.1871937	Los Angeles County
76715	Fee-for-Service	1427110691	1427110691	1	1	DEPOLO, J LAWRENCE MD INC	8/9/2006	207RP1001X	NA	Pulmonology	026	PHYSICIANS	22978	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 E MARCH LANE	SUITE C300	STOCKTON	CA	95210	6657	39	06077	38.00315652	-121.2868715	San Joaquin County
76724	Fee-for-Service	1144239336	1144239336	1	1	DOLAN, KELLEY S	7/27/1992	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	866 3RD ST	None	SANTA ROSA	CA	95404	4531	49	06097	38.44197	-122.7078945	Sonoma County
76802	Fee-for-Service	1780615963	1780615963	1	1	DUKE, DAVID O MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61176	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
76815	Fee-for-Service	1972596922	1972596922	1	1	DELAPAZ, JOEL DO	10/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6941	05	Anesthesiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
76822	Fee-for-Service	1053649376	1053649376	1	1	DHUGGA, GURPREET S MEDICAL	11/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	63219	None	None	0	In state provider	CORPORATION	1255 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4805	48	06095	38.25815459	-122.0487714	Solano County
76834	Fee-for-Service	1902309834	1902309834	1	1	DR. MICHAEL H. FRENCH, INC.	4/18/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	40949 WINCHESTER RD	None	TEMECULA	CA	92591	6031	33	06065	33.52574268	-117.1589811	Riverside County
76853	Fee-for-Service	1932294733	1932294733	1	1	DO DATT OD INC	6/8/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2021 W CARSON ST	STE A	TORRANCE	CA	90501	3275	19	06037	33.83145146	-118.317357	Los Angeles County
76881	Fee-for-Service	1376603720	1376603720	1	1	DUGONI, SUSAN J MD	9/30/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53682	40	Pediatrics	0	In state provider	None	2191 MOWRY AVE	STE 600C	FREMONT	CA	94538	1702	01	06001	37.55710897	-121.9814562	Alameda County
76890	Fee-for-Service	1275552705	1275552705	1	1	DARDASHTI, BEHROUZ MD	4/1/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35233	08	Family Practice	0	In state provider	None	7230 MEDICAL CENTER DR	STE 305	WEST HILLS	CA	91307	4012	19	06037	34.20172814	-118.6294322	Los Angeles County
76912	Fee-for-Service	1194735753	1194735753	1	1	DIAZ, TERESA L MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88588	01	General Practice	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
76931	Fee-for-Service	1821380551	1821380551	1	1	DE LEON, JOSEPH A MD	9/20/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	141917	45	Nephrology (Renal-Kidney)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
76940	Fee-for-Service	1336497775	1336497775	1	1	DAI-JU, JENNY Q MD	3/28/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	125112	67	Endocrinology	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
77008	Fee-for-Service	1487733663	1487733663	1	1	DESERT AMB SERVICE	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	831 W MAIN ST	None	BARSTOW	CA	92311	2649	36	06071	34.89680782	-117.0369196	San Bernardino County
77031	Fee-for-Service	1306865753	1306865753	1	1	DANIAL, MAGDY MD	9/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93013	08	Family Practice	0	In state provider	None	2070 CLINTON AVE	STE 2113	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
77065	Fee-for-Service	1164941910	1164941910	1	1	DIXON DE SILVA, LOUISE PHD	4/7/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
77102	Fee-for-Service	1851851091	1851851091	1	1	DONN, ERIC C DO	5/13/2022	207P00000X	NA	Other	026	PHYSICIANS	19406	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
77106	Fee-for-Service	1598992406	1598992406	1	1	DUENEZ, MARGARET LCSW	10/18/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 S VILLAGE OAKS DR	STE 201	COVINA	CA	91724	0606	19	06037	34.07200147	-117.8631788	Los Angeles County
77177	Fee-for-Service	1275552705	1275552705	1	1	DARDASHTI, BEHROUZ MD	4/1/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35233	01	General Practice	0	In state provider	None	7230 MEDICAL CENTER DR	STE 305	WEST HILLS	CA	91307	4012	19	06037	34.20172814	-118.6294322	Los Angeles County
77207	Fee-for-Service	1053948026	1053948026	1	1	DIAB, YOSEF MD	8/29/2023	390200000X	NA	Other	026	PHYSICIANS	186325	None	None	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
77224	Fee-for-Service	1184155285	1184155285	1	1	DIEU, HOLLY MD	8/18/2021	207R00000X	NA	Other	026	PHYSICIANS	159955	None	None	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
77305	Fee-for-Service	1295891224	1295891224	1	2	DAVIDSON, JONATHAN S	1/26/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	66389	None	None	0	In state provider	None	2288 AUBURN BLVD	SUITE 101	SACRAMENTO	CA	95821	1618	34	06067	38.625345	-121.4114985	Sacramento County
77337	Fee-for-Service	1689624686	1689624686	2	1	DENVER HEALTH AND HOSPITAL	2/25/2017	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	AUTHORITY	777 BANNOCK ST	None	DENVER	CO	80204	4507	00	None	39.72801239	-104.9902835	Denver County
77364	Fee-for-Service	1851897813	1851897813	1	1	DICKERSON, JAMES C MD	6/18/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	163724	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77403	Fee-for-Service	1356351555	1356351555	1	1	DROUIN,BRENT C MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70302	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
77428	Fee-for-Service	1720572274	1720572274	1	1	DAVID CARREON MD INC	12/6/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	877 W FREMONT AVE	N3	SUNNYVALE	CA	94087	2332	43	06085	37.35226149	-122.049297	Santa Clara County
77441	Fee-for-Service	1164580965	1164580965	1	1	DIKIO, NICOLAS A MD INC	6/1/2002	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40344	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9837 BELMONT ST	None	BELLFLOWER	CA	90706	5404	19	06037	33.88362396	-118.1239427	Los Angeles County
77464	Fee-for-Service	1235790692	1235790692	1	1	DIXIT, SAMEEKSHA CCC-SP	1/21/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
77496	Fee-for-Service	1881326015	1881326015	1	1	DE LUZ FAMILY COUNSELING CEN	4/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	TER	31569 CANYON ESTATES DR	105 & 107	LAKE ELSINORE	CA	92532	0475	33	06065	33.6671373	-117.3012532	Riverside County
77569	Fee-for-Service	1376691386	1376691386	1	1	DE LEON, JULIO C MD	12/4/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60170	01	General Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
77619	Fee-for-Service	1831190859	1831190859	1	1	DANIEL G BRUNNER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 JAMES SIMPSON JR WA	None	COVINGTON	KY	41011	0801	00	None	39.0715176	-84.51775131	Kenton County
77620	Fee-for-Service	1780796441	1780796441	1	1	DEGRAUW,JEFFERY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1580 W ANTELOPE DR	SUITE 200	LAYTON	UT	84041	0000	00	None	41.08922695	-111.9943717	Davis County
77623	Fee-for-Service	1689624686	1689624686	2	1	DENVER HEALTH AND HOSPITAL	2/25/2017	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	AUTHORITY	777 BANNOCK ST	None	DENVER	CO	80204	4507	00	None	39.72801239	-104.9902835	Denver County
77658	Fee-for-Service	1609858182	1609858182	1	1	DE OCAMPO, EMILLIE MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73019	40	Pediatrics	0	In state provider	None	2415 W VINE ST	STE 100	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
77737	Fee-for-Service	1053796854	1053796854	1	1	DEELY, MICHELLE T	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
77755	Fee-for-Service	1659365971	1659365971	1	1	DURBIN, MARIE J MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67541	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
77841	Fee-for-Service	1487811212	1487811212	1	1	DAGA, NIKHIL A MD	4/27/2017	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	110624	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
77850	Fee-for-Service	1588181812	1588181812	1	1	DONIS, ANA S LMFT	12/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
77860	Fee-for-Service	1881687960	1881687960	1	3	DIABETES AND ENDOCRINE	10/27/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	ASSOCIATES MEDICAL GROUP	9850 GENESEE AVE	STE 415	LA JOLLA	CA	92037	1208	37	06073	32.882913	-117.226341	San Diego County
77879	Fee-for-Service	1831188044	1831188044	1	1	DRESBACH, MARK A MD	5/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89315	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	113 S VINE ST	# A	FALLBROOK	CA	92028	2925	37	06073	33.381639	-117.2503265	San Diego County
77889	Fee-for-Service	1073827929	1073827929	1	1	DORAISWAMY, ARUL MD APC	8/11/2010	207L00000X	NA	Other	026	PHYSICIANS	71755	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
77906	Fee-for-Service	1346403953	1346403953	1	1	DEYOUNG, DUSTIN Z MD	8/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126902	36	Psychiatry	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
77955	Fee-for-Service	1386635803	1386635803	1	1	DAVIS, EDWARD L MD	2/28/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	21363	34	Urology and Urological Surgery	0	In state provider	None	412 W CARROLL AVE	STE 200	GLENDORA	CA	91741	4709	19	06037	34.13415622	-117.8702547	Los Angeles County
77991	Fee-for-Service	1285260125	1285260125	1	1	DEY, ARITRA MD	5/9/2023	207R00000X	NA	Other	026	PHYSICIANS	185039	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
78067	Fee-for-Service	1518948843	1518948843	1	1	DENNINGHOFF, KURT R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV PHYS HOSP AT KINO	2800 E AJO WAY	None	PHOENIX	AZ	85713	0000	00	None	32.175801	-110.9306925	Pima County
78077	Fee-for-Service	1972728046	1972728046	1	1	DOMINGUEZ, REBECCA C MD	4/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130955	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
78082	Fee-for-Service	1780097675	1780097675	1	1	DESCALLAR, CRISTINE A MD	11/27/2017	207R00000X	NA	Other	026	PHYSICIANS	150251	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
78098	Fee-for-Service	1588027700	1588027700	1	1	DURAN, ANTONIO MD	6/9/2023	207R00000X	NA	Other	026	PHYSICIANS	176814	None	None	0	In state provider	None	3131 BERGER AVE	None	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
78106	Fee-for-Service	1477612372	1477612372	1	1	DRISKILL, BRENT R MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146197	04	Otology, Laryngology, Rhinology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
78110	Fee-for-Service	1215451562	1215451562	1	1	DE LOS SANTOS, YVETTE LMFT	9/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HERAPY	200 N BROADWAY	STE. F	TURLOCK	CA	95380	5454	50	06099	37.49472973	-120.8495129	Stanislaus County
78113	Fee-for-Service	1619149416	1619149416	1	1	DEHKORDI, ROYA K MD	9/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102851	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1729 N OLIVE AVE	# 3	TURLOCK	CA	95382	2501	50	06099	37.50874586	-120.8399103	Stanislaus County
78151	Fee-for-Service	1609263300	1609263300	1	1	DEVLIN, SHANNON M MD	6/28/2018	208M00000X	NA	Other	026	PHYSICIANS	143825	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
78152	Fee-for-Service	1811524515	1811524515	1	1	DALLAS, JONATHAN C MD	2/3/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	188592	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
78188	Fee-for-Service	1356799340	1356799340	1	1	DUBINSKAYA, ALEXANDRA MD	8/27/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167847	09	Gynecology (D.O. only)	0	In state provider	None	4676 ADMIRALTY WAY	4TH FLOOR	MARINA DEL REY	CA	90292	6601	19	06037	33.98035311	-118.4403749	Los Angeles County
78194	Fee-for-Service	1346403953	1346403953	1	1	DEYOUNG, DUSTIN Z MD	8/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126902	01	General Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
78226	Fee-for-Service	1699301630	1699301630	1	1	D'AVANZO, JUSTIN M MD	9/26/2022	390200000X	NA	Other	026	PHYSICIANS	177986	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
78232	Fee-for-Service	1760554026	1760554026	1	1	DEL PORTILLO, LUZ S MD	11/18/2022	207R00000X	NA	Other	026	PHYSICIANS	76408	None	None	0	In state provider	None	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
78239	Fee-for-Service	1376809483	1376809483	1	1	DUVA, KYLE R PSYD	4/21/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
78285	Fee-for-Service	1376945741	1376945741	1	1	DONAHUE, JACQUELINE PSYD	12/3/2019	208000000X	NA	Pediatric Primary Care	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
78324	Fee-for-Service	1154750503	1154750503	1	1	DONOVAN, ALLISON M	2/27/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
78355	Fee-for-Service	1760671234	1760671234	1	1	DESAI, NILESH H MD INC	8/31/1980	207R00000X	NA	Other	026	PHYSICIANS	33861	41	Internal Medicine	0	In state provider	None	241 W OLIVE AVE	None	BURBANK	CA	91502	1825	19	06037	34.17425363	-118.3157858	Los Angeles County
78370	Fee-for-Service	1902163413	1902163413	1	1	DORSAINVIL, DOMINIQUE MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151831	41	Internal Medicine	0	In state provider	None	568 E HERNDON AVE	SUITE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
78389	Fee-for-Service	1912288432	1912288432	1	4	DIGNITY HEALTH MEDICAL FOUND	7/13/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2526 SISTER MARY COLUMBA	1ST FLOOR	RED BLUFF	CA	96080	4327	52	06103	40.14934389	-122.2195713	Tehama County
78413	Fee-for-Service	1508646829	1508646829	1	1	DIMAANO, KAREN KATE C NP	4/2/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
78451	Fee-for-Service	1598749335	1598749335	1	1	DEICHERT, ROBERT MD	5/31/1987	207P00000X	NA	Other	026	PHYSICIANS	44573	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2311 LOVERIDGE RD	None	PITTSBURG	CA	94565	5117	07	06013	38.00694767	-121.8712439	Contra Costa County
78526	Fee-for-Service	1205930377	1205930377	2	1	DESHMUKH, MUKUND V MD	4/8/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51789	-	NOT APPLICABLE	0	In state provider	None	5900 BROCKTON AVE	None	RIVERSIDE	CA	92506	1862	33	06065	33.96263615	-117.395639	Riverside County
78542	Fee-for-Service	1225015845	1225015845	1	1	DOHERTY, TAYLOR	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86650	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
78573	Fee-for-Service	1669412185	1669412185	1	1	DUVAL, VICTOR F MD	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77414	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
78585	Fee-for-Service	1225118383	1225118383	1	1	DESAI, GAURANG N MD	8/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	54385	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
78661	Fee-for-Service	1902163413	1902163413	1	1	DORSAINVIL, DOMINIQUE MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151831	45	Nephrology (Renal-Kidney)	0	In state provider	None	568 E HERNDON AVE	SUITE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
78675	Fee-for-Service	1912288432	1912288432	1	4	DIGNITY HEALTH MEDICAL FOUND	7/13/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2526 SISTER MARY COLUMBA	1ST FLOOR	RED BLUFF	CA	96080	4327	52	06103	40.14934389	-122.2195713	Tehama County
78686	Fee-for-Service	1477671535	1477671535	1	6	DIGNITY HEALTH	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MERCY MEDICAL CT REDDING	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
78690	Fee-for-Service	1962694208	1962694208	1	1	DAVANZO, ALESSANDRA MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91501	08	Family Practice	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
78692	Fee-for-Service	1205830684	1205830684	1	1	DANIEL PARA MD	3/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7171 S 51ST AVE	None	LAVEEN	AZ	85339	2923	00	None	33.380613	-112.16745	Maricopa County
78736	Fee-for-Service	1144484072	1144484072	1	1	DIXON, KAMI M MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117065	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
78756	Fee-for-Service	1043051428	1043051428	1	1	DELLE DONNE, BRANDON PT	6/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3908 10 STREET	None	RIVERSIDE	CA	92501	3522	33	06065	33.98117228	-117.3785355	Riverside County
78839	Fee-for-Service	1639253834	1639253834	1	1	DALMAN, RONALD L	4/30/1992	2086S0129X	NA	General Surgery	026	PHYSICIANS	73779	01	General Practice	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
78847	Fee-for-Service	1598812471	1598812471	1	1	DESAI, NIKHIL K MD	9/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104276	02	General Surgery	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
78868	Fee-for-Service	1285119388	1285119388	1	1	DENN-THIELE, TYLER PT	12/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1630 W REDLANDS BLVD.	SUITE L	REDLANDS	CA	92373	8032	36	06071	34.06293049	-117.2104992	San Bernardino County
78875	Fee-for-Service	1417092644	1417092644	1	1	DOOLEY, DIANE MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43442	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
78914	Fee-for-Service	1144497678	1144497678	1	9	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	FOUNDATION	1321 COTTONWOOD ST	STE 203	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
78947	Fee-for-Service	1962694208	1962694208	1	1	DAVANZO, ALESSANDRA MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91501	01	General Practice	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
78954	Fee-for-Service	1013304286	1013304286	1	1	DAVIDGE, RACHEL E G DO	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15105	40	Pediatrics	0	In state provider	None	25845 BARTON RD	SUITE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
78987	Fee-for-Service	1326884297	1326884297	1	1	DAO ACUPUNCTURE INC.	10/9/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1317 S BALDWIN AVE	None	ARCADIA	CA	91007	7559	19	06037	34.1245002	-118.0551014	Los Angeles County
78989	Fee-for-Service	1477917904	1477917904	1	1	DE LA CRUZ, KATIA MD	1/31/2022	207L00000X	NA	Other	026	PHYSICIANS	153069	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
78995	Fee-for-Service	1043376528	1043376528	1	1	DEAN, STEPHEN M OD	8/28/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15908 BEAR VALLEY RD	SUITE A	VICTORVILLE	CA	92395	9547	36	06071	34.4709788	-117.316553	San Bernardino County
79003	Fee-for-Service	1467955260	1467955260	1	1	DING, PRISCILLA S MD	9/14/2021	207P00000X	NA	Other	026	PHYSICIANS	174087	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
79004	Fee-for-Service	1649298290	1649298290	1	1	DAVID M GRIFFIN MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5225 23RD AVE SOUTH	None	FARGO	ND	58104	7927	00	None	46.845468	-96.8753655	Cass County
79045	Fee-for-Service	1588202162	1588202162	1	1	DAY & NIGHT HOSPICE CARE,INC	3/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11485 VENTURA BLVD	UNIT B	STUDIO CITY	CA	91604	3143	19	06037	34.13967312	-118.381726	Los Angeles County
79047	Fee-for-Service	1356304158	1356304158	1	1	DANZIGER-ISAKOV, LARA MD	4/15/2024	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
79057	Fee-for-Service	1336584515	1336584515	1	1	DAY, ANDREW J MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143775	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
79097	Fee-for-Service	1821239997	1821239997	1	1	DEL ROSARIO, AMADO B DO	5/30/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
79146	Fee-for-Service	1164500740	1164500740	1	1	DHALIWAL, AMRITA MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53952	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
79198	Fee-for-Service	1851070783	1851070783	1	1	DEL MUNDO, ROLAND JETHRO	8/29/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
79199	Fee-for-Service	1427096619	1427096619	1	1	DIRBX, JAMES M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 NE 92ND AVE	None	VANCOUVER	WA	98664	3225	00	None	45.624546	-122.579703	Clark County
79211	Fee-for-Service	1316967938	1316967938	1	1	DASILVA, DAVID A MD	7/30/1990	207R00000X	NA	Other	026	PHYSICIANS	57969	41	Internal Medicine	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
79225	Fee-for-Service	1902293046	1902293046	1	1	DENOLF, RENEE L DO MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	15386	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
79235	Fee-for-Service	1710099114	1710099114	1	1	DAVID PENGILLY MD	5/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1040 TACOMA AVE	None	BISMARCK	ND	58504	7452	00	None	46.783413	-100.7765325	Burleigh County
79279	Fee-for-Service	1174545693	1174545693	1	1	DUA, SOHAN L MD	1/1/1989	174400000X	NA	Other	026	PHYSICIANS	25072	41	Internal Medicine	0	In state provider	VALLEY RENAL MEDICAL GRP	23861 MCBEAN PKWY	STE E13	VALENCIA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
79312	Fee-for-Service	1952982761	1952982761	1	1	DASCENZO, EMILY D PT	2/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
79325	Fee-for-Service	1518363597	1518363597	1	2	DV THERAPY INC.	12/13/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	190 SIERRA CT	B6	PALMDALE	CA	93550	7607	19	06037	34.64013337	-118.1280539	Los Angeles County
79335	Fee-for-Service	1588202162	1588202162	1	1	DAY & NIGHT HOSPICE CARE,INC	3/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11485 VENTURA BLVD	UNIT B	STUDIO CITY	CA	91604	3143	19	06037	34.13967312	-118.381726	Los Angeles County
79336	Fee-for-Service	1356304158	1356304158	1	1	DANZIGER-ISAKOV, LARA MD	4/15/2024	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
79355	Fee-for-Service	1336584515	1336584515	1	1	DAY, ANDREW J MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143775	67	Endocrinology	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
79358	Fee-for-Service	1548380272	1548380272	1	1	DIGNITY HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	635 LASSEN LANE	None	MOUNT SHASTA	CA	96067	9003	47	06093	41.31928889	-122.3275083	Siskiyou County
79382	Fee-for-Service	1801906359	1801906359	1	1	DAVIS, DAVID J MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54411	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
79390	Fee-for-Service	1174100929	1174100929	1	1	DASILVA, CHRISTOPHER MD	7/5/2024	2080P0203X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
79408	Fee-for-Service	1629277322	1629277322	1	1	DE MIK, TRAVIS J MD	5/12/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	108228	15	Obstetrics (D.O. only)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
79410	Fee-for-Service	1487896288	1487896288	1	1	DESAI, PRANAV J MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
79430	Fee-for-Service	1174782288	1174782288	1	1	DICKERSON, MICHAEL C MD	5/16/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	107976	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
79435	Fee-for-Service	1366484115	1366484115	1	1	DUONG, JONATHAN OD INC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ANAHEIM PLAZA OPTOMETRY	3340 W BALL RD	STE A	ANAHEIM	CA	92804	3729	30	06059	33.81726795	-118.0068541	Orange County
79468	Fee-for-Service	1902839962	1902839962	1	8	DUMOLIN SERVICE CORP	4/30/1992	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4044 SACRAMENTO AVE	None	SANTA ROSA	CA	95405	7724	49	06097	38.436327	-122.6679435	Sonoma County
79567	Fee-for-Service	1174545693	1174545693	1	1	DUA, SOHAN L MD	1/1/1989	174400000X	NA	Other	026	PHYSICIANS	25072	45	Nephrology (Renal-Kidney)	0	In state provider	VALLEY RENAL MEDICAL GRP	23861 MCBEAN PKWY	STE E13	VALENCIA	CA	91355	2077	19	06037	34.39567343	-118.5542698	Los Angeles County
79577	Fee-for-Service	1124080593	1124080593	1	1	DAVIDS, JON R MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	68422	None	None	0	In state provider	None	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
79600	Fee-for-Service	1942422688	1942422688	1	1	DITTMER, STEPHANIE S MD DO	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	117789	None	None	0	In state provider	None	3306 RENNER DRIVE	None	FORTUNA	CA	95540	3120	12	06023	40.58239845	-124.1360414	Humboldt County
79605	Fee-for-Service	1407868540	1407868540	1	1	DEUTSCH, STEPHEN C MD	4/1/1995	174400000X	NA	Other	026	PHYSICIANS	30582	None	None	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
79648	Fee-for-Service	1548380272	1548380272	1	1	DIGNITY HEALTH	10/21/1999	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	635 LASSEN LANE	None	MOUNT SHASTA	CA	96067	9003	47	06093	41.31928889	-122.3275083	Siskiyou County
79671	Fee-for-Service	1790296705	1790296705	1	1	DUPRAY, ELIZABETH J LMFT	9/5/2019	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
79694	Fee-for-Service	1629277322	1629277322	1	1	DE MIK, TRAVIS J MD	5/12/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	108228	09	Gynecology (D.O. only)	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
79700	Fee-for-Service	1932132685	1932132685	1	1	DAWODU, ADEYOSOYE T MD	4/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89901	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
79715	Fee-for-Service	1417796897	1417796897	1	1	DEER, MARGRET NP	10/23/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23181 VERDUGO DR	STE 103A	LAGUNA HILLS	CA	92653	1313	30	06059	33.62609529	-117.7293191	Orange County
79744	Fee-for-Service	1114912516	1114912516	1	1	DAVID E HILL MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2018 W CLINCH AVE	None	KNOXVILLE	TN	37916	2301	00	None	35.95636924	-83.93810472	Knox County
79764	Fee-for-Service	1295846822	1295846822	1	1	DANIELS, STACIE R MD	6/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52291	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79827	Fee-for-Service	1902506587	1902506587	1	1	DING, LINDSEY NP	3/23/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
79850	Fee-for-Service	1972928190	1972928190	1	1	DUNN, ASHLEY LMFT	6/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5550 TELEGRAPH RD	C3	VENTURA	CA	93003	4263	56	06111	34.27717324	-119.2199411	Ventura County
79899	Fee-for-Service	1861771610	1861771610	1	1	DAVARE, DAFNEY L MD	10/27/2023	207RC0200X	NA	Other	026	PHYSICIANS	172765	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
79930	Fee-for-Service	1174531859	1174531859	1	13	DIGNITY HEALTH MEDICAL FOUND	3/1/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1098 FOSTER CITY BLVD	A 104	FOSTER CITY	CA	94404	2300	41	06081	37.5537827	-122.2558392	San Mateo County
79981	Fee-for-Service	1851698823	1851698823	1	1	DANILOV, LILIA MD	1/3/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	129893	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
80033	Fee-for-Service	1457920514	1457920514	1	1	DANLINHTON, LARRY L LMFT	4/26/2022	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
80034	Fee-for-Service	1407888738	1407888738	1	1	DUNLOP, MIRANDA B MD	7/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90292	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
80065	Fee-for-Service	1437591104	1437591104	1	1	DIAZ, ALEJANDRO E MD	4/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132627	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
80073	Fee-for-Service	1073654679	1073654679	1	1	DEUKMEJIAN, LUCY LMFT	6/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 PALMA DR FL 2	None	VENTURA	CA	93003	6451	56	06111	34.25975064	-119.2276657	Ventura County
80074	Fee-for-Service	1386147916	1386147916	1	1	DUGAN, NECOLE NP	10/20/2023	103TF0000X	NA	Mental Health Outpatient Services	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
80082	Fee-for-Service	1336554930	1336554930	1	1	DURANT, BENJAMIN J MD	10/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143250	01	General Practice	0	In state provider	None	2500 ALHAMBRA AVE	None	MARTINEZ	CA	94553	3156	07	06013	38.00658519	-122.1309063	Contra Costa County
80143	Fee-for-Service	1831146893	1831146893	1	1	DANG, PETER D DPM	4/8/2008	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15038 IMPERIAL HWY	None	LA MIRADA	CA	90638	1301	19	06037	33.91707319	-118.009999	Los Angeles County
80165	Fee-for-Service	1811075351	1811075351	1	1	DING, SHULAN MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92429	41	Internal Medicine	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
80221	Fee-for-Service	1477529170	1477529170	1	1	DESILVA-KLEBICKI, MIHIRI	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9248	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	9102	19	06037	34.19395645	-118.463265	Los Angeles County
80255	Fee-for-Service	1225386790	1225386790	1	1	DESIR, GUERLINE L LPCC	12/4/2020	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 W. SHAW AVE	STE 119	FRESNO	CA	93710	7510	10	06019	36.8064869	-119.8354798	Fresno County
80257	Fee-for-Service	1700819422	1700819422	1	1	DOMA, SIVA P MD	9/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54070	10	Gastroenterology (M.D. only)	0	In state provider	None	870 SHASTA STREET	SUITE 200	YUBA CITY	CA	95991	4117	51	06101	39.14204	-121.6161711	Sutter County
80317	Fee-for-Service	1871659433	1871659433	1	1	DEVENO, DEBORAH OD	9/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
80419	Fee-for-Service	1568456887	1568456887	1	1	DUTRA, VINCE A MD	7/31/1995	207L00000X	NA	Other	026	PHYSICIANS	80145	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
80426	Fee-for-Service	1720376536	1720376536	1	1	DUNCAN, CHRISTOPHER MD	12/2/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	25	Physical Medicine and Rehabilitation	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
80470	Fee-for-Service	1962126060	1962126060	1	1	DORADO PHARMACY INC	5/31/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13003 VAN NUYS BLVD	STE E	PACOIMA	CA	91331	8324	19	06037	34.27013384	-118.4166087	Los Angeles County
80487	Fee-for-Service	1821417957	1821417957	1	1	DENT, BRANDON M MD	8/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
80522	Fee-for-Service	1366891624	1366891624	1	1	DIANES, GABRIEL N MD	9/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162338	08	Family Practice	0	In state provider	None	5300 SNYDER LN	SUITES A & B	ROHNERT PARK	CA	94928	2915	49	06097	38.346426	-122.6855205	Sonoma County
80534	Fee-for-Service	1154337053	1154337053	1	1	DE LA CRUZ, DMITRI MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	54368	40	Pediatrics	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
80545	Fee-for-Service	1831860584	1831860584	1	1	DOMINIC ONG LMFT	9/24/2021	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1050 LAKES DR	STE 2252548	WEST COVINA	CA	91790	2924	19	06037	34.07127962	-117.9226429	Los Angeles County
80569	Fee-for-Service	1629045125	1629045125	1	1	DHRUVA, SHISHIR A MD	10/10/1994	207LP2900X	NA	Other	026	PHYSICIANS	43275	05	Anesthesiology	0	In state provider	None	12440 FIRESTONE BLVD	STE 101	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
80578	Fee-for-Service	1770556854	1770556854	1	1	DEARDEN, MARK L MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109877	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
80580	Fee-for-Service	1073827465	1073827465	1	1	DONAHUE, SARAH R NP	4/13/2017	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
80610	Fee-for-Service	1255641528	1255641528	1	1	DALEY, LUZ MARIA C PSYD	6/2/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
80682	Fee-for-Service	1316523178	1316523178	1	1	DOAN, LOI N DO	12/5/2023	390200000X	NA	Other	026	PHYSICIANS	22333	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
80692	Fee-for-Service	1619730587	1619730587	1	1	DOULA TAB LLC	2/2/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
80707	Fee-for-Service	1477573012	1477573012	1	1	DHALIWAL, KAIL S MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42833	05	Anesthesiology	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
80746	Fee-for-Service	1982866927	1982866927	1	1	DUNCAN, IAN C MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120183	20	Orthopedic Surgery	0	In state provider	None	820 S AKERS	STE 220	VISALIA	CA	93277	8309	54	06107	36.323757	-119.3491755	Tulare County
80765	Fee-for-Service	1891824652	1891824652	1	1	DEAMER, RICHARD M MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	30754	36	Psychiatry	0	In state provider	None	2200 E GONZALES RD	None	OXNARD	CA	93036	0619	56	06111	34.21872951	-119.148768	Ventura County
80778	Fee-for-Service	1861527657	1861527657	1	1	DVORAK, CHRISTOPHER C MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69578	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	M674	SAN FRANCISCO	CA	94143	1278	38	06075	37.7634502	-122.4579779	San Francisco County
80795	Fee-for-Service	1881699452	1881699452	1	1	DECANDIA, ROBERTO D PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16536 AMBER TREE LN	None	HACIENDA HEIGHTS	CA	91745	5507	19	06037	33.98721251	-117.9489252	Los Angeles County
80871	Fee-for-Service	1457939597	1457939597	1	1	D'ANNIBALE, DANIELLE A	1/3/2025	208M00000X	NA	Other	026	PHYSICIANS	192059	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80995	Fee-for-Service	1902839384	1902839384	1	1	DIALYSIS CLINIC, INC	4/26/1991	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7231 E SOUTHGATE DR	None	SACRAMENTO	CA	95823	2620	34	06067	38.494809	-121.4361225	Sacramento County
81016	Fee-for-Service	1356395800	1356395800	1	1	DHILLON, TEJWANT S	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94192	None	None	0	In state provider	None	1313 E HERNDON AVE	STE 203	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
81047	Fee-for-Service	1750462487	1750462487	1	1	DHEMING, JOSE A MD INC	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55611	01	General Practice	0	In state provider	None	5385 WALNUT AVE	STE 4	CHINO	CA	91710	2605	36	06071	34.02627451	-117.6872175	San Bernardino County
81094	Fee-for-Service	1215420138	1215420138	1	1	DEPAOLO, AMANDA L LCSW	10/6/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
81200	Fee-for-Service	1154620987	1154620987	1	1	DESAI, RONAK N MD	12/12/2019	207R00000X	NA	Other	026	PHYSICIANS	161345	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
81216	Fee-for-Service	1861912495	1861912495	1	1	DHANDI, TEJINDER K NP	12/18/2018	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
81220	Fee-for-Service	1477895050	1477895050	1	1	DORNER, REBECCA A MD	11/17/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	183088	None	None	0	In state provider	None	3003 HEALTH CENTER DRIVE	None	SAN DIEGO	CA	92123	2700	37	06073	32.79785552	-117.1563475	San Diego County
81302	Fee-for-Service	1275600025	1275600025	1	1	DINGESS, SANDRA A NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 IMPERIAL HWY	STE ABCD	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
81334	Fee-for-Service	1750462487	1750462487	1	1	DHEMING, JOSE A MD INC	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55611	08	Family Practice	0	In state provider	None	5385 WALNUT AVE	STE 4	CHINO	CA	91710	2605	36	06071	34.02627451	-117.6872175	San Bernardino County
81419	Fee-for-Service	1578792859	1578792859	1	1	DHANOA, GURPREET S MD	10/19/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	126656	01	General Practice	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94582	5400	07	06013	37.7755858	-121.958923	Contra Costa County
81432	Fee-for-Service	1538352497	1538352497	1	1	DIAZ, COURTNEY B LCSW	5/25/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27438	-	NOT APPLICABLE	0	In state provider	None	614 TULLY ROAD	None	SAN JOSE	CA	95111	1048	43	06085	37.30851705	-121.8465917	Santa Clara County
81457	Fee-for-Service	1841793619	1841793619	1	1	DARMAHKASIH, ANDREW MD	8/4/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164751	None	None	0	In state provider	None	800 S FAIRMONT ST	STE 310	PASADENA	CA	91105	3153	19	06037	34.13193177	-118.1517805	Los Angeles County
81470	Fee-for-Service	1447276365	1447276365	1	1	DURU, OBIDUGWU K MD	6/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75361	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
81534	Fee-for-Service	1730617176	1730617176	1	1	DOBBS-MARSH, LILLIAN J PSYD	10/9/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81555	Fee-for-Service	1861412751	1861412751	1	1	DANHAUER, JEFFREY T PHD	10/1/2001	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	436 N ROXBURY DR	None	BEVERLY HILLS	CA	90210	5026	19	06037	34.06771782	-118.4065755	Los Angeles County
81591	Fee-for-Service	1770830499	1770830499	1	1	DUONG, CHRISTINA K NP	7/22/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
81620	Fee-for-Service	1205850328	1205850328	1	1	DRABINSKY, ALLAN P MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	36967	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
81632	Fee-for-Service	1891128351	1891128351	1	1	DALTO, JAY B PT	7/12/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
81675	Fee-for-Service	1184083115	1184083115	1	1	DAVIDSON, DAVID W LMFT	1/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2431 W MARCH LANE	STE 210	STOCKTON	CA	95207	8211	39	06077	37.985267	-121.3372349	San Joaquin County
81727	Fee-for-Service	1679779433	1679779433	1	1	DENTON, ALFRED D LMFT	10/29/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
81738	Fee-for-Service	1295889285	1295889285	1	1	DELANEY, MARY G LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	255 W MENDOCINO AVE	None	WILLITS	CA	95490	3413	23	06045	39.4112121	-123.3584566	Mendocino County
81777	Fee-for-Service	1134407448	1134407448	1	1	DELA CRUZ, SHERWIN G MD	2/10/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	118746	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
81796	Fee-for-Service	1508227976	1508227976	1	1	DHILLON, KRISTINA	6/19/2019	207R00000X	NA	Other	026	PHYSICIANS	16551	41	Internal Medicine	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4897	36	06071	34.03717616	-117.2046115	San Bernardino County
81847	Fee-for-Service	1558335778	1558335778	1	1	DOMINIQUE VERRECCHIA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE CHILDRES HOSPITAL	13123 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742164	-104.8350375	Adams County
81957	Fee-for-Service	1114216850	1114216850	1	2	DIGNITY HEALTH	5/3/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
81959	Fee-for-Service	1033194733	1033194733	1	1	DR. WILLIAM LEE	8/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
81996	Fee-for-Service	1326523721	1326523721	1	1	DADIAN, ADIN PT	5/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9555 FOOTHILL BLVD	SUITE A	RANCHO CUCAMONGA	CA	91730	3576	36	06071	34.10650351	-117.596583	San Bernardino County
82025	Fee-for-Service	1376975300	1376975300	1	1	DEARMAN, SHATORI R LCSW	7/28/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
82140	Fee-for-Service	1659367936	1659367936	1	1	DANIEL J, GROWNEY	1/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 N LINCOLN AVE	None	YORK	NE	68467	1030	00	None	40.882527	-97.59299305	York County
82248	Fee-for-Service	1114216850	1114216850	1	2	DIGNITY HEALTH	5/3/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
82263	Fee-for-Service	1922576420	1922576420	1	1	DY, PETER C NP	11/28/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
82287	Fee-for-Service	1811003809	1811003809	1	1	DOMINGUEZ, JOANN C MD	6/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117117	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	# 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
82312	Fee-for-Service	1699976134	1699976134	1	1	DUDGEON, MAUREEN MD	6/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89401	01	General Practice	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
82338	Fee-for-Service	1033111380	1033111380	1	1	DEITEL,KEVIN M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85673	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
82339	Fee-for-Service	1477013175	1477013175	1	1	DAVID, JILL DO	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	22900	41	Internal Medicine	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
82367	Fee-for-Service	1356305437	1356305437	1	1	DEUTSCH, ANDREW L MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	37999	None	None	0	In state provider	None	44105 15TH ST W	None	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
82383	Fee-for-Service	1669537908	1669537908	1	1	DANESH, REZA MD	1/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95729	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
82398	Fee-for-Service	1598080137	1598080137	1	1	DOLINAY, TAMAS MD	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152201	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA	#365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
82423	Fee-for-Service	1851646046	1851646046	1	1	DHP OF SAN JOSE MEDICAL	8/10/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
82426	Fee-for-Service	1720024094	1720024094	1	1	DANIEL,ELAINE MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
82427	Fee-for-Service	1508879115	1508879115	1	1	DORFF, TANYA B MD	1/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82669	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO STREET	#1000	LOS ANGELES	CA	90033	4528	19	06037	34.06269295	-118.2030006	Los Angeles County
82438	Fee-for-Service	1225047889	1225047889	1	1	DARLINGTON-HANSEN,	8/5/2008	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	KRISTINA E DO	842 E MAIN ST	None	MEDFORD	OR	97504	7134	00	None	42.32787853	-122.863311	Jackson County
82450	Fee-for-Service	1528229689	1528229689	1	1	DAKAK, ALAN F MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96755	40	Pediatrics	0	In state provider	None	1111 COLUMBUS ST	STE 1100	BAKERSFIELD	CA	93305	1937	15	06029	35.39744148	-118.9822815	Kern County
82479	Fee-for-Service	1063591469	1063591469	1	1	DYOCO, ORLANTINO G MD	3/25/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	34643	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	3006 N FRESNO ST	None	FRESNO	CA	93703	1124	10	06019	36.777735	-119.7815135	Fresno County
82508	Fee-for-Service	1457812489	1457812489	1	1	DOUD, MICHAEL	11/19/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	182505	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
82533	Fee-for-Service	1669490454	1669490454	1	2	DHILLON, GURINDER S	2/19/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49131	None	None	0	In state provider	None	1525 WEBSTER ST	STE A	FAIRFIELD	CA	94533	4935	48	06095	38.2570563	-122.0475622	Solano County
82535	Fee-for-Service	1275741118	1275741118	1	1	DION, JANET	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
82538	Fee-for-Service	1568645901	1568645901	1	1	DOWLING, ERIN P MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101684	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
82545	Fee-for-Service	1881631711	1881631711	1	6	DERMATOLOGY SPECIALISTS INC	5/28/2019	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	A SURGICAL-MEDICAL GROU	31515 RANCHO PUEBLO RD	#102	TEMECULA	CA	92592	4836	33	06065	33.47922478	-117.1107757	Riverside County
82599	Fee-for-Service	1699976134	1699976134	1	1	DUDGEON, MAUREEN MD	6/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89401	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
82616	Fee-for-Service	1457549123	1457549123	1	1	DELTA EYE MED GRP INC	5/1/1981	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	521 S HAM LN	STE A	LODI	CA	95242	3528	39	06077	38.12793778	-121.2883049	San Joaquin County
82625	Fee-for-Service	1033111380	1033111380	1	1	DEITEL,KEVIN M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85673	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
82657	Fee-for-Service	1417102039	1417102039	1	1	DEPENDABLE NURSING LLC	4/11/2011	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5055 AVENIDA ENCINAS	SUITE 120	CARLSBAD	CA	92008	4375	37	06073	33.13217166	-117.3297458	San Diego County
82675	Fee-for-Service	1225060643	1225060643	1	1	DIEGO MEDICAL CORPORATION	2/22/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60216	40	Pediatrics	0	In state provider	None	23517 S. MAIN STREET	SUITE 101	CARSON	CA	90745	5227	19	06037	33.81129174	-118.2756933	Los Angeles County
82690	Fee-for-Service	1174528657	1174528657	1	1	DAVIDOVICH, RAFFAELE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29865	41	Internal Medicine	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
82695	Fee-for-Service	1134171408	1134171408	1	1	DIAMREYAN, OCHUKO G MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66432	36	Psychiatry	0	In state provider	APEX HEALTH CONSULTANTS	2380 N SIERRA WAY	None	SAN BERNARDINO	CA	92405	3546	36	06071	34.137657	-117.285168	San Bernardino County
82713	Fee-for-Service	1508879115	1508879115	1	1	DORFF, TANYA B MD	1/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82669	78	Neoplastic Diseases/Oncology	0	In state provider	None	1520 SAN PABLO STREET	#1000	LOS ANGELES	CA	90033	4528	19	06037	34.06269295	-118.2030006	Los Angeles County
82716	Fee-for-Service	1326083213	1326083213	1	1	DRACH, FREDERICK S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46960	41	Internal Medicine	0	In state provider	None	1750 BRIDGEWAY	STE B106	SAUSALITO	CA	94965	1900	21	06041	37.8615467	-122.4899285	Marin County
82760	Fee-for-Service	1417526716	1417526716	1	1	DAYBREAK MEDICAL PC	10/26/2023	103TC1900X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
82779	Fee-for-Service	1699852558	1699852558	1	1	DANIELS, ETHAN H MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56875	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
82820	Fee-for-Service	1558472159	1558472159	1	1	DRENGLER, KAY E DO	5/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7382	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
82848	Fee-for-Service	1679534796	1679534796	1	1	DONNER, BARRY MD	9/23/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	47680	10	Gastroenterology (M.D. only)	0	In state provider	None	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
82854	Fee-for-Service	1144497678	1144497678	1	12	DIGNITY HEALTH MEDICAL	10/13/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
82858	Fee-for-Service	1811211659	1811211659	1	2	DEJUN WANG M.D. INC.	9/4/2019	261QP2300X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	19115 COLIMA ROAD	104	ROWLAND HEIGHTS	CA	91748	2730	19	06037	33.987359	-117.8863645	Los Angeles County
82979	Fee-for-Service	1174528657	1174528657	1	1	DAVIDOVICH, RAFFAELE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29865	03	Allergy	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
82996	Fee-for-Service	1912288432	1912288432	1	2	DIGNITY HEALTH MEDICAL FOUND	5/1/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2510 AIRPARK DR	STE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
83004	Fee-for-Service	1326083213	1326083213	1	1	DRACH, FREDERICK S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46960	77	Infectious Disease	0	In state provider	None	1750 BRIDGEWAY	STE B106	SAUSALITO	CA	94965	1900	21	06041	37.8615467	-122.4899285	Marin County
83016	Fee-for-Service	1205930377	1205930377	2	2	DESHMUKH, MUKUND V MD	12/19/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51789	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	5900 BROCKTON AVE	None	RIVERSIDE	CA	92506	1862	33	06065	33.96263615	-117.395639	Riverside County
83027	Fee-for-Service	1841253804	1841253804	3	1	DOUGLAS CUTLER	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
83046	Fee-for-Service	1417526716	1417526716	1	1	DAYBREAK MEDICAL PC	10/26/2023	261QM0855X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
83087	Fee-for-Service	1164495826	1164495826	1	1	DHINDSA, JASMINE MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1500 E 2ND ST	SUITE 201	RENO	NV	89502	1196	00	None	39.52743427	-119.7932613	Washoe County
83100	Fee-for-Service	1073587697	1073587697	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANAHEIM DIALYSIS	1341 W LA PALMA AVE	None	ANAHEIM	CA	92801	2817	30	06059	33.84715453	-117.937089	Orange County
83138	Fee-for-Service	1548977242	1548977242	1	1	DILIGENCE CARE PLUS NURSING	2/17/2023	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	255 N D ST	STE 400	SAN BERNARDINO	CA	92401	1715	36	06071	34.1036709	-117.291874	San Bernardino County
83139	Fee-for-Service	1144497678	1144497678	1	12	DIGNITY HEALTH MEDICAL	10/13/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
83196	Fee-for-Service	1366479461	1366479461	1	1	DIMARZO, STEPHEN V MD	4/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45838	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83241	Fee-for-Service	1205364569	1205364569	1	1	DOAN, CALVIN T DO	12/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16733	None	None	0	In state provider	None	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
83271	Fee-for-Service	1982905410	1982905410	1	1	DR RUTH TANYI	1/25/2011	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	577 N D STREET	#101	SAN BERNARDINO	CA	92401	1326	36	06071	34.109613	-117.291874	San Bernardino County
83274	Fee-for-Service	1104967694	1104967694	1	1	DAWLEY, COURTNEY A DO	4/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9834	01	General Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
83283	Fee-for-Service	1467491472	1467491472	1	1	DHALIWAL, SONIA G MD	4/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81378	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
83310	Fee-for-Service	1215209101	1215209101	1	1	DE LA CRUZ, EDWARD L LMFT	3/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
83333	Fee-for-Service	1417526716	1417526716	1	1	DAYBREAK MEDICAL PC	12/2/2024	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
83358	Fee-for-Service	1952567745	1952567745	1	1	DIAZ, ROBERT E LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	0000	19	06037	34.09817553	-118.293237	Los Angeles County
83364	Fee-for-Service	1558756395	1558756395	1	1	DOROS, JOSHUA N MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153129	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
83426	Fee-for-Service	1144497678	1144497678	1	12	DIGNITY HEALTH MEDICAL	10/13/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
83428	Fee-for-Service	1548977242	1548977242	1	1	DILIGENCE CARE PLUS NURSING	2/17/2023	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	255 N D ST	STE 400	SAN BERNARDINO	CA	92401	1715	36	06071	34.1036709	-117.291874	San Bernardino County
83487	Fee-for-Service	1396407623	1396407623	1	1	DIBENEDETTO, CARMEN N CRNA	7/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	275 HOSPITAL	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
83526	Fee-for-Service	1801401377	1801401377	1	1	DIGNITY CARE HOSPICE INC	9/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH STREET	SUITE 217	GRANADA HILLS	CA	91344	5876	19	06037	34.26477251	-118.5039945	Los Angeles County
83542	Fee-for-Service	1942837927	1942837927	1	1	DESOASIDO, ANTHONY DO	1/18/2024	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
83551	Fee-for-Service	1871648840	1871648840	1	1	DUREZA, CATALINO D MD	4/1/2001	207T00000X	NA	General Surgery	026	PHYSICIANS	66607	14	Neurological Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
83624	Fee-for-Service	1417526716	1417526716	1	1	DAYBREAK MEDICAL PC	10/26/2023	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
83658	Fee-for-Service	1902887284	1902887284	1	1	DR DAVID E TRUAX	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	TRUAX CHIROPRACTIC	315 4TH ST	None	FARMINGTON	MN	55024	0000	00	None	44.639559	-93.1433355	Dakota County
83715	Fee-for-Service	1801994082	1801994082	1	1	DIAZ JR, MANUEL C DO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7575	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
83722	Fee-for-Service	1548977242	1548977242	1	1	DILIGENCE CARE PLUS NURSING	2/17/2023	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	255 N D ST	STE 400	SAN BERNARDINO	CA	92401	1715	36	06071	34.1036709	-117.291874	San Bernardino County
83748	Fee-for-Service	1083284715	1083284715	1	1	DESIMONE SURGICAL INC	7/16/2021	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1000 NEWBURY	285	NEWBURY PARK	CA	91320	6435	56	06111	34.18353384	-118.9044556	Ventura County
83787	Fee-for-Service	1659311108	1659311108	1	1	DAVIDSON, ROBERT MD	5/27/1998	207R00000X	NA	Other	026	PHYSICIANS	23565	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 207	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
83824	Fee-for-Service	1801401377	1801401377	1	1	DIGNITY CARE HOSPICE INC	9/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH STREET	SUITE 217	GRANADA HILLS	CA	91344	5876	19	06037	34.26477251	-118.5039945	Los Angeles County
83837	Fee-for-Service	1871648840	1871648840	1	1	DUREZA, CATALINO D MD	4/1/2001	207T00000X	NA	General Surgery	026	PHYSICIANS	66607	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
83839	Fee-for-Service	1790382828	1790382828	1	1	DILLER, ANTONIA F	1/29/2025	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1775 HARRISON AVE	None	EUREKA	CA	95501	1338	12	06023	40.79191911	-124.1395817	Humboldt County
83850	Fee-for-Service	1558443788	1558443788	1	1	DAVID HOWARD LEWIS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
83875	Fee-for-Service	1912288432	1912288432	1	3	DIGNITY HEALTH MEDICAL FOUND	9/19/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1755 COURT STREET	None	REDDING	CA	96001	1721	45	06089	40.58041248	-122.3945221	Shasta County
83906	Fee-for-Service	1154575363	1154575363	1	1	DANESHRAD, DIBA MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111946	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
83914	Fee-for-Service	1386716959	1386716959	1	1	DAY, RICHARD B MD	4/30/1988	174400000X	NA	Other	026	PHYSICIANS	45298	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83965	Fee-for-Service	1659386027	1659386027	1	1	DUEL, EBRAHIM MD	11/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33882	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	301 N MAIN ST	None	SANTA ANA	CA	92701	4852	30	06059	33.747309	-117.8676145	Orange County
83989	Fee-for-Service	1699183061	1699183061	1	1	DOVICH, JENNIFER L OD	10/5/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1356 EAST MAIN STREET	None	BARSTOW	CA	92311	3241	36	06071	34.89481556	-117.0051968	San Bernardino County
84002	Fee-for-Service	1346317294	1346317294	1	1	DOYLE, BRIAN S MD	11/30/1993	204D00000X	NA	Other	026	PHYSICIANS	42933	20	Orthopedic Surgery	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
84075	Fee-for-Service	1649335589	1649335589	2	1	DECUIR, BRIAN A OD	8/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	21263 ERWIN ST	None	WOODLAND HILLS	CA	91367	3715	19	06037	34.18286951	-118.5949215	Los Angeles County
84077	Fee-for-Service	1740422344	1740422344	1	1	DHILLON, RAVNEET K MD	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151651	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
84078	Fee-for-Service	1568417889	1568417889	1	1	DELRIO, GERALD R MD	8/1/1992	207RP1001X	NA	Pulmonology	026	PHYSICIANS	32797	41	Internal Medicine	0	In state provider	None	2220 GLADSTONE DR	STE 2	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
84125	Fee-for-Service	1811158264	1811158264	1	1	DARAS, MARIZA MD	12/9/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	164148	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
84132	Fee-for-Service	1114918612	1114918612	1	1	DESERT MEDICAL GROUP INC	10/24/2020	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
84157	Fee-for-Service	1942353628	1942353628	1	1	DISNEY, TODD A PHD	7/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3558 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1780	49	06097	38.47617	-122.7235455	Sonoma County
84162	Fee-for-Service	1669096384	1669096384	1	1	DAO, QUAN B OD	6/3/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
84164	Fee-for-Service	1912288432	1912288432	1	3	DIGNITY HEALTH MEDICAL FOUND	9/19/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1755 COURT STREET	None	REDDING	CA	96001	1721	45	06089	40.58041248	-122.3945221	Shasta County
84168	Fee-for-Service	1932262763	1932262763	1	1	DEL NORTE CLINICS, INC	1/1/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	411 FOURTH ST	None	WHEATLAND	CA	95692	9467	58	06115	39.01085205	-121.4234151	Yuba County
84208	Fee-for-Service	1093928079	1093928079	1	1	DINH, VU DO	10/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	12175	02	General Surgery	0	In state provider	None	425 OLD NEWPORT BLVD	None	NEWPORT BEACH	CA	92633	4250	30	06059	33.62664336	-117.9264807	Orange County
84319	Fee-for-Service	1609966357	1609966357	1	1	DALY, RICHARD G MD	7/25/1978	207RE0101X	NA	Endocrinology	026	PHYSICIANS	38188	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84320	Fee-for-Service	1003304536	1003304536	1	1	DIECKMANN, MARLOWE G MD	2/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157293	None	None	0	In state provider	None	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
84366	Fee-for-Service	1568417889	1568417889	1	1	DELRIO, GERALD R MD	8/1/1992	207RP1001X	NA	Pulmonology	026	PHYSICIANS	32797	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2220 GLADSTONE DR	STE 2	PITTSBURG	CA	94565	5123	07	06013	38.00689525	-121.8661724	Contra Costa County
84367	Fee-for-Service	1841464658	1841464658	1	2	DR SAUL MENDELSOHN	9/21/2015	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIST A PROFESSION	5478 N PALM AVE	None	FRESNO	CA	93704	1940	10	06019	36.81697011	-119.8082669	Fresno County
84405	Fee-for-Service	1891075446	1891075446	1	1	DEMING HOSPITAL CORPORATION	9/3/2019	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	900 W ASH ST	None	DEMING	NM	88030	4000	00	None	32.2612592	-107.767781	Luna County
84423	Fee-for-Service	1114918612	1114918612	1	1	DESERT MEDICAL GROUP INC	2/28/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
84544	Fee-for-Service	1093961823	1093961823	1	1	DEPENDABLE HOME CARE	12/30/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	5924 E LOS ANGELES AVE	STE O	SIMI VALLEY	CA	93063	5526	56	06111	34.27171481	-118.6755673	Ventura County
84583	Fee-for-Service	1912083429	1912083429	1	1	DOWDELL, LYNN MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	59623	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
84659	Fee-for-Service	1063673556	1063673556	1	1	DOUGLAS, DAVID B MD	12/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111076	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84685	Fee-for-Service	1174949085	1174949085	1	1	DOMINGUEZ, JOSEFINA A MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128167	02	General Surgery	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6006	34	06067	38.571084	-121.471074	Sacramento County
84694	Fee-for-Service	1891075446	1891075446	1	1	DEMING HOSPITAL CORPORATION	9/3/2019	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	900 W ASH ST	None	DEMING	NM	88030	4000	00	None	32.2612592	-107.767781	Luna County
84704	Fee-for-Service	1285071001	1285071001	1	1	DECKER, JUSTYNE MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137221	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
84715	Fee-for-Service	1114918612	1114918612	1	1	DESERT MEDICAL GROUP INC	10/25/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
84731	Fee-for-Service	1689854416	1689854416	1	1	DUNN, TAMARA J MD	6/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	100875	68	Hematology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84748	Fee-for-Service	1144497678	1144497678	1	1	DIGNITY HEALTH MEDICAL	7/23/2009	213E00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
84761	Fee-for-Service	1659340685	1659340685	1	1	DENIANKE, BARBARA F MD	12/6/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76265	40	Pediatrics	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
84767	Fee-for-Service	1982675021	1982675021	1	1	DOGGETT, STEPHEN W MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	49856	78	Neoplastic Diseases/Oncology	0	In state provider	None	1401 AVOCADO AVE	STE 100	NEWPORT BEACH	CA	92660	7710	30	06059	33.61235015	-117.8704573	Orange County
84779	Fee-for-Service	1992017826	1992017826	1	1	DORSEY, KHARY S MD	1/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133767	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
84795	Fee-for-Service	1720582083	1720582083	1	1	DOTSON, BRANDAN L	3/16/2024	207R00000X	NA	Other	026	PHYSICIANS	164074	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
84810	Fee-for-Service	1497804041	1497804041	1	1	DEVELOPMENTAL CLIENT	12/20/1992	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INDUSTRIES INC	12581 SHADYBEND DR	None	MORENO VALLEY	CA	92553	5906	33	06065	33.93753174	-117.2554027	Riverside County
84824	Fee-for-Service	1356574925	1356574925	1	1	DOLLAR, MICHAEL B CRNA	5/17/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
84856	Fee-for-Service	1740357664	1740357664	1	1	DUH, GLENN Z MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80319	10	Gastroenterology (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
84868	Fee-for-Service	1740287697	1740287697	1	2	DESERT HOME HEALTH SERVICES,	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	440 S EL CIELO ROAD	SUITE 8	PALM SPRINGS	CA	92262	7928	33	06065	33.816753	-116.5106225	Riverside County
84884	Fee-for-Service	1861017097	1861017097	1	1	DUONG, ELENA	7/4/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	777 DAVIS ST	None	SAN LEANDRO	CA	94577	6923	01	06001	37.72317409	-122.162925	Alameda County
84894	Fee-for-Service	1467560599	1467560599	2	3	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7601 HOSPITAL DR	SUITE 103	SACRAMENTO	CA	95823	5403	34	06067	38.464794	-121.415571	Sacramento County
84903	Fee-for-Service	1053855288	1053855288	1	1	DALEY, SARAH K MD	3/22/2022	207ZP0102X	NA	Other	026	PHYSICIANS	171507	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
84929	Fee-for-Service	1033361282	1033361282	1	1	DONAHUE, TIMOTHY R MD	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86040	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
84932	Fee-for-Service	1932258894	1932258894	1	1	DOSTANIC-RAKIC, Z MD	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88784	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
84967	Fee-for-Service	1912996612	1912996612	1	1	DOBERNE, YALE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24223	40	Pediatrics	0	In state provider	None	2950 SYCAMORE DR	STE 200	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
84988	Fee-for-Service	1942254438	1942254438	1	1	DREY, ELEANOR A MD	12/1/2000	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	63695	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
84999	Fee-for-Service	1114918612	1114918612	1	1	DESERT MEDICAL GROUP INC	11/14/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
85040	Fee-for-Service	1144497678	1144497678	1	1	DIGNITY HEALTH MEDICAL	7/23/2009	213E00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FOUNDATION	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
85056	Fee-for-Service	1982675021	1982675021	1	1	DOGGETT, STEPHEN W MD	8/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	49856	30	Radiology	0	In state provider	None	1401 AVOCADO AVE	STE 100	NEWPORT BEACH	CA	92660	7710	30	06059	33.61235015	-117.8704573	Orange County
85062	Fee-for-Service	1023176302	1023176302	1	1	DOUGLAS, TRENT D MD	3/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62940	24	Plastic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
85106	Fee-for-Service	1427283894	1427283894	1	1	DECICCO, DEREK M	1/13/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15775 LAGUNA CANYON RD	SUITE 110	IRVINE	CA	92618	3192	30	06059	33.6663745	-117.760682	Orange County
85111	Fee-for-Service	1013642909	1013642909	1	1	DENG, JIN X NP	8/24/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85117	Fee-for-Service	1700957735	1700957735	1	1	DUBISZ, MARY P MD	8/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66755	08	Family Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
85139	Fee-for-Service	1700250164	1700250164	1	1	DESSEL, MICHAEL PT	10/15/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
85140	Fee-for-Service	1740357664	1740357664	1	1	DUH, GLENN Z MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	80319	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
85154	Fee-for-Service	1063457620	1063457620	1	2	DOCS MEDICAL GROUP INC	7/2/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	691 MARAGLIA	STE A	REDDING	CA	96002	1029	45	06089	40.56736163	-122.3589158	Shasta County
85209	Fee-for-Service	1174662191	1174662191	1	1	DUONG, TRUC-HA L MD	12/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122751	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
85229	Fee-for-Service	1366888679	1366888679	1	1	DESAI, HARSHITA PHD	7/21/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
85248	Fee-for-Service	1306165071	1306165071	1	1	DANG, CHRISTOPHER P DO	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16621	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
85249	Fee-for-Service	1245338052	1245338052	1	1	DAVID, ANNA M MD	1/14/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61522	66	Emergency Medicine (Urgent Care)	0	In state provider	None	502 EUCLID AVE	STE 200	NATIONAL CITY	CA	91950	2984	37	06073	32.68505421	-117.0832793	San Diego County
85250	Fee-for-Service	1316226665	1316226665	1	1	DY, RAJANY V MD	7/20/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	144033	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85260	Fee-for-Service	1588725832	1588725832	1	1	DESAI, PRATIBHA R MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31924	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	502 W HOLT AVE	None	POMONA	CA	91768	3604	19	06037	34.06219961	-117.7571033	Los Angeles County
85264	Fee-for-Service	1285763631	1285763631	1	1	DOI, CAROLYN A OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
85282	Fee-for-Service	1144315276	1144315276	1	1	DIABLO DIALYSIS ACCESS	8/8/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	CENTER	2222 EAST ST	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
85287	Fee-for-Service	1114918612	1114918612	1	1	DESERT MEDICAL GROUP INC	6/19/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
85317	Fee-for-Service	1275552390	1275552390	1	1	DO, EMILY H OD	10/2/1986	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	598 E SANTA CLARA ST	STE 260	SAN JOSE	CA	95112	2037	43	06085	37.34198566	-121.8782999	Santa Clara County
85321	Fee-for-Service	1780429852	1780429852	1	1	DEISINGER, KELSIE CRNA	1/7/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
85325	Fee-for-Service	1144497678	1144497678	1	1	DIGNITY HEALTH MEDICAL	2/6/2018	213E00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
85341	Fee-for-Service	1750301503	1750301503	1	1	DEVILLE, JAIME G MD	6/30/1992	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	50817	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
85343	Fee-for-Service	1700143674	1700143674	1	1	DEVOR, RENEE L MD	12/27/2022	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
85369	Fee-for-Service	1124486311	1124486311	1	1	DINH, THOMAS H PT	12/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2755 BRISTOL ST.	STE 130	COSTA MESA	CA	92626	5985	30	06059	33.67368064	-117.889108	Orange County
85410	Fee-for-Service	1114953643	1114953643	1	1	DARDASHTI, DAN E MD INC	4/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	61457	41	Internal Medicine	0	In state provider	None	12640 RIVERSIDE DR	STE 506	VALLEY VILLAGE	CA	91607	3342	19	06037	34.15758249	-118.408581	Los Angeles County
85417	Fee-for-Service	1922349182	1922349182	1	1	DELANEY, VIVIANE G MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113947	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
85454	Fee-for-Service	1104199058	1104199058	1	1	DOYLE, RUTH LMFT	1/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
85477	Fee-for-Service	1881631711	1881631711	1	4	DERMATOLOGY SPECIALISTS INC	6/29/1987	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
85480	Fee-for-Service	1316330970	1316330970	1	1	DOSANJH, SHARNJEET	9/23/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11026 VALLEY MALL	None	EL MONTE	CA	91731	2617	19	06037	34.07443752	-118.0342966	Los Angeles County
85514	Fee-for-Service	1437323854	1437323854	1	1	DRS COLLINS AND ISRAEL	12/5/2007	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	1046 W AVENUE K	None	LANCASTER	CA	93534	5918	19	06037	34.67482357	-118.1505547	Los Angeles County
85532	Fee-for-Service	1144610064	1144610064	1	1	DE LUNA, M REGINA MD	10/5/2022	390200000X	NA	Other	026	PHYSICIANS	179602	None	None	0	In state provider	None	200 JOSE FIGUERES AVE	350	SAN JOSE	CA	95116	1594	43	06085	37.36122014	-121.8505998	Santa Clara County
85539	Fee-for-Service	1245338052	1245338052	1	1	DAVID, ANNA M MD	1/14/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	61522	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	502 EUCLID AVE	STE 200	NATIONAL CITY	CA	91950	2984	37	06073	32.68505421	-117.0832793	San Diego County
85540	Fee-for-Service	1841380763	1841380763	1	1	DEL PUERTO HEALTH CARE	4/1/1984	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	875 E STREET	None	PATTERSON	CA	95363	2670	50	06099	37.46614646	-121.1354144	Stanislaus County
85547	Fee-for-Service	1750516472	1750516472	1	1	DAVID ORME	7/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
85560	Fee-for-Service	1558894675	1558894675	1	1	DARJI, KAVITA MD	7/12/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	187264	07	Dermatology	0	In state provider	None	1300 AVENIDA VISTA HERMO	150	SAN CLEMENTE	CA	92673	6315	30	06059	33.45766933	-117.5920941	Orange County
85574	Fee-for-Service	1114918612	1114918612	1	1	DESERT MEDICAL GROUP INC	10/19/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
85610	Fee-for-Service	1821023847	1821023847	1	1	DOLAN, JUDITH C CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
85613	Fee-for-Service	1144497678	1144497678	1	1	DIGNITY HEALTH MEDICAL	7/23/2009	213E00000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	FOUNDATION	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
85619	Fee-for-Service	1538781802	1538781802	1	1	DADON, KORAL R MD	2/6/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	192539	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
85670	Fee-for-Service	1013180215	1013180215	1	1	DAVID L GUZMAN D.P.M. PROFES	8/28/2024	174400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	LINIC	3379 BEARD RD	None	NAPA	CA	94558	3407	28	06055	38.32334976	-122.295933	Napa County
85691	Fee-for-Service	1649701459	1649701459	1	1	DAVIS, JOSHUA MD	7/13/2023	390200000X	NA	Other	026	PHYSICIANS	158923	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
85698	Fee-for-Service	1336256312	1336256312	1	1	DEBORAH L. CONWAY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
85764	Fee-for-Service	1881631711	1881631711	1	4	DERMATOLOGY SPECIALISTS INC	6/29/1987	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
85766	Fee-for-Service	1891993192	1891993192	1	1	DEANGELIS, LISA A MD	9/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171657	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
85811	Fee-for-Service	1437715414	1437715414	1	3	DOSKALCHUK PHYSICAL THERAPY	9/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	SUITE 110	CARMICHAEL	CA	95608	0590	34	06067	38.659392	-121.327155	Sacramento County
85825	Fee-for-Service	1710662366	1710662366	1	1	DEUTSCH, KATHERINE	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
85826	Fee-for-Service	1124084892	1124084892	1	1	DHARLINGUE, ARTHUR E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40543	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
85833	Fee-for-Service	1750586723	1750586723	1	2	DR. SATPAL S. MULTANI, A PRO	1/15/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	RY	473 E. CARNEGIE DRIVE	#100	SAN BERNARDINO	CA	92408	4207	36	06071	34.0683677	-117.2746246	San Bernardino County
85850	Fee-for-Service	1609800309	1609800309	1	1	DESERT MOUNTAIN CONSULTANTS	6/20/2016	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	IN ANESTHESIA PC	8970 E RAINTREE DR	SUITE 100	SCOTTSDALE	AZ	85260	7300	00	None	33.620913	-111.8882565	Maricopa County
85855	Fee-for-Service	1063623593	1063623593	1	1	DRUG ABUSE ALTERNATIVES	2/18/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2403 PROFESSIONAL DRIVE	SUITE 101	SANTA ROSA	CA	95403	3007	49	06097	38.463642	-122.7245175	Sonoma County
85889	Fee-for-Service	1407241524	1407241524	1	1	DRANNIKOV, EDUARD MD	1/29/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150694	None	None	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
85902	Fee-for-Service	1144497678	1144497678	1	1	DIGNITY HEALTH MEDICAL	7/23/2009	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
85920	Fee-for-Service	1376652909	1376652909	1	1	DIESFELD, ESTELA MD	12/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	50644	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
85929	Fee-for-Service	1225484686	1225484686	1	1	DEAKIN, CAITLIN MD	1/18/2022	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	167849	None	None	0	In state provider	None	7695 CARDINAL CT	STE 240	SAN DIEGO	CA	92123	3357	37	06073	32.79146985	-117.1578472	San Diego County
85964	Fee-for-Service	1730991563	1730991563	1	1	DANIELLE VACA LICENSED MARRI	1/28/2025	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AGE AND FAMILY THERAPIST	743 SHELL BLVD	APT 104	FOSTER CITY	CA	94404	2536	41	06081	37.55606352	-122.2666344	San Mateo County
85980	Fee-for-Service	1427613108	1427613108	1	1	DJM CARE LLC	11/2/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	253 S LINCOLN WAY	None	GALT	CA	95632	1711	34	06067	38.25360421	-121.300748	Sacramento County
86027	Fee-for-Service	1376613018	1376613018	1	1	DOMINGO, LORENA T	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
86034	Fee-for-Service	1689699118	1689699118	1	1	DOYLE, FRANCE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
86058	Fee-for-Service	1063589836	1063589836	1	1	DAYRIT, MELANIE S	10/1/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
86067	Fee-for-Service	1902879760	1902879760	1	1	DARIN LEE HAUG DO	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2305 S HIGHWAY 65	None	MARSHALL	MO	65340	3702	00	None	39.090222	-93.214935	Saline County
86080	Fee-for-Service	1891960084	1891960084	1	1	DRASIN, T ERIC MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102481	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
86102	Fee-for-Service	1235104159	1235104159	1	1	DVA HEALTHCARE RENAL	8/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1700 E CESAR E CHAVEZ AV	STE L100	LOS ANGELES	CA	90033	2472	19	06037	34.05101259	-118.217259	Los Angeles County
86109	Fee-for-Service	1285819268	1285819268	1	1	DAODU, IGBEKELE A MD	6/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
86121	Fee-for-Service	1104932540	1104932540	1	1	DUNCAN, BRADFORD W MD	2/22/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78018	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
86126	Fee-for-Service	1942326418	1942326418	1	1	DANIEL KASWAN	8/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20814 W DIXIE HWY	None	AVENTURA	FL	33180	1147	00	None	25.96766305	-80.14784645	Miami-Dade County
86148	Fee-for-Service	1851117923	1851117923	1	1	DENG, LYDIA PT	3/14/2025	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
86190	Fee-for-Service	1104407279	1104407279	1	1	DANTUMA, TAYLOR N DO	9/3/2024	390200000X	NA	Other	026	PHYSICIANS	20577	40	Pediatrics	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
86262	Fee-for-Service	1770545824	1770545824	1	1	DEBRUYNE, KORINA F MD	2/1/1996	207R00000X	NA	Other	026	PHYSICIANS	74833	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
86272	Fee-for-Service	1982611109	1982611109	1	1	DAVID I TARKOFF, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 HEALTHY WAY	None	OCEANSIDE	NY	11572	1551	00	None	40.651299	-73.63107	Nassau County
86281	Fee-for-Service	1144384918	1144384918	1	1	DOROUGH, DAVID W MD	12/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79206	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	722 MEDICAL CENTER DR E	STE 101	CLOVIS	CA	93611	6810	10	06019	36.84107334	-119.6587409	Fresno County
86346	Fee-for-Service	1851303770	1851303770	1	1	DARLENE METTER,F MD	6/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
86354	Fee-for-Service	1356493159	1356493159	1	1	D'SOUZA PETER A MD	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
86386	Fee-for-Service	1962468553	1962468553	1	1	DIAL, MARY E MD	2/8/2015	193400000X	NA	Other	026	PHYSICIANS	48638	08	Family Practice	0	In state provider	None	1306 MARICOPA HWY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
86396	Fee-for-Service	1235143801	1235143801	1	1	DAMAVANDI, MICHAEL E DO	1/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8697	41	Internal Medicine	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
86397	Fee-for-Service	1750785200	1750785200	1	1	DILES, WILLIAM S III	3/11/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
86510	Fee-for-Service	1992916506	1992916506	1	2	DAN I GIURGIU M D PROFESSION	9/17/2024	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	AL CORPORATION	4060 4TH AVE	SUITE 508	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
86549	Fee-for-Service	1568554640	1568554640	1	1	DE BACA, DANIEL A OD	5/5/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9400 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
86647	Fee-for-Service	1134163298	1134163298	1	1	DEMAY, MARY G MD	11/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62108	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86652	Fee-for-Service	1215998349	1215998349	1	1	DANESHBOD, AZAR MD AMC	3/3/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
86675	Fee-for-Service	1780901322	1780901322	1	1	DANHAKL, VICTORIA L MD	11/1/2018	207L00000X	NA	Other	026	PHYSICIANS	157524	05	Anesthesiology	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
86686	Fee-for-Service	1790760551	1790760551	1	1	DJAVAHERIAN, CAESAR R MD	6/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104178	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
86693	Fee-for-Service	1023458460	1023458460	1	1	DEMBITSKY, ALANA M MD	7/10/2019	207R00000X	NA	Other	026	PHYSICIANS	145099	41	Internal Medicine	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
86703	Fee-for-Service	1548318348	1548318348	1	1	DOBOS, DAVID M	8/31/1988	2084P0804X	NA	Psychiatry	026	PHYSICIANS	57276	26	Psychiatry (child)	0	In state provider	UCI MEDICAL GROUP M H	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
86717	Fee-for-Service	1093027542	1093027542	1	1	DODSWORTH, THOMAS E NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
86720	Fee-for-Service	1568693620	1568693620	1	1	DIOKNO, DENNIS B MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103968	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
86727	Fee-for-Service	1871695684	1871695684	1	1	DILLARD, TIFFANI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	602 W UNIVERSITY AVE	None	URBANA	IL	61801	2530	00	None	40.11648632	-88.21509105	Champaign County
86737	Fee-for-Service	1407905920	1407905920	1	1	DAVOUDI, JENNIFER R CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
86785	Fee-for-Service	1487982534	1487982534	1	1	DESERT SURGICAL ASSOCIATES-	3/1/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	1	Border provider	METZLER-PLLC	3196 S MARYLAND PKWAY	STE 101A	LAS VEGAS	NV	89109	2317	00	None	36.13194	-115.136873	Clark County
86793	Fee-for-Service	1770929648	1770929648	1	1	DALLARA, HEIDI L MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148717	66	Emergency Medicine (Urgent Care)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
86813	Fee-for-Service	1912466053	1912466053	1	2	DINA CASPARRO, DPM, INC	11/19/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	581 MCCRAY STREET	SUITE F	HOLLISTER	CA	95023	9502	35	06069	36.85042871	-121.3976694	San Benito County
86855	Fee-for-Service	1306454640	1306454640	1	1	DHILLON, AMANDEEP NP	6/10/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
86879	Fee-for-Service	1548716368	1548716368	1	1	DEWITT, MARY E LCSW	10/15/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	208 PROVIDENCE MINE RD	STE 112	NEVADA CITY	CA	95959	2955	29	06057	39.25021269	-121.0300958	Nevada County
86886	Fee-for-Service	1538994728	1538994728	1	1	DOS ARBOLES PSYCHOLOGICAL SE	11/14/2024	101YA0400X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	RVICES	674 COUNTY SQUARE DR	STE 106	VENTURA	CA	93003	0439	56	06111	34.26954195	-119.2148249	Ventura County
86889	Fee-for-Service	1144714619	1144714619	1	1	DAVILA, ESTHER DO	11/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19071	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
86900	Fee-for-Service	1205158003	1205158003	1	1	DILISIO, RALPH E MD FCCP INC	3/30/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	87397	41	Internal Medicine	0	In state provider	None	585 W COLLEGE AVE	SUITE A	SANTA ROSA	CA	95401	5000	49	06097	38.445903	-122.735601	Sonoma County
86958	Fee-for-Service	1972919926	1972919926	1	1	DOBSON, CHRISTOPHER R MD	5/20/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138370	08	Family Practice	0	In state provider	None	11938 PARAMOUNT BLVD.	None	DOWNEY	CA	90242	2306	19	06037	33.93385032	-118.1444253	Los Angeles County
86991	Fee-for-Service	1548318348	1548318348	1	1	DOBOS, DAVID M	8/31/1988	2084P0804X	NA	Psychiatry	026	PHYSICIANS	57276	36	Psychiatry	0	In state provider	UCI MEDICAL GROUP M H	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
87004	Fee-for-Service	1710911466	1710911466	1	1	DJALALI, ALIMORAD G MD	10/21/2008	207L00000X	NA	Other	026	PHYSICIANS	100076	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87065	Fee-for-Service	1427438928	1427438928	1	1	DAKROUB, MAHER O MD DO	1/12/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	19179	None	None	0	In state provider	None	1510 S CENTRAL AVE	SUITE 240	GLENDALE	CA	91204	2570	19	06037	34.12709764	-118.2577911	Los Angeles County
87084	Fee-for-Service	1841375508	1841375508	1	1	DUTTA, SANJOY K MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80978	02	General Surgery	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
87099	Fee-for-Service	1346901964	1346901964	1	1	DELONEY, ERIN M	4/3/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
87122	Fee-for-Service	1649226044	1649226044	1	1	DERBIGNY, MONICA A MD	1/11/1993	207P00000X	NA	Other	026	PHYSICIANS	75824	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
87126	Fee-for-Service	1164493508	1164493508	1	1	DAUER, ALAN D MD	11/2/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	8836	45	Nephrology (Renal-Kidney)	0	In state provider	None	10155 COLIMA RD	None	WHITTIER	CA	90603	2063	19	06037	33.94349601	-118.0106968	Los Angeles County
87176	Fee-for-Service	1538994728	1538994728	1	1	DOS ARBOLES PSYCHOLOGICAL SE	11/14/2024	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RVICES	674 COUNTY SQUARE DR	STE 106	VENTURA	CA	93003	0439	56	06111	34.26954195	-119.2148249	Ventura County
87203	Fee-for-Service	1902014731	1902014731	1	1	DONAGHY, KEVIN J MD	4/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
87210	Fee-for-Service	1356490346	1356490346	1	1	DEVELOPMENTAL CLIENT	7/11/1992	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INDUSTRIES INC	24487 DELPHINIUM AVE	None	MORENO VALLEY	CA	92553	3508	33	06065	33.90636357	-117.2352924	Riverside County
87252	Fee-for-Service	1902839962	1902839962	1	2	DUMOLIN SERVICE CORP	2/7/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6133 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1157	49	06097	38.53053021	-122.7827328	Sonoma County
87277	Fee-for-Service	1306105267	1306105267	1	1	DU, JIAZHONG LAC	3/3/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	237 ESTUDILLO AVE	202	SAN LEANDRO	CA	94577	4723	01	06001	37.72538644	-122.1544221	Alameda County
87284	Fee-for-Service	1053394536	1053394536	1	1	DIAMENT, MICHAEL J MD	6/30/1987	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	37303	30	Radiology	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
87332	Fee-for-Service	1659685733	1659685733	1	1	DAVEY, PINAKIN G OD	4/18/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND STREET	SUITE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
87335	Fee-for-Service	1609312271	1609312271	1	1	DAINES, SUSAN OT	9/20/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
87338	Fee-for-Service	1720592520	1720592520	1	1	DORAIRAJ, SUSAN CNP	7/29/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
87353	Fee-for-Service	1255592408	1255592408	1	1	DUGGIRALA, CHANDRA MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105925	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
87359	Fee-for-Service	1649560731	1649560731	1	1	DICKERSON, ELLIOT C MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143231	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87389	Fee-for-Service	1578767901	1578767901	1	1	DAWN SWANSON	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
87415	Fee-for-Service	1164493508	1164493508	1	1	DAUER, ALAN D MD	11/2/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	8836	41	Internal Medicine	0	In state provider	None	10155 COLIMA RD	None	WHITTIER	CA	90603	2063	19	06037	33.94349601	-118.0106968	Los Angeles County
87418	Fee-for-Service	1336887165	1336887165	1	1	DANDURAND-REYNOLDS, TYLER J	6/23/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	310 THIRD AVE	STE C11	CHULA VISTA	CA	91910	3965	37	06073	32.64079747	-117.0798668	San Diego County
87433	Fee-for-Service	1700934692	1700934692	1	1	DOUGAN, ANN M CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3951 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	3620	33	06065	33.92276786	-117.4483793	Riverside County
87506	Fee-for-Service	1376741157	1376741157	1	1	DYM, JEAN-PAUL MD	4/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109880	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
87513	Fee-for-Service	1194226043	1194226043	1	1	DIB, CHRISTIAN M MD	8/17/2023	207L00000X	NA	Other	026	PHYSICIANS	181818	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
87561	Fee-for-Service	1841631801	1841631801	1	1	DUFFY, JENNIFER M MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135488	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
87589	Fee-for-Service	1144497678	1144497678	1	6	DIGNITY HEALTH MEDICAL	9/12/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	57	06113	38.56097929	-121.7800614	Yolo County
87601	Fee-for-Service	1861491722	1861491722	1	1	DINH, TOMMY H V MD	10/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62294	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
87602	Fee-for-Service	1790988269	1790988269	1	1	DELBELLO, DAVID P MD	11/18/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	104274	None	None	0	In state provider	None	1245 WILSHIRE BLVD.	SUITE 307	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
87640	Fee-for-Service	1255592408	1255592408	1	1	DUGGIRALA, CHANDRA MD	2/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105925	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
87665	Fee-for-Service	1205891603	1205891603	1	1	DARDICK, LAWRENCE R MD	12/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	43780	78	Neoplastic Diseases/Oncology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
87689	Fee-for-Service	1760422356	1760422356	1	1	DOBBS, LELAND G MD	12/1/1987	207RC0200X	NA	Other	026	PHYSICIANS	30025	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	431 30TH ST	None	OAKLAND	CA	94609	3304	01	06001	37.81910206	-122.2653479	Alameda County
87737	Fee-for-Service	1487848461	1487848461	1	1	DE CRUZ, SHARON J MD	7/1/2009	207R00000X	NA	Other	026	PHYSICIANS	101209	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
87739	Fee-for-Service	1275686537	1275686537	1	1	DETWILER, WESLEY PHD	10/17/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	471 E TAHQUITZ CANYON WA	219	PALM SPRINGS	CA	92262	6620	33	06065	33.8230047	-116.543381	Riverside County
87756	Fee-for-Service	1225211022	1225211022	1	1	DRS BUI & LE	3/31/1992	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY PC	2722 ABORN RD	None	SAN JOSE	CA	95121	1204	43	06085	37.31364749	-121.7928998	Santa Clara County
87783	Fee-for-Service	1891743910	1891743910	1	1	DONALDSON, CHADWICK J MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	84567	04	Otology, Laryngology, Rhinology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
87812	Fee-for-Service	1811063985	1811063985	1	1	DUARTE UNIF SCHOOL DIST	7/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1620 HUNTINGTON DR	None	DUARTE	CA	91010	2534	19	06037	34.13958538	-117.9704802	Los Angeles County
87821	Fee-for-Service	1215981402	1215981402	1	2	DALDRUP-LINK, HEIKE E MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98042	None	None	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87824	Fee-for-Service	1366410615	1366410615	1	1	DALE HUGHES, LICENSED CLINIC	3/7/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AL SOCIAL WORKER, APC	25500 HAWTHORNE BLVD	STE 1152	TORRANCE	CA	90505	6834	19	06037	33.7949648	-118.3489484	Los Angeles County
87876	Fee-for-Service	1093702904	1093702904	1	1	DONIPARTHI, CHANDRASEKHAR MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
87877	Fee-for-Service	1891734398	1891734398	1	1	DAVIS, RYAN W MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75710	30	Radiology	0	In state provider	None	168 N BRENT ST	STE 402	VENTURA	CA	93003	2824	56	06111	34.27448266	-119.2572489	Ventura County
87927	Fee-for-Service	1023253101	1023253101	1	2	DAVID B BYBEE M D INC	2/24/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	4016 DALE RD	None	MODESTO	CA	95356	9268	50	06099	37.69723812	-121.049967	Stanislaus County
87931	Fee-for-Service	1508038787	1508038787	1	1	DR. SRIVIDYA BHANDARAM	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
87937	Fee-for-Service	1336173582	1336173582	1	1	DAVYDOV, ERIK E MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66006	41	Internal Medicine	0	In state provider	None	17909 SOLEDAD CANYON RD	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
87947	Fee-for-Service	1407363120	1407363120	1	1	DUGGIN, COLLEEN LCSW	3/13/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
87968	Fee-for-Service	1356304869	1356304869	1	1	DE SILVA, SURESH J MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	2735 SIVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
87977	Fee-for-Service	1760422356	1760422356	1	1	DOBBS, LELAND G MD	12/1/1987	207RC0200X	NA	Other	026	PHYSICIANS	30025	66	Emergency Medicine (Urgent Care)	0	In state provider	None	431 30TH ST	None	OAKLAND	CA	94609	3304	01	06001	37.81910206	-122.2653479	Alameda County
87996	Fee-for-Service	1700935509	1700935509	1	1	DUKE FACILITIES INC	4/1/2004	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2661 OTTO DR	None	STOCKTON	CA	95209	1111	39	06077	38.03771811	-121.3504964	San Joaquin County
87998	Fee-for-Service	1275638009	1275638009	1	1	DHALIWAL, SIMMI P MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63694	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	160 E ARTESIA ST	STE 330	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
88026	Fee-for-Service	1568689149	1568689149	1	3	DRENNING-MANRIQUEZ, ROGELIO	12/6/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	55833	None	None	0	In state provider	Z	6485 DAY STREET	201	RIVERSIDE	CA	92507	0929	33	06065	33.931809	-117.2789185	Riverside County
88027	Fee-for-Service	1457454423	1457454423	1	1	DEUTSCH, GAYLE K PHD	1/1/2002	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88038	Fee-for-Service	1891221008	1891221008	1	1	DANG, NONG MD	9/2/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169449	None	None	0	In state provider	None	2820 ALUM ROCK AVE.	SUITE 20	SAN JOSE	CA	95127	5608	43	06085	37.3631929	-121.8334108	Santa Clara County
88039	Fee-for-Service	1992703540	1992703540	1	1	DUKE UNIVERSITY HOSP	1/18/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	ERWIN & FULTON RD	None	DURHAM	NC	27710	0001	00	None	36.008172	-78.937281	Durham County
88050	Fee-for-Service	1598194268	1598194268	1	1	DELISLE, ROBERT LCSW	8/30/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
88057	Fee-for-Service	1700302247	1700302247	1	1	DEAN, MONIQUE D LCSW	1/30/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4193 FLAT ROCK DR.	STE 200	RIVERSIDE	CA	92505	7113	33	06065	33.90361212	-117.4930456	Riverside County
88066	Fee-for-Service	1699753046	1699753046	2	2	DRUCKER, MARK MD	2/2/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1855 SAN MIGUEL DR	#28	WALNUT CREEK	CA	94596	5214	07	06013	37.89490348	-122.0529351	Contra Costa County
88078	Fee-for-Service	1760469209	1760469209	1	1	DIGESTIVE AND LIVER DISEASE	7/1/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DISEASE SPECIALISTS	1771 W ROMNEYA DR	STE C	ANAHEIM	CA	92801	1817	30	06059	33.85067649	-117.9445635	Orange County
88100	Fee-for-Service	1811063985	1811063985	1	1	DUARTE UNIF SCHOOL DIST	11/1/2018	No Taxonomy Provided	NA	None	101	UNIFIED SCHOOL DISTRICT	-	-	NOT APPLICABLE	0	In state provider	None	1620 HUNTINGTON DR	None	DUARTE	CA	91010	2534	19	06037	34.13958538	-117.9704802	Los Angeles County
88121	Fee-for-Service	1154984391	1154984391	1	1	DARLIN, SPENCER D MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	176858	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
88148	Fee-for-Service	1649403866	1649403866	1	1	DENNIS LIEN-HSUN SU, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11714 NORTHCREEK PKWY	NORTH STE 100	BOTHELL	WA	98011	0000	00	None	47.76307251	-122.182548	King County
88217	Fee-for-Service	1609010065	1609010065	1	1	DEAN, JULIANNE S DO	8/7/2017	207PH0002X	NA	Other	026	PHYSICIANS	15721	None	None	0	In state provider	None	3291 LOMA LINDA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
88240	Fee-for-Service	1265970875	1265970875	1	1	DIAZ, VERONICA LMFT	10/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	310 NORTH IRWIN ST	22	HANFORD	CA	93230	4479	16	06031	36.32789942	-119.6476719	Kings County
88272	Fee-for-Service	1639106594	1639106594	1	1	DAVID LITTLETON ROLLINS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	36060 EUCLID AVE	STE 107	WILLOUGHBY	OH	44094	4661	00	None	41.62639676	-81.4328334	Lake County
88277	Fee-for-Service	1841877446	1841877446	1	1	DEDECKER, LAUREN MD	10/2/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1919 SANTA MONICA BLVD	STE 210	SANTA MONICA	CA	90604	1970	19	06037	34.0284492	-118.4803274	Los Angeles County
88292	Fee-for-Service	1134500804	1134500804	1	1	DIEC, HUONG P LMFT	12/6/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125017	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVE	SUITE 150	SAN JOSE	CA	95119	1371	43	06085	37.23598537	-121.7783065	Santa Clara County
88298	Fee-for-Service	1841464658	1841464658	1	1	DR SAUL MENDELSOHN	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2333 W WHITENDALE AVE	None	VISALIA	CA	93277	8701	54	06107	36.305514	-119.316546	Tulare County
88327	Fee-for-Service	1992703540	1992703540	1	1	DUKE UNIVERSITY HOSP	1/18/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	ERWIN & FULTON RD	None	DURHAM	NC	27710	0001	00	None	36.008172	-78.937281	Durham County
88328	Fee-for-Service	1730100504	1730100504	1	1	DYSICO, ANTHONY S NP	4/16/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
88342	Fee-for-Service	1962552307	1962552307	1	1	DAFFRON, JASON W	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
88396	Fee-for-Service	1023076049	1023076049	1	1	DAVID M SCHMIDT M.D.	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7601 PIONEERS BLVD	None	LINCOLN	NE	68506	4675	00	None	40.76963969	-96.61649495	Lancaster County
88418	Fee-for-Service	1255370797	1255370797	1	1	DIMASSA, GIANCARLO P MD	6/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81063	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
88420	Fee-for-Service	1023002821	1023002821	1	1	DR. CHERYL H PUTNAM M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL	None	TUCSON	AZ	85719	0000	00	None	32.26833	-110.94327	Pima County
88421	Fee-for-Service	1356377071	1356377071	1	1	DIGHE, PRASAD R MD	5/11/1992	174400000X	NA	Other	026	PHYSICIANS	36810	68	Hematology	0	In state provider	None	2626 N CALIFORNIA ST	None	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
88458	Fee-for-Service	1225182322	1225182322	1	1	DAS, MILLIE S MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92503	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88499	Fee-for-Service	1730852815	1730852815	1	1	DR. CELENA HORTON, LICENSED	11/15/2021	261QM0801X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CLINICAL SOCIAL WORKER,	11799 SEBASTIAN WAY	103	RANCHO CUCAMONGA	CA	91730	0708	36	06071	34.10415255	-117.5480055	San Bernardino County
88504	Fee-for-Service	1124046560	1124046560	1	1	DUNN, JAMES S JR MD INC	6/1/2006	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	84568	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11795 EDUCATION STREET	STE 222	AUBURN	CA	95602	2469	31	06061	38.94433757	-121.098912	Placer County
88514	Fee-for-Service	1689677544	1689677544	1	1	DOUGLAS I CIFUENTES D.O.	1/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	950 W WOOSTER ST	None	BOWLING GREEN	OH	43402	2603	00	None	41.37398774	-83.66530527	Wood County
88534	Fee-for-Service	1487207676	1487207676	1	1	DOTTER, KYRA LMSW	3/20/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	34455 YUCAIPA BLVD	206	YUCAIPA	CA	92399	0000	36	06071	34.0338117	-117.0525613	San Bernardino County
88543	Fee-for-Service	1740262229	1740262229	1	1	DEL VALLE, JUAN J JR MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81970	08	Family Practice	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
88558	Fee-for-Service	1225292873	1225292873	1	1	DESAI, OJAS J MD	10/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152581	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91346	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
88595	Fee-for-Service	1336523372	1336523372	1	1	DAKIWAG, ELISA S LMFT	9/25/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	103978	-	NOT APPLICABLE	0	In state provider	None	707/ 717 FAIR AVE	None	SANTA CRUZ	CA	95060	5840	44	06087	36.95653167	-122.0453296	Santa Cruz County
88616	Fee-for-Service	1982929923	1982929923	1	1	DERPARSEGHIAN, GARO MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143579	05	Anesthesiology	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
88622	Fee-for-Service	1831775618	1831775618	1	1	DOE-WILLIAMS, SARAH M	3/26/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	181677	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88683	Fee-for-Service	1760479992	1760479992	1	1	DUKE, ALEXANDRA D MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	5708	08	Family Practice	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
88698	Fee-for-Service	1245805985	1245805985	1	1	DER SARKISSIAN, ALISSA PHD	6/21/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4153 24TH STREET	4	SAN FRANCISCO	CA	94114	3614	38	06075	37.75120501	-122.4352246	San Francisco County
88702	Fee-for-Service	1780659201	1780659201	1	1	DAVIS, CHRISTINE MD	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
88748	Fee-for-Service	1013963040	1013963040	1	1	DIPERNA, DANIELLE A MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70765	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1245 WILSHIRE BLVD	STE 801	LOS ANGELES	CA	90017	4808	19	06037	34.05362775	-118.2661889	Los Angeles County
88764	Fee-for-Service	1669831830	1669831830	1	1	DEL RIO, MARITZA M LCSW	8/23/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23180 HEMLOCK AVE	SUITE 100	MORENO VALLEY	CA	92557	8001	33	06065	33.94245952	-117.2585565	Riverside County
88772	Fee-for-Service	1174531859	1174531859	1	1	DIGNITY HEALTH MEDICAL FOUND	1/9/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FOUNDATION	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	41	06081	37.5239043	-122.2667778	San Mateo County
88794	Fee-for-Service	1942332515	1942332515	1	1	DISTEFANO, LUIGI T MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101791	None	None	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
88833	Fee-for-Service	1619171980	1619171980	1	1	DOUGLAS, CLIFFORD C MD INC	1/8/2016	193400000X	NA	Other	026	PHYSICIANS	70288	14	Neurological Surgery	0	In state provider	None	4500 BROCKTON AVE	SUITE 201	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
88837	Fee-for-Service	1023773496	1023773496	1	1	DANCY PERINATAL INC	8/20/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1648 DRUMMOND LN	None	LINCOLN	CA	95648	2935	31	06061	38.87900946	-121.312215	Placer County
88846	Fee-for-Service	1194799650	1194799650	1	1	DOUGLAS, GREGORY MD	9/30/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39164	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1995 ZINFANDEL DR	STE 203	RANCHO CORDOVA	CA	95670	2862	34	06067	38.612124	-121.27131	Sacramento County
88858	Fee-for-Service	1245318344	1245318344	1	1	DOANE, REBECCA J MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80975	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
88867	Fee-for-Service	1669636932	1669636932	1	1	DUBBERKE & DUBBERKE INVS	3/25/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5034 COAKLEY CIR	STE 200	MARIPOSA	CA	95338	8519	22	06043	37.48872243	-119.9715788	Mariposa County
88874	Fee-for-Service	1447565908	1447565908	1	1	DARDASHTI, IRAJ MD INC	2/25/2011	193400000X	NA	Other	026	PHYSICIANS	33371	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2080 CENTURY PARK EAST	STE 1010	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
88878	Fee-for-Service	1912085598	1912085598	1	1	DOAN, DANETTE H MD	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69047	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	DOAN & DOAN MD INC	10301 BOLSA AVE	STE 107	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
88894	Fee-for-Service	1356961742	1356961742	1	1	DEVRIES, JENNIFER MD	9/19/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182741	None	None	0	In state provider	None	30 MARK WEST SPRINGS RD	None	SANTA ROSA	CA	95403	1436	49	06097	38.4962723	-122.752117	Sonoma County
88899	Fee-for-Service	1629464532	1629464532	1	1	DORSEY, STEPHANIE LCSW	12/29/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 MAIN ST	UNIT 37	SAN ANDREAS	CA	95249	9332	05	06009	38.19776874	-120.680329	Calaveras County
88909	Fee-for-Service	1770662801	1770662801	1	1	DANI, JOHN W MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67800	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
88920	Fee-for-Service	1861163875	1861163875	1	1	DIAZ, LORENA LMFT	11/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
88939	Fee-for-Service	1083842165	1083842165	1	1	DAVIS, MICHAEL MD	4/14/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
88943	Fee-for-Service	1184965725	1184965725	1	1	DRAKE, MARK J DPM	3/24/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1650 LEAD HILL BLVD	STE 100	ROSEVILLE	CA	95661	3072	31	06061	38.74878178	-121.245499	Placer County
88961	Fee-for-Service	1427222934	1427222934	1	2	DIAZ, DEBORAH K MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	139009	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
88994	Fee-for-Service	1659394013	1659394013	1	1	DUBOVSKY, ELIZABETH C MD	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	89058	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
89029	Fee-for-Service	1871556431	1871556431	1	1	DOMINGO, JENNIFER D MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64430	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
89058	Fee-for-Service	1205661873	1205661873	1	1	DXM ACUPUNCTURE INC.	12/3/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	17671 IRVINE BLVD	STE 116	TUSTIN	CA	92780	3128	30	06059	33.74842552	-117.824076	Orange County
89063	Fee-for-Service	1174531859	1174531859	1	1	DIGNITY HEALTH MEDICAL FOUND	1/9/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	1301 SHOREWAY RD	STE 100	BELMONT	CA	94002	4110	41	06081	37.5239043	-122.2667778	San Mateo County
89065	Fee-for-Service	1134658065	1134658065	1	2	DR AZADEH GOLSHANI PSYCHOLOG	9/30/2024	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IST PC	3415 S SEPULVEDA BLVD	STE 1100	LOS ANGELES	CA	90034	7090	19	06037	34.02086527	-118.4235306	Los Angeles County
89096	Fee-for-Service	1205170206	1205170206	1	1	DYER, BERMESOLA M CNP	6/28/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	576 E EL CAMINO REAL	None	SUNNYVALE	CA	94087	1940	43	06085	37.36249974	-122.0260401	Santa Clara County
89107	Fee-for-Service	1730100330	1730100330	1	1	DE SILVA, UDAYA S MD	5/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	48836	05	Anesthesiology	0	In state provider	None	44725 10TH ST WEST	None	LANCASTER	CA	93536	5372	19	06037	34.695693	-118.1480965	Los Angeles County
89123	Fee-for-Service	1023773496	1023773496	1	1	DANCY PERINATAL INC	6/15/2022	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1648 DRUMMOND LN	None	LINCOLN	CA	95648	2935	31	06061	38.87900946	-121.312215	Placer County
89125	Fee-for-Service	1386053031	1386053031	1	1	DINH, NGOC N DO	10/5/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18189	40	Pediatrics	0	In state provider	None	9400 N NAME UNO	None	GILROY	CA	95020	3528	43	06085	37.03498475	-121.5729235	Santa Clara County
89139	Fee-for-Service	1780880815	1780880815	1	1	DANN, RAYMOND MD INC	6/2/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	160 N DATE ST	None	ESCONDIDO	CA	92025	3406	37	06073	33.12654803	-117.0702221	San Diego County
89163	Fee-for-Service	1447565908	1447565908	1	1	DARDASHTI, IRAJ MD INC	2/25/2011	193400000X	NA	Other	026	PHYSICIANS	33371	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK EAST	STE 1010	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
89182	Fee-for-Service	1205395209	1205395209	1	1	DRUMA, RAZVAN MD	3/8/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179112	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
89194	Fee-for-Service	1669458477	1669458477	1	1	DUBLIN, ARTHUR B MD	9/16/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	23391	01	General Practice	0	In state provider	UCD PROF SVCS GROUP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
89227	Fee-for-Service	1720250103	1720250103	1	1	DANDILLAYA, RAM C MD INC	7/21/2009	193400000X	NA	Other	026	PHYSICIANS	77410	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8631 W THIRD ST	STE 1140E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
89246	Fee-for-Service	1265808802	1265808802	1	1	DINER, STACI D LMFT	5/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
89248	Fee-for-Service	1316956378	1316956378	1	1	DE NARDI, SOFIE A MD	8/5/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	92880	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
89280	Fee-for-Service	1407053556	1407053556	1	1	DIAZ, KRISTINA M MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
89284	Fee-for-Service	1982821948	1982821948	1	1	DENG, YAO RONG CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	JERRYS ACUPUNCTURE	1620 35TH AVE	STE C	SACRAMENTO	CA	95822	3475	34	06067	38.520315	-121.499604	Sacramento County
89285	Fee-for-Service	1932111424	1932111424	1	1	DHARMARAJA, PRITHVIRAJ	6/5/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	43516	41	Internal Medicine	0	In state provider	MD	1331 W AVENUE J	STE 102	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
89317	Fee-for-Service	1700281037	1700281037	1	1	DA HEALTH CARE SERVICES	7/14/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1811 OAK STREET	SUITE 160B	BAKERSFIELD	CA	93301	3062	15	06029	35.37534422	-119.0386865	Kern County
89341	Fee-for-Service	1417155789	1417155789	1	1	DIONNE, VALERIE A LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
89355	Fee-for-Service	1316139280	1316139280	1	1	DON, SHERMAN MD	10/17/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	13732	04	Otology, Laryngology, Rhinology	0	In state provider	None	17732 BEACH BLVD	SUITE C	HUNTINGTON BEACH	CA	92647	6881	30	06059	33.705054	-117.9890625	Orange County
89387	Fee-for-Service	1679912398	1679912398	1	1	DARYL MUMFORD	3/23/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6723 N SIERRA VISTA AVE	None	FRESNO	CA	93710	9497	10	06019	36.83439711	-119.7401652	Fresno County
89406	Fee-for-Service	1407833320	1407833320	1	1	DANIELS, CURT J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	555 S 18TH ST	None	COLUMBUS	OH	43205	2654	00	None	39.95323846	-82.9765048	Franklin County
89411	Fee-for-Service	1205344116	1205344116	1	1	DVORAK, JENNIFER A NP	8/15/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
89440	Fee-for-Service	1881077642	1881077642	1	1	DANG, REBECCA MD	7/25/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	146540	40	Pediatrics	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
89483	Fee-for-Service	1669458477	1669458477	1	1	DUBLIN, ARTHUR B MD	9/16/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	23391	30	Radiology	0	In state provider	UCD PROF SVCS GROUP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
89500	Fee-for-Service	1053163816	1053163816	1	1	DR TIFFANY M KING, PC	7/12/2024	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	336 DIABLO RD	None	DANVILLE	CA	94526	3417	07	06013	37.82304469	-121.9969687	Contra Costa County
89532	Fee-for-Service	1316956378	1316956378	1	1	DE NARDI, SOFIE A MD	8/5/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	92880	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
89572	Fee-for-Service	1932111424	1932111424	1	1	DHARMARAJA, PRITHVIRAJ	6/5/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	43516	10	Gastroenterology (M.D. only)	0	In state provider	MD	1331 W AVENUE J	STE 102	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
89577	Fee-for-Service	1114927589	1114927589	1	1	DALEY, JAMES JEFFERY MD	8/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88949	08	Family Practice	0	In state provider	None	150 VERA AVE	None	RIPON	CA	95366	2343	39	06077	37.7389707	-121.133029	San Joaquin County
89584	Fee-for-Service	1457449159	1457449159	1	1	DOMINGUEZ, NORMA DO	6/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8016	None	None	0	In state provider	None	26520 CACTUS AVE	RM F2027	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
89627	Fee-for-Service	1003801556	1003801556	1	1	DOMINGUEZ, JOSEPH J MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	68741	05	Anesthesiology	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3587	48	06095	38.26109552	-122.0470245	Solano County
89634	Fee-for-Service	1396278669	1396278669	1	1	DAVIS, JENNIFER MD	10/1/2021	207L00000X	NA	Other	026	PHYSICIANS	173757	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
89639	Fee-for-Service	1275533465	1275533465	1	1	DALHOUMI, HABIB MD	10/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82095	08	Family Practice	0	In state provider	None	12550 HESPERIA RD	None	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
89669	Fee-for-Service	1972621803	1972621803	2	1	DIGNITY COMMUNITY CARE	2/1/2019	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	20 NORTH COTTONWOOD ST	None	WOODLAND	CA	95695	2585	57	06113	38.686311	-121.7936125	Yolo County
89678	Fee-for-Service	1255959540	1255959540	1	1	DELA CRUZ, TERESA S RCP	7/25/2020	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
89681	Fee-for-Service	1174531859	1174531859	1	12	DIGNITY HEALTH MEDICAL FOUND	4/1/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-SEQUOIA INC.	2900 WHIPPLE	STE 132	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
89700	Fee-for-Service	1720282817	1720282817	1	1	DESAI, NILESH K MD	11/1/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
89737	Fee-for-Service	1962418137	1962418137	1	1	DUNN, JAMES CHUNG YU MD	11/18/1993	2086S0120X	NA	General Surgery	026	PHYSICIANS	77963	02	General Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
89768	Fee-for-Service	1164427282	1164427282	1	1	DAVIDSON, SANDRA M OD	3/10/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	SUITE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
89775	Fee-for-Service	1407286743	1407286743	1	1	DEVENDRA, GRASHIKA S NP	5/29/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
89801	Fee-for-Service	1417917733	1417917733	1	1	DONALDSON, MELVIN S MD	7/11/2001	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	12220	01	General Practice	0	In state provider	None	461 34TH ST	None	OAKLAND	CA	94609	2815	01	06001	37.82196319	-122.2637023	Alameda County
89831	Fee-for-Service	1154738599	1154738599	1	1	DIAZ LEDEZMA, CLAUDIO	7/16/2024	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
89907	Fee-for-Service	1104246339	1104246339	1	1	DELONG, MICHAEL R MD	3/8/2021	208200000X	NA	General Surgery	026	PHYSICIANS	142610	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
89920	Fee-for-Service	1699834168	1699834168	1	1	DAVIDSON, IDENA C CRNA	9/17/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
89951	Fee-for-Service	1649739418	1649739418	1	1	DENAULT, DYLAN M DO	6/26/2024	390200000X	NA	Other	026	PHYSICIANS	22762	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
89968	Fee-for-Service	1174531859	1174531859	1	12	DIGNITY HEALTH MEDICAL FOUND	4/1/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	-SEQUOIA INC.	2900 WHIPPLE	STE 132	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
89979	Fee-for-Service	1144325663	1144325663	1	1	DENNERT, JAMES MD	1/10/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	184330	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
89995	Fee-for-Service	1477637445	1477637445	1	1	DIBBERN, KURT M MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81540	30	Radiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
90019	Fee-for-Service	1023642741	1023642741	1	1	DESIRE HOSPICE CARE INC	2/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 216	BURBANK	CA	91502	1850	19	06037	34.18064474	-118.3089507	Los Angeles County
90087	Fee-for-Service	1467560599	1467560599	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
90122	Fee-for-Service	1992860506	1992860506	1	1	DALY, BRIAN W MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
90124	Fee-for-Service	1154809010	1154809010	1	1	DAVIS, NATALIE NP	1/29/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90147	Fee-for-Service	1144295163	1144295163	1	1	DVA RENAL HEALTHCARE INC	1/1/2004	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SANTA MONICA DIALYSIS	1260 15TH ST	STE 102	SANTA MONICA	CA	90404	1136	19	06037	34.02648965	-118.4867439	Los Angeles County
90190	Fee-for-Service	1053451625	1053451625	1	1	DAHNKE, DAVID G MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	80673	41	Internal Medicine	0	In state provider	None	2580 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14842672	-122.2180085	Tehama County
90202	Fee-for-Service	1285957936	1285957936	1	1	DOCTORVALADAN, SAHAR V MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	148473	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DR	SUITE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
90245	Fee-for-Service	1912341371	1912341371	1	1	DOSHI, VIDHI H MD	10/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132199	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90252	Fee-for-Service	1598836561	1598836561	1	1	DINH, TIEN N MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75357	40	Pediatrics	0	In state provider	None	12712 HEACOCK ST	STE 3	MORENO VALLEY	CA	92553	3037	33	06065	33.936165	-117.2437645	Riverside County
90254	Fee-for-Service	1053991281	1053991281	1	1	DAAS, ESHAAN	12/20/2024	390200000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
90289	Fee-for-Service	1831329770	1831329770	1	1	DIAZ, ALEJANDRO L MD	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113747	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
90310	Fee-for-Service	1023642741	1023642741	1	1	DESIRE HOSPICE CARE INC	2/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 216	BURBANK	CA	91502	1850	19	06037	34.18064474	-118.3089507	Los Angeles County
90331	Fee-for-Service	1629572862	1629572862	1	1	DANG, ELIZABETH OD	8/9/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
90361	Fee-for-Service	1851890453	1851890453	1	1	DESAI, TUSHAR K MD	7/24/2024	207R00000X	NA	Other	026	PHYSICIANS	31524	41	Internal Medicine	0	In state provider	None	1180 BEVERLY DR	SUITE 700	LOS ANGELES	CA	90035	1153	19	06037	34.05550055	-118.395555	Los Angeles County
90375	Fee-for-Service	1467560599	1467560599	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
90402	Fee-for-Service	1902839962	1902839962	1	9	DUMOLIN SERVICE CORP	2/26/1992	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2793 VICTORIA DR	None	SANTA ROSA	CA	95407	7877	49	06097	38.409291	-122.7222	Sonoma County
90410	Fee-for-Service	1992860506	1992860506	1	1	DALY, BRIAN W MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66802	24	Plastic Surgery	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
90414	Fee-for-Service	1558506667	1558506667	1	1	DANIEL ROCKWELL TOM	1/10/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	610 N MICHIGAN ST	STE 400	SOUTH BEND	IN	46601	1081	00	None	41.68365158	-86.25043249	St. Joseph County
90442	Fee-for-Service	1124041959	1124041959	1	1	DOUGLAS, RAYMOND S MD	1/4/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77544	18	Ophthalmology	0	In state provider	None	8700 BERVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
90452	Fee-for-Service	1851019640	1851019640	1	1	DYCE, TAMEKA NP	3/26/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
90501	Fee-for-Service	1457532731	1457532731	1	1	DEBRUIN, MONIQUE A MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101336	78	Neoplastic Diseases/Oncology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
90510	Fee-for-Service	1962126722	1962126722	1	1	DAVENPORT ALONSO, EMILY L NP	3/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
90524	Fee-for-Service	1639153661	1639153661	1	1	DERESINSKI, STANLEY C MD	2/8/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	22154	77	Infectious Disease	0	In state provider	None	2900 WHIPPLE AVE	STE 115	REDWOOD CITY	CA	94062	2858	41	06081	37.4783072	-122.2551089	San Mateo County
90549	Fee-for-Service	1861425571	1861425571	1	1	DARREN HOLLENBAUGH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SPOKANE CARDIOLOGY	910 W 5TH AVE SUITE 300	None	SPOKANE	WA	99204	0000	00	None	47.651544	-117.4252185	Spokane County
90592	Fee-for-Service	1982065611	1982065611	1	1	DYSON, SARA J PHD	4/5/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
90638	Fee-for-Service	1609832633	1609832633	1	1	DATNOW, BRIAN MD	9/20/2007	207ZP0101X	NA	Other	026	PHYSICIANS	31095	22	Pathology (M.D. only)	0	In state provider	None	120 ELM ST	None	SAN DIEGO	CA	92101	2602	37	06073	32.72409646	-117.163485	San Diego County
90646	Fee-for-Service	1801187091	1801187091	1	1	DHOON, TAIZOON Q MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126228	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
90760	Fee-for-Service	1063682722	1063682722	1	1	DAYAL, ANURADHA MD	8/15/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161649	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
90789	Fee-for-Service	1457532731	1457532731	1	1	DEBRUIN, MONIQUE A MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101336	68	Hematology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
90811	Fee-for-Service	1639153661	1639153661	1	1	DERESINSKI, STANLEY C MD	2/8/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	22154	41	Internal Medicine	0	In state provider	None	2900 WHIPPLE AVE	STE 115	REDWOOD CITY	CA	94062	2858	41	06081	37.4783072	-122.2551089	San Mateo County
90832	Fee-for-Service	1578702924	1578702924	1	1	DADABHAI, ALIA S MD	3/30/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	92751	10	Gastroenterology (M.D. only)	0	In state provider	None	520 SUPERIOR AVE	STE 295	NEWPORT BEACH	CA	92663	3667	30	06059	33.628914	-117.9276525	Orange County
90874	Fee-for-Service	1104106442	1104106442	1	1	DELL, SHEILA K	1/12/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1224 E WARDLOW RD	None	LONG BEACH	CA	90807	4833	19	06037	33.8189015	-118.1756925	Los Angeles County
90877	Fee-for-Service	1033182951	1033182951	1	1	DAO, MICHAEL J MD	3/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	87942	08	Family Practice	0	In state provider	MEDICAL OFFICE INC	3701 W MCFADDEN AVE	STE E	SANTA ANA	CA	92704	1385	30	06059	33.73837051	-117.9189585	Orange County
90891	Fee-for-Service	1114435492	1114435492	1	1	DX SOLUTIONS LLC	4/27/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	110 DEWEY DR	STE A	NICHOLASVILLE	KY	40356	7124	00	None	37.93508392	-84.56016776	Jessamine County
90929	Fee-for-Service	1609832633	1609832633	1	1	DATNOW, BRIAN MD	9/20/2007	207ZP0101X	NA	Other	026	PHYSICIANS	31095	90	Pathology-Forensic	0	In state provider	None	120 ELM ST	None	SAN DIEGO	CA	92101	2602	37	06073	32.72409646	-117.163485	San Diego County
90942	Fee-for-Service	1760434625	1760434625	1	1	DUERINCKX, ANDRE J MD	7/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61799	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
90967	Fee-for-Service	1639990492	1639990492	1	1	DALIA DAWOUD MD INC	5/8/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	TA MARGARITA	30465 AVENIDA DE LAS FLO	STE A	RANCHO SANTA MARG	CA	92688	3937	30	06059	33.64194015	-117.5993205	Orange County
90979	Fee-for-Service	1891089363	1891089363	1	1	DOSHI, NIDHIBEN P MD	7/21/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	142541	40	Pediatrics	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
90991	Fee-for-Service	1780642280	1780642280	1	1	DUMMER, KIRSTEN B MD	8/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156520	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
91013	Fee-for-Service	1568720886	1568720886	1	1	DOUGHERTY, ADAM P MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142064	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
91050	Fee-for-Service	1285867820	1285867820	1	1	DEVARAJ, JOSEPHINE M DO	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11555	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
91055	Fee-for-Service	1982871844	1982871844	1	1	DURRETT, CRYSTAL	12/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	427 F ST	SUITE 223	EUREKA	CA	95501	1041	12	06023	40.80253539	-124.1660942	Humboldt County
91072	Fee-for-Service	1477782225	1477782225	1	2	DOUDEN, SHERRY LMFT	4/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	720 SUNRISE AVE	200C	ROSEVILLE	CA	95661	4516	31	06061	38.735307	-121.272048	Placer County
91108	Fee-for-Service	1891821112	1891821112	1	1	DOTY, SHANNON C LMFT	4/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44926	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
91116	Fee-for-Service	1588660435	1588660435	1	1	DONAHUE, JOHN P MD	7/30/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	168972	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
91123	Fee-for-Service	1578702924	1578702924	1	1	DADABHAI, ALIA S MD	3/30/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	92751	41	Internal Medicine	0	In state provider	None	520 SUPERIOR AVE	STE 295	NEWPORT BEACH	CA	92663	3667	30	06059	33.628914	-117.9276525	Orange County
91131	Fee-for-Service	1851987184	1851987184	1	1	DP CA RAL OPCO LLC	3/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3105 W ORANGE AVE	None	ANAHEIM	CA	92804	3153	30	06059	33.8247235	-117.9983205	Orange County
91132	Fee-for-Service	1538600317	1538600317	1	1	DABAGH, SARAH MD	11/12/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146945	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
91148	Fee-for-Service	1861410581	1861410581	1	6	DIGNITY HEALTH MEDICAL	4/28/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	39	06077	37.96910043	-121.284224	San Joaquin County
91175	Fee-for-Service	1497391858	1497391858	1	1	DEVOTED HOSPICE CARE INC	9/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	502 W ROUTE 66	STE 19	GLENDORA	CA	91740	4343	19	06037	34.12866451	-117.871146	Los Angeles County
91211	Fee-for-Service	1700843240	1700843240	1	1	DUBIN, MARK D MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	67625	30	Radiology	0	In state provider	None	10445 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7323	19	06037	34.259094	-118.5023365	Los Angeles County
91245	Fee-for-Service	1699797993	1699797993	1	1	DEMARTINIS, DOUGLAS S MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	45266	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
91258	Fee-for-Service	1639990492	1639990492	1	1	DALIA DAWOUD MD INC	5/8/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	TA MARGARITA	30465 AVENIDA DE LAS FLO	STE A	RANCHO SANTA MARG	CA	92688	3937	30	06059	33.64194015	-117.5993205	Orange County
91339	Fee-for-Service	1952870727	1952870727	1	1	DE LA ROSA, JOLANTA A RCP	11/18/2022	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
91350	Fee-for-Service	1457130924	1457130924	1	1	DR JOHN ATTENELLO MD APC	2/12/2024	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1201 E BIXBY RD	None	LONG BEACH	CA	90807	4221	19	06037	33.82673052	-118.1760072	Los Angeles County
91360	Fee-for-Service	1275680738	1275680738	1	1	DAVIS, TRACIE L MD	11/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89865	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
91366	Fee-for-Service	1194552869	1194552869	1	1	DOBYNS, SAVANA NP	10/24/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
91399	Fee-for-Service	1578630620	1578630620	1	1	DU, THUY-TRANG T MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62880	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
91431	Fee-for-Service	1518429844	1518429844	1	1	DESAI, PAYAL P MD	7/11/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178437	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
91460	Fee-for-Service	1255604302	1255604302	1	1	DAVIS, WENDY J LMFT	12/28/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27201 TOURNEY RD.	225	VALENCIA	CA	91355	1804	19	06037	34.41741018	-118.5770409	Los Angeles County
91462	Fee-for-Service	1497391858	1497391858	1	1	DEVOTED HOSPICE CARE INC	9/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	502 W ROUTE 66	STE 19	GLENDORA	CA	91740	4343	19	06037	34.12866451	-117.871146	Los Angeles County
91530	Fee-for-Service	1639539174	1639539174	1	1	DESTINY INTERNAL MEDICINE AN	2/9/2021	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	D POST ACUTE CARE SERVIC	1550 S POTOMAC ST	SUITE 110	AURORA	CO	80012	5414	00	None	39.689235	-104.830335	Arapahoe County
91541	Fee-for-Service	1639990492	1639990492	1	1	DALIA DAWOUD MD INC	2/6/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	TA MARGARITA	30465 AVENIDA DE LAS FLO	STE A	RANCHO SANTA MARG	CA	92688	3937	30	06059	33.64194015	-117.5993205	Orange County
91586	Fee-for-Service	1467554337	1467554337	1	1	DEBOISBLANC, MICHAEL W	8/1/2008	174400000X	NA	Other	026	PHYSICIANS	71377	02	General Surgery	0	In state provider	MD	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
91598	Fee-for-Service	1790005080	1790005080	1	1	DURSUN, DANNY A MD	6/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126074	41	Internal Medicine	0	In state provider	None	11600 INDIAN HILL RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
91605	Fee-for-Service	1255009940	1255009940	1	1	DEPENDABLE CARE HOME HEALTH	1/24/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	5816 LANKERSHIM BLVD	SUITE A	NORTH HOLLYWOOD	CA	91601	1631	19	06037	34.17619407	-118.381432	Los Angeles County
91618	Fee-for-Service	1639123383	1639123383	1	1	DUNN, JEFFREY E MD	2/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88167	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
91637	Fee-for-Service	1548272768	1548272768	1	1	D'AVILA, JAVIER MD	12/31/1986	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	40075	77	Infectious Disease	0	In state provider	None	11160 WARNER AVE	STE 323	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
91648	Fee-for-Service	1871185124	1871185124	1	1	DIZON, MARGA C CNP	11/30/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8260 MIRA MESA BLVD	None	SAN DIEGO	CA	92126	2662	37	06073	32.91277002	-117.1459433	San Diego County
91682	Fee-for-Service	1306035050	1306035050	1	1	DANIELYAN, ARMAN MD	5/1/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	118589	None	None	0	In state provider	None	1450 TREAT BLVD	STE 250A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
91697	Fee-for-Service	1629316328	1629316328	1	1	DUNAMIS SURGICAL CENTERS PLL	2/27/2023	193400000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	C	4655 COHEN AVE	None	EL PASO	TX	79924	4415	00	None	31.89285752	-106.4357823	El Paso County
91738	Fee-for-Service	1619351467	1619351467	1	1	DENNY, MATTHEW MD	6/29/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	711 VAN NESS	300	SAN FRANCISCO	CA	45242	5664	38	06075	37.78218473	-122.4208156	San Francisco County
91747	Fee-for-Service	1639293434	1639293434	1	1	DEY, SANGEETA PSYD	1/4/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
91878	Fee-for-Service	1205351749	1205351749	1	1	DOCTORS HOME HEALTH SOUTHERN	10/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	5562 PHILADELPHIA ST	SUITE 216	CHINO	CA	91710	2466	36	06071	34.03370384	-117.6837291	San Bernardino County
91931	Fee-for-Service	1801022405	1801022405	1	1	DAVENPORT, JOSHUA A MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120322	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
91948	Fee-for-Service	1942578232	1942578232	1	1	DAUB, CHRISTOPHER PHD	4/20/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
91954	Fee-for-Service	1053886945	1053886945	1	1	DELLOTA, MA CLARISSA ALMALBI	4/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	S PT	7737 MEANY AVE	B5-7	BAKERSFIELD	CA	93308	5266	15	06029	35.39423549	-119.0882835	Kern County
91972	Fee-for-Service	1487133195	1487133195	1	1	DAVIS, KATHRYN M LCSW	2/27/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4401 SEPULVEDA BLVD	210	SHERMAN OAKS	CA	91403	3934	19	06037	34.150356	-118.467397	Los Angeles County
91977	Fee-for-Service	1598297459	1598297459	1	1	DOAN, THANH NGA T MD	7/26/2023	207RX0202X	NA	Oncology	026	PHYSICIANS	169643	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
91989	Fee-for-Service	1568960318	1568960318	1	1	DEANO, JEANNETTE	11/27/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
91992	Fee-for-Service	1487917423	1487917423	1	1	DASHE, JESSE MD	8/28/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	126655	46	Hand Surgery	0	In state provider	None	1409 E BRIGGSMORE AVE	None	MODESTO	CA	95355	2707	50	06099	37.66742737	-120.9731413	Stanislaus County
92001	Fee-for-Service	1578253191	1578253191	1	1	DUNN, ISAAC NP	11/2/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
92047	Fee-for-Service	1396978037	1396978037	1	1	DIEDRICH, JUSTIN T MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114859	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 TACHEVAH DR	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
92051	Fee-for-Service	1588610596	1588610596	1	1	DIETEL, DANIEL MD	8/29/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	0000	00	None	44.08199228	-123.0283538	Lane County
92070	Fee-for-Service	1689711129	1689711129	1	1	DE SANCHEZ-DAVIS, MEKKIA LC	11/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	28125 BRADLEY RD	220	SUN CITY	CA	92586	2288	33	06065	33.71309746	-117.1898349	Riverside County
92102	Fee-for-Service	1508818246	1508818246	1	1	DENNING, JOHN R MD	5/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7411	08	Family Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
92113	Fee-for-Service	1235287186	1235287186	1	1	DHALIWAL, JASMIT MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78378	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92158	Fee-for-Service	1023169471	1023169471	1	1	DELTA PODIATRY GROUP INC	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1205 N HUNTER ST	None	STOCKTON	CA	95202	1499	39	06077	37.96502346	-121.2918213	San Joaquin County
92161	Fee-for-Service	1366412165	1366412165	1	1	DAR, SAIRA M MD	12/27/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163926	None	None	0	In state provider	None	700 17TH ST	None	MODESTO	CA	95354	1209	50	06099	37.64283069	-120.9903982	Stanislaus County
92232	Fee-for-Service	1740517127	1740517127	1	1	DEUTSCH, KAREN G NP	12/16/2019	363LC1500X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
92249	Fee-for-Service	1740337914	1740337914	1	1	DELMONICO, RICHARD PHD	9/11/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
92324	Fee-for-Service	1578668299	1578668299	1	1	DATAR, SANJEEV A MD	6/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82243	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92333	Fee-for-Service	1518946292	1518946292	1	1	DUCRET, RENE P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST JOHN'S HOSPITAL	1575 BEAM AVE	None	MAPLEWOOD	MN	55109	0000	00	None	45.02818044	-93.03372281	Ramsey County
92377	Fee-for-Service	1982083630	1982083630	1	1	DANIEL, MALINI P MD	8/15/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	165086	02	General Surgery	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
92442	Fee-for-Service	1609403641	1609403641	1	1	DOLAN, BRAEDEN H MD	8/3/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187401	None	None	0	In state provider	None	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
92484	Fee-for-Service	1437470952	1437470952	1	1	DAUPHINEE, KRISTEN MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125151	05	Anesthesiology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
92494	Fee-for-Service	1265531164	1265531164	1	1	DAVISON DRUG &STATIONARY	3/22/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	640 MARKET ST	None	COLUSA	CA	95932	2441	06	06011	39.21456168	-122.0101352	Colusa County
92506	Fee-for-Service	1316359581	1316359581	1	1	DANG, DAVID T MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133218	41	Internal Medicine	0	In state provider	None	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
92529	Fee-for-Service	1548295249	1548295249	1	1	DAVIS, ROBERT LEE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
92531	Fee-for-Service	1952598104	1952598104	1	1	DELMAN, ALLAN M MD	8/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38639	20	Orthopedic Surgery	0	In state provider	None	1294 W 6TH ST	STE 210	SAN PEDRO	CA	90731	2998	19	06037	33.73885348	-118.3056165	Los Angeles County
92562	Fee-for-Service	1306310404	1306310404	1	1	DR. AIRA CANLAS, OD, INC	2/15/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4445 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6017	19	06037	34.09772372	-118.2863833	Los Angeles County
92566	Fee-for-Service	1831508977	1831508977	1	1	DUONG, HENRY OD	2/9/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9548 E ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87471995	-118.1301762	Los Angeles County
92648	Fee-for-Service	1043262421	1043262421	1	1	DODOO, GARLNAD S MD	9/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94748	41	Internal Medicine	0	In state provider	None	24451 HEALTH CENTER DRIV	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
92678	Fee-for-Service	1790957280	1790957280	1	1	DOUBNOVA, TATIANA	4/3/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1204 VICENTE ST	None	SAN FRANCISCO	CA	94116	3044	38	06075	37.7391317	-122.480086	San Francisco County
92711	Fee-for-Service	1053511667	1053511667	1	1	DECALO, NIV E MD	3/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120987	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94410	3518	38	06075	37.75548534	-122.4065362	San Francisco County
92730	Fee-for-Service	1932261880	1932261880	1	1	DANESHGAR, KOUROSH K MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64700	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	3710 CESAR CHAVEZ AVE	2ND FLOOR	LOS ANGELES	CA	90063	0000	19	06037	34.04048853	-118.1854845	Los Angeles County
92749	Fee-for-Service	1215074844	1215074844	1	1	DEAN, ROBYN	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3772 HOWE ST	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
92760	Fee-for-Service	1588903371	1588903371	1	1	DENNIS, AMANDA K CRNA	3/1/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
92801	Fee-for-Service	1043741028	1043741028	1	1	DILLON, DAVID J MD	6/12/2021	207P00000X	NA	Other	026	PHYSICIANS	159976	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
92806	Fee-for-Service	1396933818	1396933818	1	1	DUHAYLONGSOD, LISA MD	4/9/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	92366	None	None	0	In state provider	None	12625 HIGH BLUFF	318	SAN DIEGO	CA	92130	2054	37	06073	32.94734997	-117.2404952	San Diego County
92815	Fee-for-Service	1912997354	1912997354	1	1	DIANON SYSTEMS INC	5/12/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	840 RESEARCH PKWY	None	OKLAHOMA CITY	OK	73104	3616	00	None	35.47492315	-97.50448941	Oklahoma County
92828	Fee-for-Service	1891883401	1891883401	2	1	DAMIRCHI, CYRUS MD	2/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	50298	01	General Practice	0	In state provider	None	355 E 21ST ST	SUITE F	SAN BERNARDINO	CA	92404	4851	36	06071	34.13404548	-117.2779515	San Bernardino County
92831	Fee-for-Service	1548385594	1548385594	1	1	DENTON, LESLIE DO	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
92845	Fee-for-Service	1548238702	1548238702	1	1	DEVONSHIRE CARE CENTER, LLC	8/15/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1350 E DEVONSHIRE AVE	None	HEMET	CA	92544	8629	33	06065	33.75125933	-116.9577919	Riverside County
92887	Fee-for-Service	1265477343	1265477343	1	1	DOCKENDORF, GEORGE DO	6/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
92919	Fee-for-Service	1174619720	1174619720	1	1	DAVENPORT, STEPHEN R MD	9/7/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171708	None	None	0	In state provider	None	41889 EAST FLORIDA AVE	None	HEMET	CA	92544	5042	33	06065	33.7476747	-116.9145363	Riverside County
92943	Fee-for-Service	1407366503	1407366503	1	1	DENNING, NATALIE L NP	12/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92963	Fee-for-Service	1336694488	1336694488	1	1	DAULTON, CARLY E NP	10/4/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
92971	Fee-for-Service	1790165801	1790165801	1	1	DANG, KATHLEEN Q OD	8/19/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	936 S BROOKHURST ST	None	ANAHEIM	CA	92804	4305	30	06059	33.819075	-117.9589105	Orange County
92981	Fee-for-Service	1578686242	1578686242	1	1	DONEPUDI, SREECHANDRA K MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133242	01	General Practice	0	In state provider	None	2365 QUIMBY ROAD	None	SAN JOSE	CA	95122	1337	43	06085	37.325106	-121.8094335	Santa Clara County
92993	Fee-for-Service	1164437471	1164437471	1	1	DUBOSE, DANIEL T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67089	47	Miscellaneous	0	In state provider	None	940 SYLVA LN	STE B	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
93026	Fee-for-Service	1326070251	1326070251	1	1	DOW, RICHARD J MD	4/6/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78595	40	Pediatrics	0	In state provider	None	141 CAMINO ALTO	STE 1	MILL VALLEY	CA	94941	2219	21	06041	37.89756834	-122.5300877	Marin County
93063	Fee-for-Service	1548318496	1548318496	1	1	DRESKIN, ALBERT MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	24043	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
93112	Fee-for-Service	1093888133	1093888133	1	1	DELLARIPA, TRACEY A MD	6/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69208	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
93122	Fee-for-Service	1174531859	1174531859	1	10	DIGNITY HEALTH MEDICAL FOUND	6/28/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-SEQUOIA INC.	799 MAIN ST	STE D	HALF MOON BAY	CA	94019	1996	41	06081	37.45841679	-122.4300072	San Mateo County
93165	Fee-for-Service	1831344910	1831344910	1	1	DE LA PLANTE, NICHOLE A DO	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13406	01	General Practice	0	In state provider	None	1090 THIRD ST	SUITE 1	SOUTH LAKE TAHOE	CA	96150	3485	09	06017	38.91492536	-119.9966528	El Dorado County
93173	Fee-for-Service	1922596089	1922596089	1	2	DELUCIA, MARY E LMFT	6/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11500 W OLYMPIC BLVD	STE 500	LOS ANGELES	CA	90064	1569	19	06037	34.03617514	-118.4445122	Los Angeles County
93213	Fee-for-Service	1720300312	1720300312	1	1	DELTA BAY SURGERY CENTER LLC	6/13/2011	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1208 EAST FIFTH STREET	2ND FLOOR	BENICIA	CA	94510	3502	48	06095	38.05032887	-122.1471983	Solano County
93273	Fee-for-Service	1720183650	1720183650	1	1	DIETERICH, FREDERICK MD	7/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	41537	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1275 N ROSE DR	STE 124	PLACENTIA	CA	92870	3919	30	06059	33.8868003	-117.8420447	Orange County
93281	Fee-for-Service	1164437471	1164437471	1	1	DUBOSE, DANIEL T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67089	02	General Surgery	0	In state provider	None	940 SYLVA LN	STE B	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
93330	Fee-for-Service	1679611669	1679611669	1	1	DALY, MARTHA Y MD	10/21/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	50203	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
93352	Fee-for-Service	1841243912	1841243912	1	1	DOEMENY, JOHN M MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50925	30	Radiology	0	In state provider	None	12620 MONTE VISTA RD	STE A	POWAY	CA	92064	2531	37	06073	32.99536145	-117.056826	San Diego County
93377	Fee-for-Service	1205994340	1205994340	1	1	DANG, TRUC-CHI N OD	4/4/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1192 GLENDALE GALLERIA	None	GLENDALE	CA	91210	1301	19	06037	34.144848	-118.2596735	Los Angeles County
93399	Fee-for-Service	1912176876	1912176876	2	1	DELANO AMBULANCE SERVICE	4/6/2011	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	403 MAIN ST	None	DELANO	CA	93215	3529	15	06029	35.761478	-119.2439513	Kern County
93412	Fee-for-Service	1174531859	1174531859	1	10	DIGNITY HEALTH MEDICAL FOUND	6/28/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	-SEQUOIA INC.	799 MAIN ST	STE D	HALF MOON BAY	CA	94019	1996	41	06081	37.45841679	-122.4300072	San Mateo County
93420	Fee-for-Service	1912288432	1912288432	1	7	DIGNITY HEALTH MEDICAL FOUND	6/16/2017	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	2430 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14832201	-122.2216203	Tehama County
93457	Fee-for-Service	1376677310	1376677310	1	1	DAN RANGER MEDICAL EQUIP	2/23/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DAN RANGER MEDICAL EQUIP	6109 SOUTH WESTERN AVE	STE 310	LOS ANGELES	CA	90047	1454	19	06037	33.984198	-118.3089895	Los Angeles County
93463	Fee-for-Service	1609926781	1609926781	1	1	DR SHAD S SAREMI OD PROF COR	6/15/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	P	13550 W PAXTON STREET	None	PACOIMA	CA	91331	2352	19	06037	34.27263559	-118.4275767	Los Angeles County
93519	Fee-for-Service	1013124890	1013124890	1	1	DRISCOLL, MILES E MD	10/11/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157833	36	Psychiatry	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
93522	Fee-for-Service	1932124021	1932124021	1	1	DIEGO, ILUMINADA T MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24403	40	Pediatrics	0	In state provider	A MEDICAL CORP	23517 MAIN ST	STE 101	CARSON	CA	90745	5227	19	06037	33.81129174	-118.2756933	Los Angeles County
93554	Fee-for-Service	1265443303	1265443303	1	1	DIABLO PULMONARY MEDICAL	5/1/1995	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	GROUP INC	2299 BACON STREET	SUITE 2	CONCORD	CA	94520	2045	07	06013	37.98199042	-122.0349518	Contra Costa County
93568	Fee-for-Service	1023146149	1023146149	1	1	DELDUCA,KEVIN D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 S WOODWORTH LOOP	None	PALMER	AK	99645	8984	00	None	61.56185332	-149.2602134	Matanuska-Susitna Borough
93598	Fee-for-Service	1720599350	1720599350	1	1	DAWSON, DIANA I LMFT	6/13/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	18700 OXNARD STREET	None	TARZANA	CA	91356	1413	19	06037	34.18014349	-118.5410025	Los Angeles County
93667	Fee-for-Service	1679760094	1679760094	1	1	DEDES, HOWARD MD	6/24/2020	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	103665	25	Physical Medicine and Rehabilitation	0	In state provider	None	295 IMPERIAL HWY	SUITE 100	FULLERTON	CA	92835	1020	30	06059	33.91748047	-117.9291825	Orange County
93704	Fee-for-Service	1659373603	1659373603	1	1	DEL MAR, MAIKA MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89703	08	Family Practice	0	In state provider	KARINA F MD	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
93706	Fee-for-Service	1508981549	1508981549	1	1	DESERT FAMILY PRACTICE	10/20/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ASSOCIATES MED GRP INC	1301 E MAIN ST	None	BARSTOW	CA	92311	3219	36	06071	34.89602072	-117.0069329	San Bernardino County
93720	Fee-for-Service	1639512684	1639512684	1	1	DIAZ, ELIZABETH C LCSW	5/1/2020	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	614 GRAND AVE	SUITE 203	OAKLAND	CA	94610	3554	01	06001	37.80970653	-122.2493811	Alameda County
93802	Fee-for-Service	1962498568	1962498568	1	1	DR. ROBERT T WECHSLER MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1499 W HAYS ST	None	BOISE	ID	83702	5029	00	None	43.62496359	-116.2063174	Ada County
93804	Fee-for-Service	1639649098	1639649098	1	1	DUCA, CHRISTINA A	2/11/2019	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1139 GRAY AVE	STE B	YUBA CITY	CA	95991	3211	51	06101	39.145338	-121.6301835	Sutter County
93814	Fee-for-Service	1851404743	1851404743	1	1	DAVIS, PETER W MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	45275	02	General Surgery	0	In state provider	None	136 N 3RD STREET	None	LOMPOC	CA	93436	7002	42	06083	34.64013944	-120.4451768	Santa Barbara County
93817	Fee-for-Service	1669778056	1669778056	1	1	DE LA LAMA, MAURICIO MD	7/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121020	30	Radiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
93826	Fee-for-Service	1942277678	1942277678	1	1	DUDOW, IRWIN R OD	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8101 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3949	19	06037	34.21796378	-118.3699948	Los Angeles County
93850	Fee-for-Service	1568689149	1568689149	1	2	DRENNING-MANRIQUEZ, ROGELIO	11/10/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	55833	None	None	0	In state provider	ATHEDRAL CITY	34131 DATE PALM DR	F-2	CATHEDRAL CITY	CA	92234	6884	33	06065	33.80013	-116.4581675	Riverside County
93854	Fee-for-Service	1508829714	1508829714	1	1	DURAIRAJ, DAMAYANTHI MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39805	08	Family Practice	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
93952	Fee-for-Service	1215924741	1215924741	1	1	DINH, SON THAI MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74785	01	General Practice	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
93993	Fee-for-Service	1659373603	1659373603	1	1	DEL MAR, MAIKA MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89703	01	General Practice	0	In state provider	KARINA F MD	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
94069	Fee-for-Service	1396305074	1396305074	1	1	DEVOTED HEARTS HOSPICE CORP	9/8/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15300 VENTURA BLVD	STE 505	SHERMAN OAKS	CA	91403	3103	19	06037	34.15387425	-118.4666626	Los Angeles County
94077	Fee-for-Service	1588850309	1588850309	1	1	DIMITRIADES, VICTORIA R MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143141	03	Allergy	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
94098	Fee-for-Service	1760915219	1760915219	1	1	DOBBINS TRANSPORTATION	5/15/2020	343800000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1264 DRAKELEY AVE	None	ATWATER	CA	95301	4027	24	06047	37.34825123	-120.6085501	Merced County
94100	Fee-for-Service	1063034692	1063034692	1	1	DEMPSEY, KAITLIN CRNA	9/1/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
94113	Fee-for-Service	1447232467	1447232467	1	1	DALRYMPLE, JOHN L MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84788	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
94125	Fee-for-Service	1790289585	1790289585	1	1	DAGHER, TALIA H MD	8/23/2022	207L00000X	NA	Other	026	PHYSICIANS	165478	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
94142	Fee-for-Service	1508829714	1508829714	1	1	DURAIRAJ, DAMAYANTHI MD	4/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	39805	70	Clinic (mixed specialty)	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
94160	Fee-for-Service	1912298076	1912298076	1	1	DR. EPHESE MOISE	9/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4900 HOUSTON RD	None	FLORENCE	KY	41042	4824	00	None	39.016422	-84.6300285	Boone County
94169	Fee-for-Service	1205921731	1205921731	1	1	DEHOVITZ, DAN R MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	45330	05	Anesthesiology	0	In state provider	None	2701 W ALAMEDA AVE	STE 405	BURBANK	CA	91505	4409	19	06037	34.15751343	-118.3303715	Los Angeles County
94238	Fee-for-Service	1215924741	1215924741	1	1	DINH, SON THAI MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74785	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
94291	Fee-for-Service	1932814860	1932814860	1	1	DEATON, HAVILAH A DOULA	8/20/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
94342	Fee-for-Service	1356565741	1356565741	1	1	DAY, THOMAS F MD	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99705	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
94358	Fee-for-Service	1396305074	1396305074	1	1	DEVOTED HEARTS HOSPICE CORP	9/8/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15300 VENTURA BLVD	STE 505	SHERMAN OAKS	CA	91403	3103	19	06037	34.15387425	-118.4666626	Los Angeles County
94376	Fee-for-Service	1760829618	1760829618	1	1	DARNELL, ANDREA MD	5/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21271	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 250A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
94464	Fee-for-Service	1801423108	1801423108	1	1	DHAMI, RUBEENA MD	4/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	2621 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.92734436	-122.0231145	Contra Costa County
94523	Fee-for-Service	1073606737	1073606737	1	1	DELAWARE COUNTY MEMORIAL	11/7/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	501 NORTH LANSDOWNE AVE	None	DREXEL HILL	PA	19026	1114	00	None	39.95425444	-75.28413772	Delaware County
94536	Fee-for-Service	1598846271	1598846271	1	1	DANOVITCH, DAINA MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100486	08	Family Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
94553	Fee-for-Service	1497974968	1497974968	1	1	DE CARBONEL, CLAUDETTE E LMF	6/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HD MFT	1601 OLD BAYSHORE HIGHWA	SUITE 123	BURLINGAME	CA	94010	1323	41	06081	37.59954916	-122.367774	San Mateo County
94566	Fee-for-Service	1588988919	1588988919	1	1	DECONDE, ADAM S MD	10/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110107	04	Otology, Laryngology, Rhinology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
94585	Fee-for-Service	1114037397	1114037397	1	1	DUNCAN, KARYNNE O MD INC	1/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86640	None	None	0	In state provider	None	1104 ADAMS ST	STE 201	ST HELENA	CA	94574	1175	28	06055	38.50580491	-122.4697395	Napa County
94593	Fee-for-Service	1578944559	1578944559	1	1	DEDEAUX, ROYA J LMFT	7/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
94618	Fee-for-Service	1295992550	1295992550	1	1	DORAIRAJ, SYRIL K MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115934	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
94643	Fee-for-Service	1255415329	1255415329	1	1	DAYHOFF, DEBORAH A	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48287	22	Pathology (M.D. only)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
94674	Fee-for-Service	1164460200	1164460200	1	1	DAY, ANTHONY A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 KIMBALL AVE	None	WATERLOO	IA	50702	5014	00	None	42.47079524	-92.35696208	Black Hawk County
94691	Fee-for-Service	1811188451	1811188451	1	1	DAKA, SMITHA MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96708	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
94706	Fee-for-Service	1811573330	1811573330	1	1	DALEY, ERIN LMFT	3/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 KENYON ST	101/102	SAN DIEGO	CA	92110	5333	37	06073	32.75016963	-117.2160064	San Diego County
94730	Fee-for-Service	1871509307	1871509307	1	1	DONOVAN, JOHN F MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83782	None	None	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
94767	Fee-for-Service	1962780098	1962780098	1	1	DEMURI, THOMAS R LMFT	3/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
94779	Fee-for-Service	1609808765	1609808765	1	1	DILLINGHAM, MICHAEL F MD	6/30/1991	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	23134	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
94811	Fee-for-Service	1073606737	1073606737	1	1	DELAWARE COUNTY MEMORIAL	11/7/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	501 NORTH LANSDOWNE AVE	None	DREXEL HILL	PA	19026	1114	00	None	39.95425444	-75.28413772	Delaware County
94824	Fee-for-Service	1083807184	1083807184	1	1	DHOLAKIA, RISHI T DO	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11963	02	General Surgery	0	In state provider	None	9400 ROSECRANS	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
94844	Fee-for-Service	1144497678	1144497678	1	13	DIGNITY HEALTH MEDICAL	10/24/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	1119 COTTONWOOD ST	None	WOODLAND	CA	95695	4318	57	06113	38.666277	-121.793344	Yolo County
94847	Fee-for-Service	1821109083	1821109083	1	1	DUNCAN, JAN W MD	8/1/1996	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	38275	20	Orthopedic Surgery	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 106	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
94896	Fee-for-Service	1962720706	1962720706	1	1	DURAND, ANISA C MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128821	40	Pediatrics	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
94905	Fee-for-Service	1285194233	1285194233	1	1	DAVIDSON, JASON BRANT	8/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	36205 KETCHUM RD	None	WILDOMAR	CA	92595	7553	33	06065	33.59459929	-117.2554307	Riverside County
94909	Fee-for-Service	1679943880	1679943880	1	1	D'SOUZA, RIA MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142018	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
94937	Fee-for-Service	1881893501	1881893501	1	1	DOWNS, STEPHANIE LMFT	1/1/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4110 EDISON AVE	206A	CHINO	CA	91710	8417	36	06071	33.99723746	-117.7140555	San Bernardino County
94961	Fee-for-Service	1538583463	1538583463	1	1	DAUGHERTY, KRISTINE	10/6/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53247	-	NOT APPLICABLE	0	In state provider	None	1550 HUMBOLDT ROAD	SUITE 3	CHICO	CA	95928	9115	04	06007	39.73641173	-121.8122593	Butte County
95003	Fee-for-Service	1063027845	1063027845	1	1	DEHGHANI, ALEXIS A LMFT	8/19/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	133965	-	NOT APPLICABLE	0	In state provider	None	6022 VARIEL AVENUE	None	WOODLAND HILLS	CA	91367	3719	19	06037	34.180029	-118.592771	Los Angeles County
95084	Fee-for-Service	1659803583	1659803583	1	1	DESAI, ROHAN MD	10/26/2022	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	179409	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
95144	Fee-for-Service	1629318167	1629318167	1	1	DENISON, MARGO M LMFT	6/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1029 N DEMAREE ST	None	VISALIA	CA	93291	4117	54	06107	36.338409	-119.3335065	Tulare County
95145	Fee-for-Service	1912288432	1912288432	1	14	DIGNITY HEALTH MEDICAL FOUND	6/4/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ATION	2020 COURT ST	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
95147	Fee-for-Service	1649201740	1649201740	1	1	DJULBEGOVIC, BENJAMIN MD	9/28/2017	207RH0000X	NA	Hematology	026	PHYSICIANS	151810	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
95153	Fee-for-Service	1750836524	1750836524	1	2	DINSMORES INPATIENT SERVICES	11/1/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AMC	3300 RENNER DRIVE	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
95172	Fee-for-Service	1003171372	1003171372	1	1	DHILLON, RAMANDEEP S MD	6/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139738	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
95194	Fee-for-Service	1750442422	1750442422	1	1	DASGUPTA, SUNAVO MD	10/31/2022	207L00000X	NA	Other	026	PHYSICIANS	171447	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
95196	Fee-for-Service	1285194233	1285194233	1	1	DAVIDSON, JASON BRANT	8/1/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	36205 KETCHUM RD	None	WILDOMAR	CA	92595	7553	33	06065	33.59459929	-117.2554307	Riverside County
95208	Fee-for-Service	1164439535	1164439535	1	1	DONALD REGIER	3/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 CEDAR ST	None	JULESBURG	CO	80737	1121	00	None	40.99391368	-102.2693559	Sedgwick County
95218	Fee-for-Service	1932168796	1932168796	1	1	DEBIAN, KHALDOUN A MD	12/8/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	63521	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
95232	Fee-for-Service	1598861866	1598861866	1	1	DEZFULI, MASSOUD G	6/30/1993	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	5819	41	Internal Medicine	0	In state provider	None	4314 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2854	19	06037	33.98885257	-118.3509655	Los Angeles County
95310	Fee-for-Service	1629399563	1629399563	1	1	DEVERA, DIANA S DO	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13947	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
95366	Fee-for-Service	1619991742	1619991742	1	1	DANG, BRYAN, Q MD	12/12/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	80925	45	Nephrology (Renal-Kidney)	0	In state provider	None	307 PLACENTIA AVE	#103	NEWPORT BEACH	CA	92663	3307	30	06059	33.62631386	-117.9310576	Orange County
95400	Fee-for-Service	1457316598	1457316598	1	1	DONALD MICHAEL CRAWFORD, D.O	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
95404	Fee-for-Service	1972727493	1972727493	1	1	DE LIMA, MARIA ZENILDE A M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53359	36	Psychiatry	0	In state provider	MD	8760 CUYAMACA STREET	None	SANTEE	CA	92071	3026	37	06073	32.83485269	-116.9839185	San Diego County
95424	Fee-for-Service	1346420122	1346420122	1	1	DAYRIT, CARLOS M JR MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34641	01	General Practice	0	In state provider	None	21530 PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
95457	Fee-for-Service	1659497600	1659497600	1	1	DAVIDSON, LISA A PHD	2/3/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	14015 MIDLAND RD	None	POWAY	CA	92064	3959	37	06073	32.96820406	-117.0360659	San Diego County
95458	Fee-for-Service	1386981728	1386981728	1	1	DIRKSEN, SARAH C PT	8/31/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1519 W YOSEMITE AVE	None	MANTECA	CA	95337	5159	39	06077	37.79738017	-121.2413628	San Joaquin County
95460	Fee-for-Service	1962418889	1962418889	1	1	DIGGS, THOMAS E II MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	230 PROSPECT PL	STE 250	CORONADO	CA	92118	1986	37	06073	32.69468235	-117.1677128	San Diego County
95499	Fee-for-Service	1730215534	1730215534	1	1	DETISCH, JENNIFER L NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12815 HEACOCK STREET	None	MORENO VALLEY	CA	92553	3116	33	06065	33.934842	-117.2438195	Riverside County
95505	Fee-for-Service	1932168796	1932168796	1	1	DEBIAN, KHALDOUN A MD	12/8/2009	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	63521	10	Gastroenterology (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
95535	Fee-for-Service	1629344015	1629344015	1	1	DIALYSIS NEWCO INC	4/1/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2227 S EL CAMINO REAL	SUITE B	OCEANSIDE	CA	92054	6397	37	06073	33.186375	-117.3305565	San Diego County
95544	Fee-for-Service	1346334513	1346334513	1	1	DUEKER FEE PHYSICAL THERAPY	10/6/2006	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	7275 N 1ST ST	STE 106	FRESNO	CA	93720	2977	10	06019	36.84277747	-119.7748349	Fresno County
95557	Fee-for-Service	1497198204	1497198204	1	1	DARDEN, CHRISTINA L	5/25/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
95561	Fee-for-Service	1053163816	1053163816	1	2	DR TIFFANY M KING, PC	7/12/2024	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 NEAL STREET	None	PLEASANTON	CA	94566	7317	01	06001	37.65848249	-121.8720632	Alameda County
95573	Fee-for-Service	1013336189	1013336189	1	1	DER, DENISE C MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140861	40	Pediatrics	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
95587	Fee-for-Service	1942693411	1942693411	1	1	DELACRUZ, SANDIE J R	1/20/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2925 PALO VERDE AVE	2ND FL	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
95682	Fee-for-Service	1861716722	1861716722	1	1	DIAZ-SMOIRE, MARCELA S LMFT	8/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
95683	Fee-for-Service	1043692866	1043692866	1	1	DUHAIME, PHILIPPE MD	11/11/2019	207R00000X	NA	Other	026	PHYSICIANS	152444	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
95685	Fee-for-Service	1538157177	1538157177	1	1	DUVAL, CLINTON E. MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 N MACARTHUR BLVD	None	IRVING	TX	75061	2220	00	None	32.834691	-96.95924802	Dallas County
95709	Fee-for-Service	1003176785	1003176785	1	1	DAO, ANH K MD	8/1/2019	2080P0201X	NA	Neurology	026	PHYSICIANS	162446	03	Allergy	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
95712	Fee-for-Service	1346420122	1346420122	1	1	DAYRIT, CARLOS M JR MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34641	08	Family Practice	0	In state provider	None	21530 PIONEER BLVD	None	HAWAIIAN GARDENS	CA	90716	2608	19	06037	33.83358457	-118.0817796	Los Angeles County
95716	Fee-for-Service	1497748776	1497748776	1	1	DAVIS, CATHERINE MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	70242	None	None	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
95748	Fee-for-Service	1962418889	1962418889	1	1	DIGGS, THOMAS E II MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56679	01	General Practice	0	In state provider	None	230 PROSPECT PL	STE 250	CORONADO	CA	92118	1986	37	06073	32.69468235	-117.1677128	San Diego County
95753	Fee-for-Service	1598833501	1598833501	1	1	DOLZONEK, CYNTHIA M PHD	2/24/1986	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4620 BERWICK DR	None	SAN DIEGO	CA	92117	4230	37	06073	32.82477962	-117.1654288	San Diego County
95793	Fee-for-Service	1477843928	1477843928	1	1	DUVALL, JESSICA L MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123788	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
95840	Fee-for-Service	1578553590	1578553590	1	1	DEKKER, ALBERT MD	5/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87223	78	Neoplastic Diseases/Oncology	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
95854	Fee-for-Service	1033197082	1033197082	1	1	DASTAGIR, MUHAMMAD T MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55842	None	None	0	In state provider	None	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
95860	Fee-for-Service	1619675055	1619675055	1	1	DUMAS, ERICA RENEE	9/26/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13151 KEOKUK ST	None	VICTORVILLE	CA	92395	5502	36	06071	34.48965337	-117.3234036	San Bernardino County
95861	Fee-for-Service	1063547644	1063547644	1	1	DAVIDSON, BERT J MD	8/29/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32633	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	# 24143	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
95862	Fee-for-Service	1285923540	1285923540	1	1	DAWES, AARON J MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125152	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
95915	Fee-for-Service	1396712188	1396712188	2	1	DIJULIO, THOMAS P MD	3/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	30897	13	Neurology (M.D. only)	0	In state provider	None	1703 TERMINO AVE	STE 208	LONG BEACH	CA	90804	2128	19	06037	33.7883073	-118.1459488	Los Angeles County
96021	Fee-for-Service	1730527219	1730527219	1	1	DIERDRE GARTON	3/8/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
96037	Fee-for-Service	1962418889	1962418889	1	1	DIGGS, THOMAS E II MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56679	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	230 PROSPECT PL	STE 250	CORONADO	CA	92118	1986	37	06073	32.69468235	-117.1677128	San Diego County
96100	Fee-for-Service	1467440115	1467440115	1	1	DAUPHINE, RICHARD T MD	6/8/1976	No Taxonomy Provided	NA	None	026	PHYSICIANS	22565	20	Orthopedic Surgery	0	In state provider	INC	980 CASS ST	None	MONTEREY	CA	93940	4548	27	06053	36.59233374	-121.896488	Monterey County
96138	Fee-for-Service	1235371675	1235371675	1	1	DO, JOHNNY N MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107046	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
96147	Fee-for-Service	1619675055	1619675055	1	1	DUMAS, ERICA RENEE	9/26/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13151 KEOKUK ST	None	VICTORVILLE	CA	92395	5502	36	06071	34.48965337	-117.3234036	San Bernardino County
96148	Fee-for-Service	1063547644	1063547644	1	1	DAVIDSON, BERT J MD	8/29/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32633	67	Endocrinology	0	In state provider	None	10833 LE CONTE AVE	# 24143	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
96171	Fee-for-Service	1578615746	1578615746	1	1	DREW HITTENBERGER AND	11/1/1993	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES	181 LYNCH CREEK WAY	STE 101	PETALUMA	CA	94954	8303	49	06097	38.25155449	-122.6349373	Sonoma County
96218	Fee-for-Service	1679671622	1679671622	1	1	DANG, NGUYEN D MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67415	41	Internal Medicine	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
96226	Fee-for-Service	1407203599	1407203599	1	1	DESON, AMANDA M DO	8/7/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18165	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
96240	Fee-for-Service	1477671535	1477671535	1	3	DIGNITY HEALTH	5/15/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MERCY MEDICAL CT REDDING	2656 EDITH AVE	STE A	REDDING	CA	96001	3043	45	06089	40.57073094	-122.3974088	Shasta County
96304	Fee-for-Service	1780984294	1780984294	1	1	DONABEDIAN, M H PC	6/7/2011	193400000X	NA	Other	026	PHYSICIANS	54188	41	Internal Medicine	0	In state provider	None	1509 WILSON TERRACE	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
96361	Fee-for-Service	1023334497	1023334497	1	1	DELANEY, MIJA NP	7/7/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
96384	Fee-for-Service	1679092571	1679092571	1	1	DURIGAN, SHAWNA LCSW	7/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
96399	Fee-for-Service	1285659169	1285659169	1	1	DELYAEI, JACQUELINE J MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96268	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96404	Fee-for-Service	1407816630	1407816630	1	1	DEMERA, RICHARD S MD	5/1/1999	207K00000X	NA	Other	026	PHYSICIANS	65003	83	Rheumatology	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
96414	Fee-for-Service	1316918634	1316918634	1	1	DEVINE, TIMOTHY J MD	6/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	86719	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
96429	Fee-for-Service	1750572178	1750572178	1	1	DIRAIMONDO, CHARLES V MD	3/31/1989	193400000X	NA	Other	026	PHYSICIANS	60786	20	Orthopedic Surgery	0	In state provider	INC	2485 HIGH SCHOOL AVE	# 112	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
96479	Fee-for-Service	1205214814	1205214814	1	1	DIENER, RONNIE J LMFT	1/18/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11601 WILSHIRE BLVD	5TH FL	LOS ANGELES	CA	90025	0509	19	06037	34.05052592	-118.4595943	Los Angeles County
96506	Fee-for-Service	1952036675	1952036675	1	1	DR. ADAM D. GOLDSTONE, O.D.,	1/10/2023	305R00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC.	44665 VALLEY CENTRAL WAY	None	LANCASTER	CA	93536	6500	19	06037	34.69311041	-118.1722239	Los Angeles County
96523	Fee-for-Service	1700851433	1700851433	1	1	D'AVIGNON, LAURIE C MD	10/26/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	149571	77	Infectious Disease	0	In state provider	None	3400 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
96525	Fee-for-Service	1932343746	1932343746	1	1	DELA CRUZ, MA LYDIA M MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114700	08	Family Practice	0	In state provider	None	6601 RUGBY AVE	STE 300	HUNTINGTON PARK	CA	90255	4046	19	06037	33.979113	-118.2265595	Los Angeles County
96550	Fee-for-Service	1477671535	1477671535	1	9	DIGNITY HEALTH	8/25/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2175 ROSALINE AVE	STE A	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
96570	Fee-for-Service	1962672089	1962672089	1	1	DEVRIES, BARBARA M CRNA	1/6/2009	390200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
96599	Fee-for-Service	1144497678	1144497678	1	3	DIGNITY HEALTH MEDICAL	3/5/2019	261QM1300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
96662	Fee-for-Service	1902087091	1902087091	1	1	D'SOUZA, SWATI F MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102080	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	#101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
96690	Fee-for-Service	1801649363	1801649363	1	1	DEANGELIS, ALECIA	1/3/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2102 BUSINESS CENTER DR	STE 250	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
96692	Fee-for-Service	1407816630	1407816630	1	1	DEMERA, RICHARD S MD	5/1/1999	207K00000X	NA	Other	026	PHYSICIANS	65003	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
96693	Fee-for-Service	1609883024	1609883024	1	1	DRINNAN, MICHAEL J MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50381	18	Ophthalmology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
96708	Fee-for-Service	1114344033	1114344033	1	1	DOWNING, ROBERT DO	1/21/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	20462	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
96727	Fee-for-Service	1164849378	1164849378	1	1	DAVIS, RICHARD B	6/13/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6670 ALTON PKWY	None	IRVINE	CA	92618	3734	30	06059	33.65837833	-117.7727118	Orange County
96733	Fee-for-Service	1972530137	1972530137	1	1	DRINHAUS, ROLF RICHARD	1/31/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	75993	20	Orthopedic Surgery	0	In state provider	None	521 E ELDER ST	STE 105	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
96795	Fee-for-Service	1104081777	1104081777	1	1	DR PHILLIP BROWN MB BS A	4/6/2012	207L00000X	NA	Other	026	PHYSICIANS	42562	05	Anesthesiology	0	In state provider	PROFESSIONAL CORPORATION	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
96796	Fee-for-Service	1275970972	1275970972	1	1	DEFRIES, TRIVENI B MD	8/28/2018	207R00000X	NA	Other	026	PHYSICIANS	133535	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
96810	Fee-for-Service	1700851433	1700851433	1	1	D'AVIGNON, LAURIE C MD	10/26/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	149571	41	Internal Medicine	0	In state provider	None	3400 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
96817	Fee-for-Service	1881631711	1881631711	1	1	DERMATOLOGY SPECIALISTS INC	6/30/1989	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	A SURGICL/MEDICAL GROUP	1309 S MISSION	#A	FALLBROOK	CA	92028	4168	37	06073	33.36938909	-117.2510954	San Diego County
96831	Fee-for-Service	1255344271	1255344271	1	1	DOWLING, CAROLINE D OT	10/8/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
96834	Fee-for-Service	1225599327	1225599327	1	1	DUGGAL, RYAN MD	4/16/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
96858	Fee-for-Service	1306282603	1306282603	1	1	DICK-MUEHLKE, CORDULA V PHD	5/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
96886	Fee-for-Service	1548207939	1548207939	1	1	DEPAEPE, JESSICA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
96888	Fee-for-Service	1144497678	1144497678	1	3	DIGNITY HEALTH MEDICAL	2/6/2018	261QM1300X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
96905	Fee-for-Service	1902893399	1902893399	1	1	DAVIS, BENNET E MD MPH	6/26/2020	207LP2900X	NA	Other	026	PHYSICIANS	43683	05	Anesthesiology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
96982	Fee-for-Service	1447376678	1447376678	1	1	DIAZ, JOEL CRNA	5/28/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
96988	Fee-for-Service	1508887761	1508887761	1	1	DEARTOLO, IGNACIO JR MD	1/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51149	08	Family Practice	0	In state provider	None	14624 SHERMAN WAY	STE 506	VAN NUYS	CA	91405	2289	19	06037	34.20078354	-118.450843	Los Angeles County
96994	Fee-for-Service	1861534901	1861534901	1	1	DAVIS, RACHEL M LMFT	12/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
96997	Fee-for-Service	1144869322	1144869322	1	1	DAVID, DARRELL J CRNA	8/22/2023	163WE0003X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
97007	Fee-for-Service	1568089548	1568089548	1	1	DMG WELLNESS INC	9/17/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2651 NEVIN AVE	None	LOS ANGELES	CA	90011	2242	19	06037	34.0131454	-118.2453233	Los Angeles County
97137	Fee-for-Service	1124038328	1124038328	1	1	DOUMAS, JENNIFER W DO	1/1/1989	207P00000X	NA	Other	026	PHYSICIANS	5707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
97153	Fee-for-Service	1841368396	1841368396	1	1	DEMILLE, BRANDON C	10/25/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
97163	Fee-for-Service	1780785766	1780785766	1	1	DOLAN, DEBORA D	12/2/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
97167	Fee-for-Service	1932307808	1932307808	1	1	DEBONIS, JASON J MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105157	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
97174	Fee-for-Service	1144497678	1144497678	1	3	DIGNITY HEALTH MEDICAL	12/27/2017	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
97294	Fee-for-Service	1174672265	1174672265	1	1	DEVELOPMENTAL CLIENT	5/7/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INDUSTRIES INC	12728 GORHAM ST	None	MORENO VALLEY	CA	92553	5676	33	06065	33.93561491	-117.2520464	Riverside County
97330	Fee-for-Service	1386720894	1386720894	1	1	DONOVAN, MONICA MD	3/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56767	08	Family Practice	0	In state provider	None	596 CARROLL ST	None	SUNNYVALE	CA	94086	6207	43	06085	37.36853041	-122.0305901	Santa Clara County
97344	Fee-for-Service	1750578712	1750578712	1	1	DEJESSE, LEIGH ANN D PHD	2/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
97374	Fee-for-Service	1083687891	1083687891	1	2	DESANTO, JOSEPH A MD	10/17/2017	207R00000X	NA	Other	026	PHYSICIANS	81151	41	Internal Medicine	0	In state provider	None	3151 AIRWAY AVE.	SUITE M1	COSTA MESA	CA	92626	4626	30	06059	33.67783408	-117.8720921	Orange County
97427	Fee-for-Service	1912288432	1912288432	1	5	DIGNITY HEALTH MEDICAL FOUND	3/11/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	-NORTH STATE	2656 EDITH AVE	None	REDDING	CA	96001	3030	45	06089	40.57073094	-122.3974088	Shasta County
97430	Fee-for-Service	1548204423	1548204423	1	1	DAVIS, DANIEL P MD	7/1/1998	207P00000X	NA	Other	026	PHYSICIANS	62140	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
97449	Fee-for-Service	1053361642	1053361642	1	1	DEACONESS HOSPITAL, INC	5/10/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 MARY STREET	None	EVANSVILLE	IN	47747	0001	00	None	37.98309188	-87.57072541	Vanderburgh County
97465	Fee-for-Service	1144497678	1144497678	1	3	DIGNITY HEALTH MEDICAL	9/12/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
97470	Fee-for-Service	1073717732	1073717732	1	1	DOWLING, MARIE A MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
97482	Fee-for-Service	1427516384	1427516384	1	1	DEGUZMAN, DENNIS V CNP	1/27/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2760 FLETCHER PKWY	None	EL CAJON	CA	92020	2110	37	06073	32.80015674	-117.0036982	San Diego County
97523	Fee-for-Service	1245535517	1245535517	1	1	DOWNING, SAMATRA M LCSW	2/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97542	Fee-for-Service	1538279559	1538279559	1	1	DHALLA, PRABHU V MD	6/30/1993	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	35069	20	Orthopedic Surgery	0	In state provider	None	4444 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4136	33	06065	33.97614344	-117.3797664	Riverside County
97545	Fee-for-Service	1629058755	1629058755	1	1	DIMAURO, ROBERT M. MD	2/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	941 KAMEHAMEHA HWY	STE 208	PEARL CITY	HI	96782	2516	00	None	21.39429472	-157.97183	Honolulu County
97604	Fee-for-Service	1285049379	1285049379	1	1	DODSON, PORSHA PSYD	2/19/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97612	Fee-for-Service	1215170956	1215170956	1	1	DUNN, SARAH M MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113392	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
97645	Fee-for-Service	1023246048	1023246048	1	1	DE LEON, MIGNON M MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142590	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
97657	Fee-for-Service	1881123560	1881123560	1	1	DOUCOT, PAUL R	6/26/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	844 BRIDGE ST	STE C	COLUSA	CA	95932	2867	06	06011	39.20645023	-122.0035419	Colusa County
97666	Fee-for-Service	1962513093	1962513093	1	1	DENENBERG, LAURA B MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60244	40	Pediatrics	0	In state provider	None	1300 BANCROFT AVE	None	SAN LEANDRO	CA	94577	5147	01	06001	37.72690979	-122.1477291	Alameda County
97678	Fee-for-Service	1821023540	1821023540	1	1	DHAWAN, KAMLESH T MD	11/19/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	38701	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
97714	Fee-for-Service	1912288432	1912288432	1	5	DIGNITY HEALTH MEDICAL FOUND	3/11/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	-NORTH STATE	2656 EDITH AVE	None	REDDING	CA	96001	3030	45	06089	40.57073094	-122.3974088	Shasta County
97728	Fee-for-Service	1629242532	1629242532	1	1	DR TRAN MEDICAL OFFICE	5/20/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	7900 GARVEY AVE	None	ROSEMEAD	CA	91770	2419	19	06037	34.0625847	-118.0970623	Los Angeles County
97733	Fee-for-Service	1477671535	1477671535	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MERCY MEDICAL CT REDDING	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
97743	Fee-for-Service	1235464272	1235464272	1	1	DAVID, JOAN PHD	10/29/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICES	9550 WARNER AVE	STE 250-05	FOUNTAIN VALLEY	CA	92708	2800	30	06059	33.71597354	-117.9624555	Orange County
97754	Fee-for-Service	1922489657	1922489657	1	1	DIMALANTA, GENINA CNP	4/7/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	738 BANCROFT RD	None	WALNUT CREEK	CA	94598	1531	07	06013	37.92857256	-122.041705	Contra Costa County
97810	Fee-for-Service	1699110049	1699110049	1	1	DAO, BELINDA M MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132369	40	Pediatrics	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3857	36	06071	34.04824949	-117.2401425	San Bernardino County
97818	Fee-for-Service	1043253255	1043253255	1	1	DOUEK, MICHAEL L MD	4/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81947	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
97876	Fee-for-Service	1164603635	1164603635	1	1	DE GUZMAN, GRACE C MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103279	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
97912	Fee-for-Service	1043425895	1043425895	1	1	DALAL, ISHANI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HENRY FORD HEALTH SYSTEM	2799 W GRAND BLVD	None	DETROIT	MI	48202	2608	00	None	42.36645079	-83.08385497	Wayne County
97920	Fee-for-Service	1871699561	1871699561	1	1	DMORIAS, LINET R MD INC	2/2/2015	207R00000X	NA	Other	026	PHYSICIANS	48021	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	9860	10	06019	36.83626596	-119.7674879	Fresno County
97936	Fee-for-Service	1023225885	1023225885	1	1	DAVIS, TAMME J DO	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14562	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2105 FOREST AVENUE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
97939	Fee-for-Service	1700838620	1700838620	1	1	DAVAE, KETAN MD	7/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52690	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
97956	Fee-for-Service	1194354001	1194354001	1	1	DELL, LYNDSAY E PSYD	12/28/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
97963	Fee-for-Service	1467491159	1467491159	1	1	DAVID LARSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 S MAPLE ST	None	WACONIA	MN	55387	1752	00	None	44.843139	-93.79078701	Carver County
97970	Fee-for-Service	1689919037	1689919037	1	1	DE LA RIVA MORENO, ANDREA E	6/17/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74794	-	NOT APPLICABLE	0	In state provider	LCSW	100 EAST WARDLOW ROAD	None	LONG BEACH	CA	90807	4417	19	06037	33.8188341	-118.1923297	Los Angeles County
97971	Fee-for-Service	1235225467	1235225467	1	1	DOBALIAN, DEREK M MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48996	10	Gastroenterology (M.D. only)	0	In state provider	None	3816 WOODRUFF AVE	STE 307	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
97972	Fee-for-Service	1174790026	1174790026	1	1	DENG, HOLLY Y MD	10/11/2010	390200000X	NA	Other	026	PHYSICIANS	105953	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
97977	Fee-for-Service	1437195849	1437195849	1	1	DRY, SARAH M MD	11/1/2000	207ZP0101X	NA	Other	026	PHYSICIANS	70470	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
97982	Fee-for-Service	1346393659	1346393659	1	1	DORSEY, JOHN B MD INC	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	18078	20	Orthopedic Surgery	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 521	MISSION VIEJO	CA	92691	6376	30	06059	33.56347704	-117.66546	Orange County
97991	Fee-for-Service	1235552951	1235552951	1	1	DALY CITY OPTOMETRY APC	6/29/2015	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	94-B SERRAMONTE CENTER	None	DALY CITY	CA	94015	2345	41	06081	37.66947057	-122.4690456	San Mateo County
97997	Fee-for-Service	1861704058	1861704058	1	1	DANIALAN, RICHARD DO	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13177	90	Pathology-Forensic	0	In state provider	None	2625 COFFEE ROAD	SUITE S	MODESTO	CA	95355	2050	50	06099	37.67888506	-120.9759048	Stanislaus County
98016	Fee-for-Service	1629242532	1629242532	1	1	DR TRAN MEDICAL OFFICE	5/20/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	INC	7900 GARVEY AVE	None	ROSEMEAD	CA	91770	2419	19	06037	34.0625847	-118.0970623	Los Angeles County
98041	Fee-for-Service	1033786900	1033786900	1	1	DR WILLIAM HURTT FOOT AND AN	5/1/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	KLE CENTER CORPORATION	700 W OLIVE AVE	SUITE C	MERCED	CA	95348	2435	24	06047	37.31918006	-120.480202	Merced County
98085	Fee-for-Service	1033168034	1033168034	1	1	DEVEREUX FOUNDATION	2/13/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	1150 DEVEREUX DR	None	LEAGUE CITY	TX	77573	2043	00	None	29.50830975	-95.10612621	Galveston County
98100	Fee-for-Service	1588697387	1588697387	1	1	DIGESTIVE AND LIVER	3/3/2008	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	DISEASE SPECIALISTS	4111 MAINE AVE	None	BALDWIN PARK	CA	91706	3307	19	06037	34.08715391	-117.9604861	Los Angeles County
98102	Fee-for-Service	1629189394	1629189394	1	1	DEVEREUX, LIZA S	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
98106	Fee-for-Service	1841212081	1841212081	1	1	DUGGAN, BRIDGETTE D MD	3/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66287	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
98154	Fee-for-Service	1932447893	1932447893	1	1	DILLIKAR, ROOPA MD	4/5/2019	207R00000X	NA	Other	026	PHYSICIANS	133737	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	SUITE 167	FOUNTAIN VALLEY	CA	92708	7515	30	06059	33.71632048	-117.9334575	Orange County
98195	Fee-for-Service	1699936120	1699936120	1	1	DAVIS-MOORE, DENISE LCSW	8/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
98225	Fee-for-Service	1295239382	1295239382	1	1	DUH, ERICA D MD	5/4/2021	390200000X	NA	Other	026	PHYSICIANS	164348	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
98254	Fee-for-Service	1376787937	1376787937	1	1	DYER, ALISHA R DO	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11439	08	Family Practice	0	In state provider	None	2020 SUTTER PLACE	None	DAVIS	CA	95616	6217	57	06113	38.56287659	-121.7715536	Yolo County
98259	Fee-for-Service	1801967666	1801967666	1	1	DECAMBRE, MARVALYN E MD	2/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93958	34	Urology and Urological Surgery	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
98263	Fee-for-Service	1093206658	1093206658	1	1	DARWISH, MALIK MD	9/8/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	174088	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
98285	Fee-for-Service	1366685091	1366685091	1	2	DAILEY, ERIN A PSYD	12/1/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6828 BLACK OAK STREET	None	NICE	CA	95464	5464	17	06033	39.12446177	-122.8538554	Lake County
98304	Fee-for-Service	1629242532	1629242532	1	1	DR TRAN MEDICAL OFFICE	5/20/2008	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	7900 GARVEY AVE	None	ROSEMEAD	CA	91770	2419	19	06037	34.0625847	-118.0970623	Los Angeles County
98307	Fee-for-Service	1831576131	1831576131	1	1	DAVES, ALEXANDER DO	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
98340	Fee-for-Service	1205170453	1205170453	1	1	DE LEON, MABEL D CCC-SLP	8/10/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
98369	Fee-for-Service	1750906061	1750906061	1	1	DAVIS, CALEB A CNP	2/13/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
98379	Fee-for-Service	1780001776	1780001776	1	1	DEGESYS, NIDA F MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140973	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
98386	Fee-for-Service	1326309881	1326309881	1	1	DUONG, THU A MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127187	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
98391	Fee-for-Service	1841212081	1841212081	1	1	DUGGAN, BRIDGETTE D MD	3/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66287	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
98418	Fee-for-Service	1497731673	1497731673	1	1	DANIELSON, MATTHEW D MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	93533	30	Radiology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
98442	Fee-for-Service	1679630776	1679630776	2	1	DEIGNAN, PATRICIA E LCSW	5/15/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2496 E ST	2F	SAN DIEGO	CA	92102	6208	37	06073	32.71480484	-117.1404023	San Diego County
98552	Fee-for-Service	1255438925	1255438925	1	1	DRYAN, LISA M LCSW	5/9/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4164 BROCKTON AVE	None	RIVERSIDE	CA	92501	3400	33	06065	33.98077024	-117.3813862	Riverside County
98616	Fee-for-Service	1760917157	1760917157	1	1	DENNIS, STEVEN K MD	6/29/2022	390200000X	NA	Other	026	PHYSICIANS	157348	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
98667	Fee-for-Service	1215562897	1215562897	1	1	DEGENNARO, ANGIE E NP	9/18/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23180 HEMLOCK AVE	SUITE 201	MORENO VALLEY	CA	92557	8001	33	06065	33.94245952	-117.2585565	Riverside County
98668	Fee-for-Service	1669856654	1669856654	1	1	DING, ANNIE NP	5/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
98682	Fee-for-Service	1841212081	1841212081	1	1	DUGGAN, BRIDGETTE D MD	3/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66287	78	Neoplastic Diseases/Oncology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
98725	Fee-for-Service	1245409721	1245409721	1	1	DENNIS M GIROUX AND	1/9/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES INC	314 WEST 4TH STREET	None	OXNARD	CA	93030	5910	56	06111	34.1989635	-119.180308	Ventura County
98762	Fee-for-Service	1295990224	1295990224	1	1	DRIS, LAMIA MD	3/6/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122418	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
98763	Fee-for-Service	1891973467	1891973467	1	1	DIXON, FAYE J PHD	3/7/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
98810	Fee-for-Service	1619907359	1619907359	2	1	DEPOLO, JOHN L MD	12/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	22978	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 E MARCH LANE	SUITE C300	STOCKTON	CA	95210	6657	39	06077	38.00315652	-121.2868715	San Joaquin County
98831	Fee-for-Service	1447516919	1447516919	1	1	DULAI, AMANPREET K MD	9/16/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	172938	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
98874	Fee-for-Service	1457549776	1457549776	1	1	DONG, YASMINE K MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103669	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
98909	Fee-for-Service	1356315329	1356315329	1	1	DVA RENAL HEALTHCARE INC	9/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ENCINITAS DIALYSIS	332 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5143	37	06073	33.039567	-117.2850165	San Diego County
98935	Fee-for-Service	1316231020	1316231020	1	1	DESERT VIEW ENDOSCOPY CENTER	1/17/2013	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	12595 HESPERIA ROAD	STE 100	VICTORVILLE	CA	92395	5882	36	06071	34.47992741	-117.2908165	San Bernardino County
98959	Fee-for-Service	1013451673	1013451673	1	1	DELLAPIANA, GABRIELA MD	10/1/2022	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	146572	None	None	0	In state provider	None	8700 BEVERLY BLVD	# 3611	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
99011	Fee-for-Service	1851534259	1851534259	1	1	DA VANIA CLARK, MEGAN A PHD	11/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
99046	Fee-for-Service	1245791565	1245791565	1	1	DIAMOND CULTURAL FAMILY THER	5/28/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ONSULTING CENTER	12821 NEWPORT AVE	None	TUSTIN	CA	92780	2711	30	06059	33.75101941	-117.8093474	Orange County
99049	Fee-for-Service	1295990224	1295990224	1	1	DRIS, LAMIA MD	3/6/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122418	41	Internal Medicine	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
99058	Fee-for-Service	1871546010	1871546010	2	1	DECKER, JOSEPH H MD	8/30/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	11266	49	Unknown	0	In state provider	None	725 E SANTA CLARA ST	STE 202	SAN JOSE	CA	95112	1936	43	06085	37.34328626	-121.8756374	Santa Clara County
99078	Fee-for-Service	1528627189	1528627189	1	1	DANG, ALEXANDER N MD	10/16/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	177789	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
99080	Fee-for-Service	1104492321	1104492321	1	1	DINH, SON QUYEN H MD	8/26/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
99107	Fee-for-Service	1235456195	1235456195	1	1	DALAL, MONA V MD	7/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138303	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
99126	Fee-for-Service	1386135630	1386135630	1	1	DING, ELAINE PHD	3/3/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	R	5851 MISSION ST	None	SAN FRANCISCO	CA	94112	4017	38	06075	37.70914783	-122.4515964	San Francisco County
99133	Fee-for-Service	1558362467	1558362467	1	1	DAHLQUIST, GREGORY E	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56074	08	Family Practice	0	In state provider	None	4200 CHINO HILLS PKWY	STE 905	CHINO HILLS	CA	91709	3784	36	06071	33.98274451	-117.7129305	San Bernardino County
99140	Fee-for-Service	1336725365	1336725365	1	1	DUNNSIRI, TEEVIT T DO	8/2/2024	207R00000X	NA	Other	026	PHYSICIANS	22700	41	Internal Medicine	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
99148	Fee-for-Service	1992199160	1992199160	1	1	DIAGNOSTIC PATHOLOGY MEDICAL	9/28/2015	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP INC	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
99166	Fee-for-Service	1033101001	1033101001	1	1	DORIS, JAMES F MD	3/12/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56107	08	Family Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
99186	Fee-for-Service	1245547249	1245547249	1	1	DR ABRAHAMIAN FAMILY MEDICAL	6/2/1992	261QP2300X	NA	Other	026	PHYSICIANS	50782	01	General Practice	0	In state provider	CENTER INC	12507 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3135	19	06037	34.18670353	-118.405791	Los Angeles County
99222	Fee-for-Service	1578331732	1578331732	1	1	DORADO, KATRINA-GRACE	4/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
99223	Fee-for-Service	1588611263	1588611263	1	1	DUERR, ROBERT MD	8/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
99280	Fee-for-Service	1912273707	1912273707	1	1	DOVE-MAGUIRE, KALIE L MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129423	66	Emergency Medicine (Urgent Care)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
99291	Fee-for-Service	1316107774	1316107774	1	1	DIMAS, JUANITA M PHD	6/2/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
99330	Fee-for-Service	1790742146	1790742146	1	1	DUNCAN, DAVID W MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	59412	08	Family Practice	0	In state provider	None	999 S FAIRMONT AVE	STE 135	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
99333	Fee-for-Service	1245791565	1245791565	1	1	DIAMOND CULTURAL FAMILY THER	4/14/2025	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ONSULTING CENTER	12821 NEWPORT AVE	None	TUSTIN	CA	92780	2711	30	06059	33.75101941	-117.8093474	Orange County
99342	Fee-for-Service	1871546010	1871546010	2	1	DECKER, JOSEPH H MD	8/30/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	11266	18	Ophthalmology	0	In state provider	None	725 E SANTA CLARA ST	STE 202	SAN JOSE	CA	95112	1936	43	06085	37.34328626	-121.8756374	Santa Clara County
99384	Fee-for-Service	1790059350	1790059350	1	1	DARRAH, SUSAN C MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122296	05	Anesthesiology	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
99450	Fee-for-Service	1477513943	1477513943	1	1	DAHL, BARBARA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 W 9000 S	None	WEST JORDAN	UT	84088	8812	00	None	40.590153	-111.974634	Salt Lake County
99471	Fee-for-Service	1508822768	1508822768	1	1	DRUMMOND, PETER R DO	8/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	6699	41	Internal Medicine	0	In state provider	None	3132 W MARCH LN	None	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
99557	Fee-for-Service	1437445699	1437445699	1	1	DHILLON, AMRITA OD	1/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
99587	Fee-for-Service	1841687043	1841687043	1	1	DO, RUTH N DPM	5/7/2020	213ES0103X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
99613	Fee-for-Service	1487727657	1487727657	1	1	DIX, CORINNE R MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
99643	Fee-for-Service	1881713022	1881713022	1	1	DEVANEY-BURNS, STEPHANIE L M	5/15/2017	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	D	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
99663	Fee-for-Service	1043564198	1043564198	1	1	DAUBMD INC	3/22/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	9460 CUYAMACA STREET	SUITE 104	SANTEE	CA	92071	5921	37	06073	32.84923331	-116.9835047	San Diego County
99664	Fee-for-Service	1225553589	1225553589	1	1	DURAN, JESSICA P LMFT	8/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
99693	Fee-for-Service	1952344434	1952344434	1	1	DR MICHAEL ROSS MD	3/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST LUKE'S REGIONAL MD	520 S EAGLE RD	None	BOISE	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
99846	Fee-for-Service	1376504639	1376504639	1	1	DANDEKAR, ABHAY S MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68803	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
99868	Fee-for-Service	1225673072	1225673072	1	1	DAVIS, NICHOLAS PT	5/14/2020	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
99880	Fee-for-Service	1609852888	1609852888	1	1	DESAI, ASEEM D MD	3/1/1998	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60648	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
99883	Fee-for-Service	1619934916	1619934916	1	1	DUKE, DEREK A MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	14	Neurological Surgery	1	Border provider	None	3061 S MARYLAND PKWY	STE 200	LAS VEGAS	NV	89109	6227	00	None	36.134172	-115.1369265	Clark County
99887	Fee-for-Service	1740642610	1740642610	1	1	DE ASIS, CHRISCILE C MD	2/1/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
99892	Fee-for-Service	1154323715	1154323715	1	1	DERLET, MIKLA N MD	4/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77577	40	Pediatrics	0	In state provider	None	13975 MONO WAY	SUITE G	SONORA	CA	95370	2824	55	06109	37.97831488	-120.3396851	Tuolumne County
99939	Fee-for-Service	1265529259	1265529259	1	1	DORMAN, HENRY MD	2/28/1989	207RN0300X	NA	Nephrology	026	PHYSICIANS	46481	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
99950	Fee-for-Service	1043564198	1043564198	1	1	DAUBMD INC	3/22/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9460 CUYAMACA STREET	SUITE 104	SANTEE	CA	92071	5921	37	06073	32.84923331	-116.9835047	San Diego County
99989	Fee-for-Service	1720690217	1720690217	1	1	D&C ANGELS HOME CARE LLC	4/20/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1859 SHEDDEN DR	None	LOMA LINDA	CA	92354	1794	36	06071	34.067754	-117.2487415	San Bernardino County
100079	Fee-for-Service	1386606457	1386606457	1	1	DOMINGUEZ-JONES, JULIETA	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78899	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
100086	Fee-for-Service	1871851154	1871851154	1	1	DEJULIO, PAUL A	9/16/2024	208VP0000X	NA	Other	026	PHYSICIANS	175852	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
100125	Fee-for-Service	1134757016	1134757016	1	1	DOS SANTOS, AMANDA MD	7/3/2023	390200000X	NA	Other	026	PHYSICIANS	185156	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
100168	Fee-for-Service	1609852888	1609852888	1	1	DESAI, ASEEM D MD	3/1/1998	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	60648	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
100170	Fee-for-Service	1700534757	1700534757	1	1	DREWNO, JENNIFER L LMFT	2/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
100175	Fee-for-Service	1154498178	1154498178	1	1	DUDEK, RYSZARD R MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62405	45	Nephrology (Renal-Kidney)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
100201	Fee-for-Service	1497056154	1497056154	1	1	DUFFAUT, CALVIN J III MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114487	41	Internal Medicine	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
100237	Fee-for-Service	1043564198	1043564198	1	1	DAUBMD INC	3/22/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	9460 CUYAMACA STREET	SUITE 104	SANTEE	CA	92071	5921	37	06073	32.84923331	-116.9835047	San Diego County
100252	Fee-for-Service	1942353230	1942353230	1	1	DESILVA, GAYANI V MD	2/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	81916	36	Psychiatry	0	In state provider	None	2501 E CHAPMAN AVENUE	SUITE 301	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
100262	Fee-for-Service	1023093507	1023093507	1	1	DAN S ZUCKERMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
100291	Fee-for-Service	1235902800	1235902800	1	1	DR. VIDENNE SATH, OPTOMETRY	10/9/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ETRIC CENTER	3412 COLLEGE AVE	None	SAN DIEGO	CA	92115	7134	37	06073	32.741586	-117.0536265	San Diego County
100344	Fee-for-Service	1417947102	1417947102	1	1	DANG, VINCENT PAUL MD	6/30/1991	174400000X	NA	Other	026	PHYSICIANS	41282	66	Emergency Medicine (Urgent Care)	0	In state provider	None	14900 IMPERIAL HWY	None	LA MIRADA	CA	90638	2172	19	06037	33.91710433	-118.0132986	Los Angeles County
100361	Fee-for-Service	1962820597	1962820597	1	1	DE GUZMAN, JONATHAN M DPM	7/14/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3031 W MARCH LN	STE 310	STOCKTON	CA	95219	6562	39	06077	37.9842796	-121.3494311	San Joaquin County
100383	Fee-for-Service	1881668234	1881668234	1	1	DVA HEALTHCARE RENAL	2/12/1990	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1498 SOUTHGATE AVE	SUITE 101	DALY CITY	CA	94015	4015	41	06081	37.67558947	-122.4761175	San Mateo County
100400	Fee-for-Service	1659419307	1659419307	1	1	DEL ROSARIO MEDICAL	10/31/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC, INC	3400 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5835	19	06037	33.97216076	-118.2058415	Los Angeles County
100437	Fee-for-Service	1902839962	1902839962	1	7	DUMOLIN SERVICE CORP	10/8/1993	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3825 DOUGLAS DR	None	SANTA ROSA	CA	95405	7613	49	06097	38.437578	-122.6729205	Sonoma County
100454	Fee-for-Service	1336588623	1336588623	1	1	DAVE, AMAR M MD	5/18/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138428	None	None	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
100463	Fee-for-Service	1114075025	1114075025	1	1	DHAWAN, KAMAL P MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89903	36	Psychiatry	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100465	Fee-for-Service	1154498178	1154498178	1	1	DUDEK, RYSZARD R MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62405	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
100466	Fee-for-Service	1760483317	1760483317	2	2	DUR ENTERPRISE INC	8/15/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5353 BALBOA BLVD	STE 109	ENCINO	CA	91316	2862	19	06037	34.169067	-118.501128	Los Angeles County
100470	Fee-for-Service	1215371844	1215371844	1	1	DOMINIA, ROSEMARIE N NP	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	708353	-	NOT APPLICABLE	0	In state provider	None	433 TURK STREET	None	SAN FRANCISCO	CA	94102	3392	38	06075	37.78247225	-122.4163506	San Francisco County
100492	Fee-for-Service	1497056154	1497056154	1	1	DUFFAUT, CALVIN J III MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114487	40	Pediatrics	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
100554	Fee-for-Service	1427879444	1427879444	1	1	DUGGAN, SIERRA A BIRTH DOULA	12/5/2024	171M00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
100627	Fee-for-Service	1538194352	1538194352	1	1	DE LOS REYES, BERNARDITA	1/24/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	37605	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2760 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	19	06037	33.97370839	-118.2207184	Los Angeles County
100655	Fee-for-Service	1740203512	1740203512	1	1	DEMOS, DEBRA S MD	6/4/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40861	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
100660	Fee-for-Service	1386627644	1386627644	1	1	DO, LYNNE D MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88620	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
100711	Fee-for-Service	1972024701	1972024701	1	1	DAVE, SHIVALI PA	11/23/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
100748	Fee-for-Service	1780001974	1780001974	1	1	DCRUZ, GEOFFREY J MD	6/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141210	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
100756	Fee-for-Service	1326049727	1326049727	1	1	DO-DAI, DANIEL MD	9/19/2023	2085N0700X	NA	MRI Provider	026	PHYSICIANS	76480	None	None	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2302	19	06037	34.02980528	-118.4786605	Los Angeles County
100808	Fee-for-Service	1932106002	1932106002	1	1	DUNLAP, THOMAS E MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	44459	None	None	0	In state provider	None	3536 MENDOCINO AVE	STE 200	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
100819	Fee-for-Service	1699246470	1699246470	1	1	D'ALEXANDRIA HOSPICE INC	8/30/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1535 WEST MERCED AVE	SUITE 300	WEST COVINA	CA	91790	3417	19	06037	34.06295577	-117.9482872	Los Angeles County
100834	Fee-for-Service	1144256801	1144256801	1	1	DIAMOND BAR SURGERY	12/4/2006	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	1448 BRIDGEGATE DR	None	DIAMOND BAR	CA	91765	3922	19	06037	33.99590179	-117.8376511	Los Angeles County
100876	Fee-for-Service	1114189099	1114189099	1	1	DOBLUIS, EMILY S LMFT	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50978	-	NOT APPLICABLE	0	In state provider	None	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
100879	Fee-for-Service	1710982731	1710982731	1	1	DUVIVIER, HERBERT MD APC	1/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67229	78	Neoplastic Diseases/Oncology	0	In state provider	PREMIERE HEMATO/ONCOLOGY	2701 W ALAMEDA AVE	STE 503	BURBANK	CA	91505	4410	19	06037	34.15751343	-118.3303715	Los Angeles County
100884	Fee-for-Service	1821594540	1821594540	1	1	DROESSLER, JONATHAN T MD	4/19/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	164073	None	None	0	In state provider	None	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
100949	Fee-for-Service	1437824067	1437824067	1	1	DANI'S HELPING HANDS INC	7/11/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	108 REMINGTON DRIVE	None	FOLSOM	CA	95630	1500	34	06067	38.677275	-121.145013	Sacramento County
100967	Fee-for-Service	1336881291	1336881291	1	1	DONG, ELIZABETH E MD	4/22/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
100971	Fee-for-Service	1588910558	1588910558	1	1	DOAN, ANDREW MD	7/28/2017	2080P0207X	NA	Hematology	026	PHYSICIANS	142694	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
100985	Fee-for-Service	1316947351	1316947351	1	1	DIAMOND, LYNN M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40195	38	Geriatrics	0	In state provider	None	4200 CHINO HILLS PKWY	STE 905	CHINO HILLS	CA	91709	3784	36	06071	33.98274451	-117.7129305	San Bernardino County
101030	Fee-for-Service	1932690948	1932690948	1	1	DOWDY, ANGELA OT	5/31/2018	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1190 BURNETT AVE	SUITE D	CONCORD	CA	94520	5640	07	06013	37.97820603	-122.0557192	Contra Costa County
101059	Fee-for-Service	1235155938	1235155938	1	2	DOLAN, KRISTEN M	2/8/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	9705 HWY 267	STE 3	TRUCKEE	CA	96161	0348	29	06057	39.31645013	-120.1525915	Placer County
101075	Fee-for-Service	1568058477	1568058477	1	1	DELA CRUZ, ELENA	1/14/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1824 BASTONA DRIVE	None	ELK GROVE	CA	95758	7101	34	06067	38.422242	-121.4839935	Sacramento County
101081	Fee-for-Service	1174597033	1174597033	1	1	DVA HEALTHCARE RENAL	12/1/1977	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	125 E ARBOR VITAE ST	None	INGLEWOOD	CA	90301	3839	19	06037	33.95274752	-118.353663	Los Angeles County
101107	Fee-for-Service	1699246470	1699246470	1	1	D'ALEXANDRIA HOSPICE INC	8/30/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1535 WEST MERCED AVE	SUITE 300	WEST COVINA	CA	91790	3417	19	06037	34.06295577	-117.9482872	Los Angeles County
101125	Fee-for-Service	1144689175	1144689175	1	1	DACANAY-HERMAN, ROWENA NP	2/12/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
101163	Fee-for-Service	1538156245	1538156245	1	1	DO, LUAN K MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65161	41	Internal Medicine	0	In state provider	None	3500 5TH AVE	STE 307	SAN DIEGO	CA	92103	5020	37	06073	32.74173	-117.1604085	San Diego County
101167	Fee-for-Service	1710982731	1710982731	1	1	DUVIVIER, HERBERT MD APC	1/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67229	41	Internal Medicine	0	In state provider	PREMIERE HEMATO/ONCOLOGY	2701 W ALAMEDA AVE	STE 503	BURBANK	CA	91505	4410	19	06037	34.15751343	-118.3303715	Los Angeles County
101246	Fee-for-Service	1306039706	1306039706	1	1	DAVIS, ALEXANDER A MD INC	3/15/2016	261QM2500X	NA	Other	026	PHYSICIANS	67830	20	Orthopedic Surgery	0	In state provider	None	1401 SPANOS CT	STE 101	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
101249	Fee-for-Service	1811269806	1811269806	1	1	DANIELSON, ADAM M MD	7/13/2022	208M00000X	NA	Other	026	PHYSICIANS	156635	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
101251	Fee-for-Service	1851554208	1851554208	1	1	DIAN, SHAHAB	10/25/2022	207R00000X	NA	Other	026	PHYSICIANS	115541	None	None	0	In state provider	None	7202 MILLBROOK	105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
101276	Fee-for-Service	1316947351	1316947351	1	1	DIAMOND, LYNN M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40195	08	Family Practice	0	In state provider	None	4200 CHINO HILLS PKWY	STE 905	CHINO HILLS	CA	91709	3784	36	06071	33.98274451	-117.7129305	San Bernardino County
101298	Fee-for-Service	1255357315	1255357315	1	1	DASWANI, MOTI S MD INC.	4/1/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	3300 E SOUTH ST	STE 110	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
101308	Fee-for-Service	1679079958	1679079958	1	1	DARWISH, ALI G MD	1/18/2022	207R00000X	NA	Other	026	PHYSICIANS	173308	None	None	0	In state provider	None	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
101363	Fee-for-Service	1568058477	1568058477	1	1	DELA CRUZ, ELENA	1/14/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1824 BASTONA DRIVE	None	ELK GROVE	CA	95758	7101	34	06067	38.422242	-121.4839935	Sacramento County
101400	Fee-for-Service	1508392457	1508392457	1	1	DIKE, UZOAMAKA MD	9/3/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	1919 SANTA MONICA BLVD	STE 210	SANTA MONICA	CA	90604	1970	19	06037	34.0284492	-118.4803274	Los Angeles County
101406	Fee-for-Service	1740555630	1740555630	1	1	DIEU-AGLIPAY, MARIA PT	1/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 W ARROW HWY	130	SAN DIMAS	CA	91773	2330	19	06037	34.10677054	-117.8331379	Los Angeles County
101450	Fee-for-Service	1538156245	1538156245	1	1	DO, LUAN K MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65161	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3500 5TH AVE	STE 307	SAN DIEGO	CA	92103	5020	37	06073	32.74173	-117.1604085	San Diego County
101454	Fee-for-Service	1710982731	1710982731	1	1	DUVIVIER, HERBERT MD APC	1/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67229	68	Hematology	0	In state provider	PREMIERE HEMATO/ONCOLOGY	2701 W ALAMEDA AVE	STE 503	BURBANK	CA	91505	4410	19	06037	34.15751343	-118.3303715	Los Angeles County
101482	Fee-for-Service	1295448967	1295448967	1	1	DEERGRASS HEALTHCARE INC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	950 S FAIRMONT AVENUE	None	LODI	CA	95240	5131	39	06077	38.12153834	-121.2857963	San Joaquin County
101485	Fee-for-Service	1235682824	1235682824	1	1	DOCTOLERO, KIMBERLY DAWN M O	5/17/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	T	7313 WHITTIER AVE	None	WHITTIER	CA	90602	1132	19	06037	33.975027	-118.043219	Los Angeles County
101496	Fee-for-Service	1689628810	1689628810	1	1	DAVE, HARIKRSIHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
101505	Fee-for-Service	1093839813	1093839813	1	1	DE PERALTA, RUTH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41727	70	Clinic (mixed specialty)	0	In state provider	None	457 WYANDOTTE AVE	None	DALY CITY	CA	94014	2167	41	06081	37.69369497	-122.4599998	San Mateo County
101540	Fee-for-Service	1023107364	1023107364	1	1	DATE, ELAINE S MD	2/28/1987	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	50923	02	General Surgery	0	In state provider	None	525 UNIVERSITY AVE	STE 400	PALO ALTO	CA	94301	1903	43	06085	37.44861996	-122.1589531	Santa Clara County
101563	Fee-for-Service	1609944529	1609944529	1	1	DIDIO, LORI J PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
101584	Fee-for-Service	1255357315	1255357315	1	1	DASWANI, MOTI S MD INC.	4/1/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3300 E SOUTH ST	STE 110	LONG BEACH	CA	90805	4550	19	06037	33.86018093	-118.1537163	Los Angeles County
101620	Fee-for-Service	1932174844	1932174844	1	1	DVA HEALTHCARE RENAL CARE	9/29/1995	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	14014 MAGNOLIA ST	None	WESTMINSTER	CA	92683	4736	30	06059	33.75841062	-117.9723816	Orange County
101628	Fee-for-Service	1003545567	1003545567	1	1	DR DANA GIRARD CLINICAL PSYC	3/29/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HOLOGIST INC	1788 KANSAS ST	None	REDWOOD CITY	CA	94061	2635	41	06081	37.46030665	-122.2304988	San Mateo County
101707	Fee-for-Service	1063620367	1063620367	1	1	DAVIS, ARTHUR PSYD	2/16/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
101736	Fee-for-Service	1538156245	1538156245	1	1	DO, LUAN K MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65161	13	Neurology (M.D. only)	0	In state provider	None	3500 5TH AVE	STE 307	SAN DIEGO	CA	92103	5020	37	06073	32.74173	-117.1604085	San Diego County
101742	Fee-for-Service	1457570376	1457570376	1	1	DUKKIPATI, RAMANATH B MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88861	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	# 100	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
101781	Fee-for-Service	1134185887	1134185887	1	1	DUBE, MICHAEL P MD	7/16/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	55902	77	Infectious Disease	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
101792	Fee-for-Service	1861410581	1861410581	1	5	DIGNITY HEALTH MEDICAL	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	FOUNDATION	1617 N CALIFORNIA ST	STE 1E	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
101800	Fee-for-Service	1356850572	1356850572	1	1	DAN M KAHEN, DO APC	10/11/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	5504 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4104	19	06037	34.01907641	-118.1513095	Los Angeles County
101839	Fee-for-Service	1346768470	1346768470	1	1	DAUGHRITY, AMBER R LMFT	5/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
101914	Fee-for-Service	1699218776	1699218776	1	1	DERDERIAN, OKSANA CCC-SLP	8/22/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
101915	Fee-for-Service	1003545567	1003545567	1	1	DR DANA GIRARD CLINICAL PSYC	3/29/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	HOLOGIST INC	1788 KANSAS ST	None	REDWOOD CITY	CA	94061	2635	41	06081	37.46030665	-122.2304988	San Mateo County
101962	Fee-for-Service	1760264246	1760264246	1	1	DIVINE TRUTH UNITY FELLOWSHI	9/17/2024	172V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	330 D ST	421	SAN BERNARDINO	CA	92401	1545	36	06071	34.10508603	-117.2919187	San Bernardino County
102010	Fee-for-Service	1588130470	1588130470	1	1	DEOMPOC, LEXI NP	2/12/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
102012	Fee-for-Service	1124370051	1124370051	1	1	DELUCCHI, KAREN L LMFT	3/15/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	831 ALAMO DRIVE	SUITE 6C	VACAVILLE	CA	95688	5343	48	06095	38.34840279	-121.9987874	Solano County
102014	Fee-for-Service	1255330809	1255330809	1	1	DAMANIA, RUSTOM F MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	32213	41	Internal Medicine	0	In state provider	None	255 W BULLARD AVE	STE 113	CLOVIS	CA	93612	0861	10	06019	36.82308345	-119.714949	Fresno County
102040	Fee-for-Service	1154979870	1154979870	1	1	DUONG, KELVIN NP	2/10/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
102044	Fee-for-Service	1194024687	1194024687	1	1	DESAI, JYOTI V MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	1707 W CHARLESTON BLVD	STE 120	LAS VEGAS	NV	89102	2319	00	None	36.15879353	-115.1643015	Clark County
102146	Fee-for-Service	1497802094	1497802094	1	1	DE LA LLANA, ANDRES G	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54374	None	None	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
102188	Fee-for-Service	1598954562	1598954562	1	1	DAVIS, MARK H MD INC	3/31/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	42634	34	Urology and Urological Surgery	0	In state provider	None	1485 PARKWAY DR	None	CRESCENT CITY	CA	95531	8502	08	06015	41.77251006	-124.1848537	Del Norte County
102203	Fee-for-Service	1659449569	1659449569	1	1	DAMBOWIC, JUDITH C	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
102407	Fee-for-Service	1255678215	1255678215	1	1	DANG-VU, MILAN D MD	6/3/2022	207L00000X	NA	Other	026	PHYSICIANS	163245	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
102495	Fee-for-Service	1407960388	1407960388	1	1	DEFREEST,MELISSA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
102504	Fee-for-Service	1245674480	1245674480	1	1	DALLAS, KAI B MD	8/29/2020	208800000X	NA	Other	026	PHYSICIANS	131901	34	Urology and Urological Surgery	0	In state provider	None	4676 ADMIRALTY WAY	4TH FLOOR	MARINA DEL REY	CA	90292	6601	19	06037	33.98035311	-118.4403749	Los Angeles County
102551	Fee-for-Service	1578180618	1578180618	1	1	DEVAGUDI, DEEPTHI MD	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186617	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
102627	Fee-for-Service	1255477147	1255477147	1	1	DAVIS, JENNIFER OT	2/12/2025	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
102644	Fee-for-Service	1932135076	1932135076	1	1	DESROCHERS, ANN-RENEE	6/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98858	08	Family Practice	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5105	36	06071	34.130214	-117.2788065	San Bernardino County
102694	Fee-for-Service	1528534427	1528534427	1	1	DALE, HEATHER J LICENSED	11/27/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CLINICAL SOCIAL WORKER C	3500 ROSEHEDGE DR	None	FULLERTON	CA	92835	1628	30	06059	33.91164218	-117.9203516	Orange County
102721	Fee-for-Service	1326021619	1326021619	1	1	DIERCKS, DEBORAH B MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64890	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
102767	Fee-for-Service	1215223474	1215223474	1	1	DUBIN, STERLING M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123277	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
102799	Fee-for-Service	1609538834	1609538834	1	1	DEGUZMAN, CINDY CNP	3/4/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1720 S BASCOM AVE	None	CAMPBELL	CA	95008	0608	43	06085	37.292472	-121.9315815	Santa Clara County
102859	Fee-for-Service	1699180935	1699180935	1	1	DU GRAFF, DOROTHY MD	2/9/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14763	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
102869	Fee-for-Service	1548662190	1548662190	1	1	DEAL, DECEMBER CCC-SLP	6/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
102870	Fee-for-Service	1528190832	1528190832	1	1	DIABETIC FOOT & WOUND	6/18/2012	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	TREATMENT CENTERS	1553 GRAND AVENUE	SUITE B	SAN MARCOS	CA	92078	2427	37	06073	33.14507952	-117.1976581	San Diego County
102882	Fee-for-Service	1649760281	1649760281	1	1	DISTINCTIVE HOME HEALTH INC	5/22/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4502 DYER ST	SUITE 105	LA CRESCENTA	CA	91214	2857	19	06037	34.22533027	-118.2409842	Los Angeles County
102918	Fee-for-Service	1982048112	1982048112	1	1	DRIVER, TRACY Y MD	10/14/2020	207RR0500X	NA	Other	026	PHYSICIANS	133863	83	Rheumatology	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
102927	Fee-for-Service	1154757854	1154757854	1	1	DO, LOTUS LCSW	5/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
102949	Fee-for-Service	1497973184	1497973184	1	1	DUFFY, WILLIAM P MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31255	None	None	0	In state provider	None	3000 L ST	STE 210	SACRAMENTO	CA	95816	5248	34	06067	38.570517	-121.4672175	Sacramento County
102950	Fee-for-Service	1871796086	1871796086	1	1	DOMINGUEZ, DENNIS O MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	43179	08	Family Practice	0	In state provider	None	505 N MOLLISON AVE	STE 201	EL CAJON	CA	92021	6159	37	06073	32.80048689	-116.9509459	San Diego County
102951	Fee-for-Service	1750971446	1750971446	1	1	DR. DIANA TRAN-KIM CORP	1/26/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	11160 WARNER AVE	SUITE 301	FOUNTAIN VALLEY	CA	92708	4055	30	06059	33.71630854	-117.934317	Orange County
102959	Fee-for-Service	1215113618	1215113618	1	1	DOLAN, PATRICIA S LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
103001	Fee-for-Service	1417191925	1417191925	1	1	DUBLIN UNIFIED SD	3/25/2008	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	7471 LARKDALE AVE	None	DUBLIN	CA	94568	1500	01	06001	37.71633745	-121.9309027	Alameda County
103018	Fee-for-Service	1245356427	1245356427	1	1	DALE, ELIZABETH E	7/1/1998	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4926 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	6102	19	06037	34.10174551	-118.2970215	Los Angeles County
103097	Fee-for-Service	1740312446	1740312446	1	1	DEANGELIS, GINA M MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95572	None	None	0	In state provider	None	400 PROFESSIONAL CNTR DR	SUITE 424	NOVATO	CA	94947	4367	21	06041	38.09591405	-122.5779059	Marin County
103098	Fee-for-Service	1528198934	1528198934	1	1	DOEZIE, ALLEN M MD	2/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69209	02	General Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
103117	Fee-for-Service	1972853893	1972853893	1	1	DRIEMEYER, LINDSAY OT	11/10/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
103142	Fee-for-Service	1710050810	1710050810	1	1	DOYLE, WILLIAM A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
103143	Fee-for-Service	1063444883	1063444883	1	1	DR STUART HANDELSMAN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NORTH ATLANTA KIDNEY	980 JOHNSON FERRY RD	None	ATLANTA	GA	30342	0000	00	None	33.90785725	-84.35538974	Fulton County
103162	Fee-for-Service	1881631711	1881631711	1	2	DERMATOLOGY SPECIALISTS INC	8/31/1990	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	SURGICAL/MEDICAL GROUP	838 NORDAHL RD	250	SAN MARCOS	CA	92069	1005	37	06073	33.13569751	-117.1191477	San Diego County
103209	Fee-for-Service	1982048112	1982048112	1	1	DRIVER, TRACY Y MD	10/14/2020	207RR0500X	NA	Other	026	PHYSICIANS	133863	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
103232	Fee-for-Service	1184712168	1184712168	1	1	DUTTA, SUJAY	9/1/2000	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	85674	41	Internal Medicine	0	In state provider	None	2220 LYNN RD	STE 301	THOUSAND OAKS	CA	91360	8005	56	06111	34.20863046	-118.8852156	Ventura County
103236	Fee-for-Service	1871796086	1871796086	1	1	DOMINGUEZ, DENNIS O MD	11/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	43179	01	General Practice	0	In state provider	None	505 N MOLLISON AVE	STE 201	EL CAJON	CA	92021	6159	37	06073	32.80048689	-116.9509459	San Diego County
103252	Fee-for-Service	1922693563	1922693563	1	1	DECENA, KATHLYN-ANN O OT	7/6/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
103289	Fee-for-Service	1417191925	1417191925	1	1	DUBLIN UNIFIED SD	1/24/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	7471 LARKDALE AVE	None	DUBLIN	CA	94568	1500	01	06001	37.71633745	-121.9309027	Alameda County
103312	Fee-for-Service	1295230563	1295230563	1	1	DILLY, JOO-HYE P MD	8/3/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165121	None	None	0	In state provider	None	2901 N VENTURA RD	SUITE 100	OXNARD	CA	93036	1126	56	06111	34.24479149	-119.1814409	Ventura County
103321	Fee-for-Service	1386675445	1386675445	1	1	DILLMANN, WOLFGANG MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	33658	67	Endocrinology	0	In state provider	UCSD DE OF MEDICINE	225 DICKINSON ST	STE H20	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
103322	Fee-for-Service	1992199954	1992199954	1	1	DO, MICHAEL MD	6/11/2019	390200000X	NA	Other	026	PHYSICIANS	148388	05	Anesthesiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
103351	Fee-for-Service	1821095662	1821095662	1	1	DR. HARJEET KOHLI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3735 NAZARETH RD	STE 3	EASTON	PA	18045	8338	00	None	40.71157012	-75.28182598	Northampton County
103375	Fee-for-Service	1336215607	1336215607	2	1	DIEHL, PAUL E MD	11/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44437	41	Internal Medicine	0	In state provider	None	7320 WOODLAKE AVE	SUITE 270	WEST HILLS	CA	91307	1470	19	06037	34.20245266	-118.6321273	Los Angeles County
103390	Fee-for-Service	1366529448	1366529448	1	1	DHALIWAL, KAMALBIR K MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101102	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
103413	Fee-for-Service	1053385971	1053385971	1	1	DUDEE,JITANDER S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2459 NICHOLASVILLE RD	None	LEXINGTON	KY	40503	0000	00	None	38.00201656	-84.51994072	Fayette County
103460	Fee-for-Service	1316109937	1316109937	1	1	DORMAN, CHERYL LMFT	5/17/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	15224	-	NOT APPLICABLE	0	In state provider	None	23390 HEMLOCK AVE	None	MORENO VALLEY	CA	92557	8805	33	06065	33.94254348	-117.2538957	Riverside County
103484	Fee-for-Service	1174043681	1174043681	1	1	DAVENPORT, GREGORY P LMFT	11/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
103523	Fee-for-Service	1306900980	1306900980	1	1	DEDIOS, JENNIFER G MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55085	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS ROAD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
103532	Fee-for-Service	1447280144	1447280144	1	1	DO, TRANG U MD INC	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	76681	41	Internal Medicine	0	In state provider	None	2114 SENTER RD	STE 15	SAN JOSE	CA	95112	2608	43	06085	37.31161529	-121.8513661	Santa Clara County
103573	Fee-for-Service	1982975488	1982975488	1	1	DONESKY, DORANNE M NP	8/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
103582	Fee-for-Service	1962444570	1962444570	1	1	DESAI, KUSUM MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129590	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3551 Q ST	STE 100	BAKERSFIELD	CA	93301	1638	15	06029	35.392059	-119.010556	Kern County
103583	Fee-for-Service	1982227823	1982227823	1	1	DCB OPTOMETRY, INC	10/28/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12819 VALLEY VIEW AVE	None	LA MIRADA	CA	90638	1945	19	06037	33.91521727	-118.0293935	Los Angeles County
103591	Fee-for-Service	1083002257	1083002257	1	1	DESERT MOUNTAIN MEDICAL	8/31/2015	193400000X	NA	Other	026	PHYSICIANS	6319	41	Internal Medicine	0	In state provider	GROUP INC	16049 TUSCOLA ROAD	SUITE B	APPLE VALLEY	CA	92307	0824	36	06071	34.542837	-117.2692605	San Bernardino County
103753	Fee-for-Service	1043875461	1043875461	1	1	DAULAT, AASHISH J DO	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20235	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
103778	Fee-for-Service	1811958895	1811958895	1	1	DOUGHERTY, KATHLEEN C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 UNIVERSITY DR	None	HERSHEY	PA	17033	0000	00	None	40.26440258	-76.67394583	Dauphin County
103843	Fee-for-Service	1639534365	1639534365	1	1	DR STACEY LE OD APC	5/12/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	807 W GRAND BLVD	STE A	CORONA	CA	92882	3264	33	06065	33.87379603	-117.5737828	Riverside County
103871	Fee-for-Service	1962444570	1962444570	1	1	DESAI, KUSUM MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129590	41	Internal Medicine	0	In state provider	None	3551 Q ST	STE 100	BAKERSFIELD	CA	93301	1638	15	06029	35.392059	-119.010556	Kern County
103902	Fee-for-Service	1366500522	1366500522	1	1	DELAFIELD, JUDITH P MD	8/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	48086	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
103913	Fee-for-Service	1295746972	1295746972	1	1	DOSIK, GARY M MD	2/18/1982	207RH0003X	NA	Oncology	026	PHYSICIANS	39314	None	None	0	In state provider	None	16311 VENTURA BLVD	STE 780	ENCINO	CA	91436	4327	19	06037	34.15706864	-118.4885978	Los Angeles County
103976	Fee-for-Service	1053593095	1053593095	1	1	DEPASQUALE, EUGENE C MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122141	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
103994	Fee-for-Service	1679733927	1679733927	1	1	DARGON, PHONG T MD	6/4/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	128212	70	Clinic (mixed specialty)	0	In state provider	None	15030 7TH ST.	None	VICTORVILLE	CA	92395	3811	36	06071	34.52471945	-117.3042336	San Bernardino County
104103	Fee-for-Service	1356425425	1356425425	1	1	DELFANTI, JOHN B MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	55829	04	Otology, Laryngology, Rhinology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
104118	Fee-for-Service	1477969079	1477969079	1	1	DELAROSA, JESSICA LCSW	10/13/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	673 S AUBURN ST	STE B	GRASS VALLEY	CA	95945	7576	29	06057	39.2060146	-121.0613316	Nevada County
104140	Fee-for-Service	1316095110	1316095110	1	1	DIAB, SAMIR S MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52204	40	Pediatrics	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
104165	Fee-for-Service	1477790590	1477790590	1	1	DARIN AHLERS TRANSPORT INC	3/28/2008	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	1281 HASSETT AVE	STE A	YUBA CITY	CA	95991	7228	51	06101	39.10925049	-121.6139895	Sutter County
104190	Fee-for-Service	1497732911	1497732911	1	1	DAWSON, MICHAEL J MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55255	None	None	0	In state provider	None	5110 W GOLDLEAF CIR	None	LOS ANGELES	CA	90056	1282	19	06037	33.98790164	-118.367233	Los Angeles County
104265	Fee-for-Service	1053593095	1053593095	1	1	DEPASQUALE, EUGENE C MD	10/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122141	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
104306	Fee-for-Service	1477829661	1477829661	1	1	DOREMUS, BRITTANY A DO	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12983	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
104335	Fee-for-Service	1720398985	1720398985	1	1	DICKEY, JAMES W III MD INC	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	37842	02	General Surgery	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
104353	Fee-for-Service	1881631711	1881631711	1	5	DERMATOLOGY SPECIALISTS INC	6/30/1993	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	A SURGICAL MEDICAL GROUP	25495 MEDICAL CENTER DR	STE 200	MURRIETA	CA	92562	4903	33	06065	33.55804188	-117.1834064	Riverside County
104405	Fee-for-Service	1942457999	1942457999	1	1	DIWAN, SHILPA P MD	5/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134348	36	Psychiatry	0	In state provider	None	441 N. LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
104408	Fee-for-Service	1770635575	1770635575	1	1	DEFISHER, IRINA SC MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40015	01	General Practice	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
104447	Fee-for-Service	1841711249	1841711249	1	1	DARMANI, MARIAM DO	10/4/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15536	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
104463	Fee-for-Service	1346681293	1346681293	1	1	DE LA CRUZ, MELVIN P MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143139	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
104467	Fee-for-Service	1467522482	1467522482	1	1	DOERZBACHER, KELLY J MD	8/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106787	05	Anesthesiology	0	In state provider	None	1801 HANOVER DR	SUITE F	DAVIS	CA	95616	1067	57	06113	38.55895232	-121.7567316	Yolo County
104480	Fee-for-Service	1750961322	1750961322	1	1	DEVITO, JULIA R MD	3/7/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183641	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
104517	Fee-for-Service	1295096873	1295096873	1	1	DEQUATTRO, KIMBERLY A MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128565	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
104560	Fee-for-Service	1194799650	1194799650	1	2	DOUGLAS, GREGORY	9/2/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39164	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9281 OFFICE PARK CIRCLE	STE 120	ELK GROVE	CA	95758	8069	34	06067	38.418264	-121.39641	Sacramento County
104612	Fee-for-Service	1770077828	1770077828	1	1	DILJAK, STEPHAN MD	9/25/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
104658	Fee-for-Service	1881631711	1881631711	1	5	DERMATOLOGY SPECIALISTS INC	6/30/1993	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	A SURGICAL MEDICAL GROUP	25495 MEDICAL CENTER DR	STE 200	MURRIETA	CA	92562	4903	33	06065	33.55804188	-117.1834064	Riverside County
104663	Fee-for-Service	1518444579	1518444579	1	1	DURAN, MELINDA A LCSW	6/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8075 W. 3RD STREET	306	LOS ANGELES	CA	90048	4318	19	06037	34.07210461	-118.3655242	Los Angeles County
104704	Fee-for-Service	1619242708	1619242708	1	1	DAVE, PREETI N MD	10/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120596	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
104714	Fee-for-Service	1346750171	1346750171	1	1	DAN M KAHEN, DO APC	2/28/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1146 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3538	19	06037	33.8923084	-118.2954064	Los Angeles County
104724	Fee-for-Service	1699753046	1699753046	2	1	DRUCKER, MARK MD	2/1/2022	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1855 SAN MIGUEL DR	#28	WALNUT CREEK	CA	94596	5214	07	06013	37.89490348	-122.0529351	Contra Costa County
104731	Fee-for-Service	1831752138	1831752138	1	1	DESHPANDE, RASIKA R MD	3/27/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180946	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
104747	Fee-for-Service	1396812103	1396812103	1	1	DAVIS, BRENT R MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62762	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
104757	Fee-for-Service	1689723439	1689723439	1	1	DEVELOPMENTAL CLIENT	8/7/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INDUSTRIES INC	13434 REINDEER ST	None	MORENO VALLEY	CA	92553	3291	33	06065	33.9258235	-117.247011	Riverside County
104826	Fee-for-Service	1528139383	1528139383	1	1	DOHIL, MAGDALENE A MD	7/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86265	07	Dermatology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
104844	Fee-for-Service	1780761718	1780761718	1	1	DE GUZMAN, MARILYN M DO	10/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10190	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
104846	Fee-for-Service	1558989673	1558989673	1	1	DOUROS, VAGELIS T MD	2/22/2024	208M00000X	NA	Other	026	PHYSICIANS	187594	None	None	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
104847	Fee-for-Service	1568081586	1568081586	1	1	DEMPSEY, LESLIE	6/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
104883	Fee-for-Service	1669753315	1669753315	1	1	DIXON, KATHERINE R MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122393	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
104905	Fee-for-Service	1447271242	1447271242	1	1	DEY, SAMUEL E MD	9/16/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	54997	36	Psychiatry	0	In state provider	None	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	33	06065	33.95782448	-117.3904065	Riverside County
104922	Fee-for-Service	1467436113	1467436113	1	1	DURAND, CURTISS J MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	28314	01	General Practice	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
104935	Fee-for-Service	1558493189	1558493189	1	1	DETCH, ROBERT C MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	86859	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR	None	STANFORD	CA	94035	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
104943	Fee-for-Service	1225319700	1225319700	1	1	DEYAL, SARA J OT	6/22/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
104967	Fee-for-Service	1023048865	1023048865	1	1	DJOKIC, MIROSLAV MD INC	9/26/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	87463	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE C300	STOCKTON	CA	95210	6674	39	06077	38.00315652	-121.2868715	San Joaquin County
104976	Fee-for-Service	1598734204	1598734204	1	1	DWAYNE DETURK	12/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	119 W IRON AVE	FL 5	SALINA	KS	67401	2600	00	None	38.84052466	-97.61007206	Saline County
104988	Fee-for-Service	1205967064	1205967064	1	1	DEEMINTER, RENINA T LMFT	10/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5800 HANNUM AVE	105	CULVER CITY	CA	90230	6553	19	06037	33.98724995	-118.3858338	Los Angeles County
105020	Fee-for-Service	1992705230	1992705230	1	1	DJUKIC, SRDJAN MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51055	30	Radiology	0	In state provider	None	1239 MCHENERY AVE	STE A	MODESTO	CA	95350	5330	50	06099	37.66148527	-120.9939207	Stanislaus County
105031	Fee-for-Service	1457439226	1457439226	1	1	DAWSON, KATHERINE G MD	2/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71985	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
105035	Fee-for-Service	1144274531	1144274531	1	1	DEMAIO, ERIN F MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83498	01	General Practice	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
105049	Fee-for-Service	1699119289	1699119289	1	1	DOSHI, NEETI V MD	5/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135497	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
105090	Fee-for-Service	1124037171	1124037171	1	1	DR DWIGHT HOOD	4/7/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5520 4TH ST	None	LUBBOCK	TX	79416	4220	00	None	33.59240097	-101.9339615	Lubbock County
105113	Fee-for-Service	1528139383	1528139383	1	1	DOHIL, MAGDALENE A MD	7/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86265	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
105131	Fee-for-Service	1255331385	1255331385	1	1	DU, LIANJIE MD AMC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84426	36	Psychiatry	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
105140	Fee-for-Service	1932945557	1932945557	1	1	DHANANI CORPORATION	8/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2345 E 8TH ST	STE 108	NATIONAL CITY	CA	91950	2863	37	06073	32.68268563	-117.082682	San Diego County
105150	Fee-for-Service	1316331069	1316331069	1	1	DIAZ, CINDELLE L OT	7/8/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
105159	Fee-for-Service	1093740680	1093740680	1	1	DIXON, VARONICA B MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68653	40	Pediatrics	0	In state provider	None	245 TERRACINA BLVD	STE 202	REDLANDS	CA	92373	4867	36	06071	34.03858912	-117.2066515	San Bernardino County
105211	Fee-for-Service	1467436113	1467436113	1	1	DURAND, CURTISS J MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	28314	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
105223	Fee-for-Service	1649202011	1649202011	1	1	DYNER, LAURA L MD	2/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88531	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
105226	Fee-for-Service	1669788980	1669788980	1	1	DOVES DIALYSIS LLC	12/1/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	9850 CARMEL MOUNTAIN RD	# A-D	SAN DIEGO	CA	92129	2892	37	06073	32.95999076	-117.1152181	San Diego County
105234	Fee-for-Service	1235185620	1235185620	1	1	DE SA, WATSON A MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	32717	41	Internal Medicine	0	In state provider	None	3801 KATELLA AVE	STE 125	LOS ALAMITOS	CA	90720	3338	30	06059	33.80318951	-118.066068	Orange County
105237	Fee-for-Service	1669509063	1669509063	1	1	DE GOLIA, SALLIE GRANT	5/31/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	77447	36	Psychiatry	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
105240	Fee-for-Service	1952600207	1952600207	1	1	DOS SANTOS, DAMIAN D MD	10/29/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
105255	Fee-for-Service	1821191305	1821191305	1	1	DESJARDIN,JEFFREY A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WESTERN INFECTIOUS-	DISEASE CONSULTANTS	3885 UPHAM STR STE 200	WHEAT RIDGE	CO	80033	0000	00	None	0	0	None
105259	Fee-for-Service	1629412614	1629412614	1	1	DEOGRACIAS, REINA T DPM	8/29/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	795 E SECOND ST	STE 7	POMONA	CA	91766	2007	19	06037	34.05845654	-117.7423951	Los Angeles County
105272	Fee-for-Service	1578118766	1578118766	1	1	DAVIS, ARLETTE G LMFT	1/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 N 15TH WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
105285	Fee-for-Service	1417059346	1417059346	1	1	DUMARS, KAREN L MD	11/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81054	13	Neurology (M.D. only)	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
105339	Fee-for-Service	1487626032	1487626032	1	1	DEMERS, GERARD DO	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11662	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
105391	Fee-for-Service	1154852119	1154852119	1	1	DIAZ, LAURA Q NP	8/7/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
105401	Fee-for-Service	1255861522	1255861522	1	1	DHILLON, POOJA S MD	7/21/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	160938	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
105455	Fee-for-Service	1861563843	1861563843	1	1	DRYJANSKY-YANOVSKY, JOSE	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42482	77	Infectious Disease	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
105472	Fee-for-Service	1801961412	1801961412	1	1	DEPENDABLE CARE	10/11/1993	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION, INC	639 N FAIRFAX AVE	FL 2	LOS ANGELES	CA	90036	1714	19	06037	34.082829	-118.361556	Los Angeles County
105486	Fee-for-Service	1285701136	1285701136	1	1	DINERMAN, CHARLES J MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72584	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
105503	Fee-for-Service	1255707493	1255707493	1	1	DHINSA, SUKHVIR K NP	3/5/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
105514	Fee-for-Service	1477574010	1477574010	1	1	DURAN, MARGARITA LCSW	10/19/2007	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	722 FREMONT AVE	None	SOUTH PASADENA	CA	91030	2530	19	06037	34.116939	-118.1530725	Los Angeles County
105523	Fee-for-Service	1235185620	1235185620	1	1	DE SA, WATSON A MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	32717	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3801 KATELLA AVE	STE 125	LOS ALAMITOS	CA	90720	3338	30	06059	33.80318951	-118.066068	Orange County
105527	Fee-for-Service	1376856450	1376856450	1	1	DEMARCO VOLTZ, ALICIA A MD	12/10/2019	2080P0203X	NA	Other	026	PHYSICIANS	125973	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
105557	Fee-for-Service	1821057480	1821057480	1	1	DAVID L WASSELL MD	7/25/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1703 N BUERKLE ST	None	STUTTGART	AR	72160	3153	00	None	34.517799	-91.5583365	Arkansas County
105743	Fee-for-Service	1235601295	1235601295	1	1	DAMANAKIS, DENISE CNP	8/23/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	45 N MILPITAS BLVD	None	MILPITAS	CA	95035	4402	43	06085	37.43408286	-121.9005444	Santa Clara County
105747	Fee-for-Service	1861563843	1861563843	1	1	DRYJANSKY-YANOVSKY, JOSE	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42482	47	Miscellaneous	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
105751	Fee-for-Service	1497910129	1497910129	1	1	DR THOMAS TSENG MEDICAL	9/1/1998	207R00000X	NA	Other	026	PHYSICIANS	6968	41	Internal Medicine	0	In state provider	CLINIC INC	880 S ATLANTIC AVE	STE 208	MONTEREY PARK	CA	91754	4728	19	06037	34.05038485	-118.1383456	Los Angeles County
105754	Fee-for-Service	1205155363	1205155363	1	1	DALY, PAUL M MFT	6/1/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48320	-	NOT APPLICABLE	0	In state provider	None	976 LENZEN AVE	1ST FLOOR	SAN JOSE	CA	95126	2737	43	06085	37.33463902	-121.9121497	Santa Clara County
105824	Fee-for-Service	1255572194	1255572194	1	1	DE LA MOTA PEYNADO, JOSE M M	2/13/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	148339	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	D	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
105851	Fee-for-Service	1215978176	1215978176	1	1	DANON, GUY D DPM	8/1/1988	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1045 ATLANTIC AVE	STE 807	LONG BEACH	CA	90813	3414	19	06037	33.780267	-118.1850795	Los Angeles County
105909	Fee-for-Service	1245871136	1245871136	1	1	DIANA FINNEGAN	7/3/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	68733 PEREZ ROAD	STE C-14	CATHEDRAL CITY	CA	92234	7223	33	06065	33.7842997	-116.4631858	Riverside County
105914	Fee-for-Service	1548697204	1548697204	1	1	DORAN, JULIE L H LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
105923	Fee-for-Service	1538115290	1538115290	1	1	DO, HENRY D MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77453	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
106049	Fee-for-Service	1528190832	1528190832	1	2	DIABETIC FOOT & WOUND	6/18/2012	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	TREATMENT CENTERS	1600 S IMPERIAL AVENUE	SUITE 3	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
106075	Fee-for-Service	1174253454	1174253454	1	1	DATOR, ISABELA CCC-SLP	3/14/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	380 MELROSE DR	315	VISTA	CA	92081	6641	37	06073	33.19121306	-117.2537723	San Diego County
106076	Fee-for-Service	1417997925	1417997925	1	1	DIGNITY HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3400 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7956	34	06067	38.584575	-121.294782	Sacramento County
106080	Fee-for-Service	1629248067	1629248067	1	1	DOZIER, TAWNYA L MD	4/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95732	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
106101	Fee-for-Service	1700851870	1700851870	1	1	DUNHAM, ROBERT H MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74484	02	General Surgery	0	In state provider	None	3434 VILLA LANE	SUITE 260	NAPA	CA	94558	6415	28	06055	38.32515937	-122.2938358	Napa County
106110	Fee-for-Service	1750649919	1750649919	1	1	DHILLON, GURPREET S MD	6/17/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	168488	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
106151	Fee-for-Service	1750522991	1750522991	1	1	DYE, DESIREE S	6/29/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
106215	Fee-for-Service	1003087313	1003087313	1	1	DOWNEY CARDIO MEDICAL GROUP	3/18/1987	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11544 DOWNEY AVE	None	DOWNEY	CA	90241	4955	19	06037	33.93652705	-118.1353448	Los Angeles County
106253	Fee-for-Service	1578717302	1578717302	1	1	DEIMLING, KIMBERLY S	2/2/2009	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0725	36	06071	34.5406159	-117.2658221	San Bernardino County
106261	Fee-for-Service	1881643534	1881643534	1	1	DERDEMEZI, JEANETTE MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51982	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
106278	Fee-for-Service	1619198298	1619198298	1	1	DAO, MIMI T DO	12/6/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	9235	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
106286	Fee-for-Service	1811029168	1811029168	1	1	DIAS, COLIN P MD	5/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84321	36	Psychiatry	0	In state provider	None	1520 SAN PABLO ST	HCT 1652	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
106310	Fee-for-Service	1770710485	1770710485	1	1	DETORA, ADAM W MD	5/12/2017	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	148002	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
106316	Fee-for-Service	1437210523	1437210523	1	1	DELANEY-NEVES, KAREN	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
106324	Fee-for-Service	1972181485	1972181485	1	1	DESAI, JINIT MD	8/15/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
106361	Fee-for-Service	1417997925	1417997925	1	1	DIGNITY HEALTH	12/31/2005	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3400 DATA DRIVE	None	RANCHO CORDOVA	CA	95670	7956	34	06067	38.584575	-121.294782	Sacramento County
106379	Fee-for-Service	1639648009	1639648009	1	1	DEMPSEY, SHANNON PT	9/26/2022	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
106390	Fee-for-Service	1700851870	1700851870	1	1	DUNHAM, ROBERT H MD	4/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	74484	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3434 VILLA LANE	SUITE 260	NAPA	CA	94558	6415	28	06055	38.32515937	-122.2938358	Napa County
106401	Fee-for-Service	1619317856	1619317856	1	1	DELACRUZ, RYAN B DO	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13121	08	Family Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
106417	Fee-for-Service	1992748214	1992748214	1	1	DUNFORD, JAMES MD	7/1/1987	207P00000X	NA	Other	026	PHYSICIANS	34860	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
106442	Fee-for-Service	1881687960	1881687960	1	4	DIABETES AND ENDOCRINE	10/27/1999	193400000X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	ASSOCIATES	1745 S IMPERIAL AVE	STE 114	EL CENTRO	CA	92243	4243	13	06025	32.77792365	-115.569499	Imperial County
106486	Fee-for-Service	1720068000	1720068000	1	1	DODD, MICHAEL J	1/1/1997	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	APPLIED ORTHOTICS & PROS	2577 SAMARITAN DR	STE 765	SAN JOSE	CA	95124	4109	43	06085	37.25246494	-121.9501879	Santa Clara County
106489	Fee-for-Service	1710035530	1710035530	1	1	DO LIEN, THI MD	10/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80318	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
106493	Fee-for-Service	1114032885	1114032885	1	1	DAVID LARSEN, MD	11/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
106494	Fee-for-Service	1164637153	1164637153	1	1	DELENGOCKY, TAYSON DO	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12784	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1452 S LA BRUCHERIE RD	STE A	EL CENTRO	CA	92243	9676	13	06025	32.78015511	-115.578482	Imperial County
106505	Fee-for-Service	1003087313	1003087313	1	1	DOWNEY CARDIO MEDICAL GROUP	3/18/1987	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11544 DOWNEY AVE	None	DOWNEY	CA	90241	4955	19	06037	33.93652705	-118.1353448	Los Angeles County
106519	Fee-for-Service	1932387586	1932387586	1	1	DURMASHKIN, YANA A MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104801	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
106599	Fee-for-Service	1316599004	1316599004	1	1	DARWISH, SONJA M MD	6/26/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	182238	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
106634	Fee-for-Service	1801829528	1801829528	1	1	DINICOLA, ALBERT F MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	61028	01	General Practice	0	In state provider	None	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	30	06059	33.71118647	-117.885452	Orange County
106654	Fee-for-Service	1174805279	1174805279	1	1	DAS, SOURAV MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140660	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
106682	Fee-for-Service	1407044456	1407044456	1	1	DUNAGAN, MELISSA S MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104929	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
106704	Fee-for-Service	1629067327	1629067327	1	2	DEJESUS, DENNIS MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
106718	Fee-for-Service	1487662573	1487662573	1	1	DURKIN, ANDREW P MD	5/5/1995	2085N0904X	NA	Other	026	PHYSICIANS	21883	30	Radiology	0	In state provider	None	480 MONTEREY AVE	None	LOS GATOS	CA	95030	5303	43	06085	37.23190465	-121.9808305	Santa Clara County
106742	Fee-for-Service	1114065117	1114065117	1	1	DRISCOLL, MICHAEL E DO	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6528	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
106779	Fee-for-Service	1245312107	1245312107	1	1	DANDAMUDI, SATYA N MD	1/31/1985	207R00000X	NA	Other	026	PHYSICIANS	32157	41	Internal Medicine	0	In state provider	None	44215 15TH ST W	STE 103	LANCASTER	CA	93534	5503	19	06037	34.68666415	-118.1568572	Los Angeles County
106805	Fee-for-Service	1669706123	1669706123	1	1	DESAI, RIMPLE M MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123041	05	Anesthesiology	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
106828	Fee-for-Service	1427078781	1427078781	1	1	DIAZ, JOSE M MD	8/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76805	40	Pediatrics	0	In state provider	None	9315 TELEGRAPH RD	None	PICO RIVERA	CA	90660	5424	19	06037	33.95706394	-118.1042161	Los Angeles County
106836	Fee-for-Service	1265920052	1265920052	1	1	DASTMALCHI, YALDA S MD	11/3/2021	207P00000X	NA	Other	026	PHYSICIANS	173634	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
106844	Fee-for-Service	1396783585	1396783585	1	1	DANG, MARK M MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76922	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25405 HANCOCK AVE	STE 216	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
106875	Fee-for-Service	1528123759	1528123759	1	1	DITOMAS, MICHELE E MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79322	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	RM 4F	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
106888	Fee-for-Service	1053593657	1053593657	1	1	DAUPHIN-BAPTISTE, ROSELINE	1/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55469	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	191 SOUTH BUENA VISTA ST	STE 475	BURBANK	CA	91505	4554	19	06037	34.15872557	-118.3283863	Los Angeles County
106912	Fee-for-Service	1326122268	1326122268	1	1	DOLACK, LEE G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4011 TALBOT RD S	STE 500	RENTON	WA	98055	5782	00	None	47.44331246	-122.2117632	King County
106943	Fee-for-Service	1194034959	1194034959	1	1	DELGADO, ADOLPH THOMAS	4/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
106944	Fee-for-Service	1124110309	1124110309	1	1	DELANEY, LESLIE R MD	6/26/2000	208VP0000X	NA	Other	026	PHYSICIANS	85784	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
106957	Fee-for-Service	1215192497	1215192497	1	1	DOSUNMU, OLADOYIN B MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115862	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
107061	Fee-for-Service	1780893495	1780893495	1	1	DUBIN, RUTH F MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103670	41	Internal Medicine	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
107068	Fee-for-Service	1477612091	1477612091	1	1	DO, BAO-KHANH Q MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90094	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
107071	Fee-for-Service	1578798369	1578798369	1	1	DUNAVIN, NEIL C MD	10/8/2019	207RH0000X	NA	Hematology	026	PHYSICIANS	162772	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107073	Fee-for-Service	1801160874	1801160874	1	1	DARFLINGER, ROBERT J MD	6/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119657	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
107088	Fee-for-Service	1568540037	1568540037	1	1	DAVIS, AUDREY J MD	9/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79917	02	General Surgery	0	In state provider	None	3100 SUMMIT ST	None	OAKLAND	CA	94609	3410	01	06001	37.82018974	-122.2643221	Alameda County
107113	Fee-for-Service	1215076914	1215076914	1	1	DUBERNET, TERESA MD	3/31/1992	207RH0000X	NA	Hematology	026	PHYSICIANS	51675	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
107116	Fee-for-Service	1427078781	1427078781	1	1	DIAZ, JOSE M MD	8/1/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76805	08	Family Practice	0	In state provider	None	9315 TELEGRAPH RD	None	PICO RIVERA	CA	90660	5424	19	06037	33.95706394	-118.1042161	Los Angeles County
107135	Fee-for-Service	1275901738	1275901738	1	1	DETWILER, DANA W CRNA	6/3/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
107187	Fee-for-Service	1164674248	1164674248	1	1	DARYA SOTO MD INC	7/29/2022	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES OF MARIN	100 ROWLAND WAY	STE 300	NOVATO	CA	94945	5009	21	06041	38.09698106	-122.5587348	Marin County
107226	Fee-for-Service	1316119449	1316119449	1	1	DEAN, ALINA MD	4/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116312	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
107355	Fee-for-Service	1477612091	1477612091	1	1	DO, BAO-KHANH Q MD	11/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90094	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
107470	Fee-for-Service	1407845852	1407845852	1	1	DESHMUKH, RASHMI S MD	10/24/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	83933	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	#223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
107484	Fee-for-Service	1992989578	1992989578	1	1	DINH, NHON MD	12/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	30	06059	33.89691672	-117.9291749	Orange County
107518	Fee-for-Service	1417213869	1417213869	1	1	DOMANSKI, KRISTINA H MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 SOUTH MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
107680	Fee-for-Service	1538245071	1538245071	1	1	DANIELS, BETTY R S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	46150	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
107750	Fee-for-Service	1932131307	1932131307	1	1	DAMORE, ANTHONY J MD	11/27/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	12987	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15899 LOS GATOS ALMADEN	None	LOS GATOS	CA	95032	3739	43	06085	37.24342542	-121.9487944	Santa Clara County
107757	Fee-for-Service	1023680014	1023680014	1	1	DANNER, KAITLYN MD	9/18/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
107770	Fee-for-Service	1992989578	1992989578	1	1	DINH, NHON MD	12/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	85591	08	Family Practice	0	In state provider	None	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	30	06059	33.89691672	-117.9291749	Orange County
107777	Fee-for-Service	1992066500	1992066500	1	1	DUNNE, AMBER C PSYD	11/28/2022	101YA0400X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
107805	Fee-for-Service	1235261538	1235261538	1	1	DRY, SHELLI OT	2/21/2025	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
107806	Fee-for-Service	1982099263	1982099263	1	1	DELGADILLO, JAMES Q MD	8/1/2019	207P00000X	NA	Other	026	PHYSICIANS	159284	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
107826	Fee-for-Service	1518591247	1518591247	1	1	DIAZ, DIANNA	1/16/2025	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
107830	Fee-for-Service	1932305000	1932305000	1	1	DOMICO, MICHELE B MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83525	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
107832	Fee-for-Service	1922339175	1922339175	1	1	DREYER, JERROLD MD INC	1/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	31161	41	Internal Medicine	0	In state provider	None	4835 VAN NUYS BLVD	SUITE 109	SHERMAN OAKS	CA	91403	2134	19	06037	34.1587068	-118.4487394	Los Angeles County
107888	Fee-for-Service	1194840231	1194840231	1	1	DAVIS, CHARLES R MD	8/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41219	08	Family Practice	0	In state provider	None	1241 CARLSBAD VILLAGE DR	# 207	CARLSBAD	CA	92008	1960	37	06073	33.16424532	-117.3405818	San Diego County
107994	Fee-for-Service	1720458987	1720458987	1	1	DONAHUE, BRIDGETTE PT	11/4/2022	2251P0200X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
108032	Fee-for-Service	1467466409	1467466409	1	1	DEJONG, CLAYTON	9/1/1995	207R00000X	NA	Other	026	PHYSICIANS	42912	41	Internal Medicine	0	In state provider	None	300 REDONDO AVE	None	LONG BEACH	CA	90814	2651	19	06037	33.768324	-118.152404	Los Angeles County
108059	Fee-for-Service	1669933552	1669933552	1	1	DU, EMILY MD	9/1/2023	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	181493	None	None	0	In state provider	None	101 LAGUNA RD	STE 100	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
108087	Fee-for-Service	1982910295	1982910295	1	1	DIABLO NEUROLOGY INC	1/13/2011	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	970 DEWING AVE	STE 300	LAFAYETTE	CA	94549	4280	07	06013	37.89042853	-122.1235399	Contra Costa County
108093	Fee-for-Service	1699888610	1699888610	1	1	DENIGRIS, STEPHEN J MD	9/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	87469	10	Gastroenterology (M.D. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
108100	Fee-for-Service	1295891224	1295891224	1	1	DAVIDSON, JONATHAN S	8/25/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	66389	None	None	0	In state provider	None	4213 DALE RD	None	MODESTO	CA	95350	2454	50	06099	37.701621	-121.050099	Stanislaus County
108106	Fee-for-Service	1912214404	1912214404	1	1	DEL GAVIO, SARAH LCSW	8/26/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
108144	Fee-for-Service	1679669014	1679669014	1	1	DESAI, MIHIR M MD	1/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54801	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
108160	Fee-for-Service	1649492547	1649492547	1	1	DR.SCOTT OBERLIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10820 PARKSIDE DRIVE	None	KNOXVILLE	TN	37934	0000	00	None	35.90003918	-84.14416556	Knox County
108181	Fee-for-Service	1962794776	1962794776	1	1	DAVIS, FIONNA LCSW	10/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
108208	Fee-for-Service	1598732604	1598732604	1	1	DAHI, HOUMAN MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	98386	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
108209	Fee-for-Service	1952463754	1952463754	1	1	DENNIS L MYERS CPO	10/1/2010	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1665 W KATELLA AVE	None	ANAHEIM	CA	92802	3053	30	06059	33.80327652	-117.9400365	Orange County
108222	Fee-for-Service	1609249523	1609249523	1	1	DIAMOND HOSPICE SERVICES INC	10/24/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18411 CRENSHAW BLVD	STE 110	TORRANCE	CA	90504	5078	19	06037	33.86333387	-118.3265193	Los Angeles County
108227	Fee-for-Service	1477595395	1477595395	1	1	DOGGETT, REUBEN S MD	10/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41035	22	Pathology (M.D. only)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
108278	Fee-for-Service	1366805822	1366805822	1	1	DIGNITY HOME HEALTH INC	12/18/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5300 SANTA MONICA BLVD	STE 412	LOS ANGELES	CA	90029	1260	19	06037	34.09075271	-118.305509	Los Angeles County
108284	Fee-for-Service	1477671535	1477671535	1	4	DIGNITY HEALTH	7/2/2008	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	2625 EDITH AVENUE	STE B	REDDING	CA	96001	3040	45	06089	40.5711638	-122.3974245	Shasta County
108306	Fee-for-Service	1346278967	1346278967	1	1	DOBSON, ANTHONY T MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84486	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
108309	Fee-for-Service	1508070566	1508070566	1	1	DHOOT, DILSHER S MD	7/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119711	18	Ophthalmology	0	In state provider	None	515 E MICHELTORENA ST	STE C	SANTA BARBARA	CA	93103	4223	42	06083	34.43172339	-119.7024817	Santa Barbara County
108332	Fee-for-Service	1609224369	1609224369	1	1	DASON, ADLEY C MD	11/30/2020	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	153116	None	None	0	In state provider	None	24785 STEWART ST	STE 111	LOMA LINDA	CA	92350	1721	36	06071	34.0538151	-117.2632755	San Bernardino County
108349	Fee-for-Service	1902839962	1902839962	1	4	DUMOLIN SERVICE CORP	3/28/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1450 VELMA AVE	None	SANTA ROSA	CA	95403	7208	49	06097	38.452203	-122.7658905	Sonoma County
108374	Fee-for-Service	1235845959	1235845959	1	1	DL CARE FACILITY LLC	8/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ON COMPASS	21302 COMPASS LN	None	HUNTINGTON BEACH	CA	92646	7217	30	06059	33.6530916	-117.9635962	Orange County
108377	Fee-for-Service	1982910295	1982910295	1	1	DIABLO NEUROLOGY INC	1/13/2011	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	970 DEWING AVE	STE 300	LAFAYETTE	CA	94549	4280	07	06013	37.89042853	-122.1235399	Contra Costa County
108379	Fee-for-Service	1346536711	1346536711	1	1	DOSANJH, BALTEJ S MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127059	01	General Practice	0	In state provider	None	1209 WOODROW AVE	SUITE B-10	MODESTO	CA	95350	1273	50	06099	37.68575206	-121.0112235	Stanislaus County
108382	Fee-for-Service	1245673896	1245673896	1	1	DESA, NOLAN S MD	7/10/2019	208600000X	NA	General Surgery	026	PHYSICIANS	160199	02	General Surgery	0	In state provider	None	1040 ELM AVE	STE 100	LONG BEACH	CA	90813	3265	19	06037	33.779799	-118.1879535	Los Angeles County
108404	Fee-for-Service	1508582610	1508582610	1	1	DZIKOWSKI, ALEXANDRA C NP	12/29/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6001B TRUXTUN	220	BAKERSFIELD	CA	93309	0611	15	06029	35.36254873	-119.0727158	Kern County
108433	Fee-for-Service	1013681840	1013681840	1	1	DELLINGER, KORI NP	2/10/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
108439	Fee-for-Service	1780029082	1780029082	1	1	DEL ROSARIO, KARINA M MD	7/10/2017	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	133240	20	Orthopedic Surgery	0	In state provider	None	1001 POTRERO AVE	RM 3A36	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
108490	Fee-for-Service	1598732604	1598732604	1	1	DAHI, HOUMAN MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	98386	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
108510	Fee-for-Service	1609249523	1609249523	1	1	DIAMOND HOSPICE SERVICES INC	10/24/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18411 CRENSHAW BLVD	STE 110	TORRANCE	CA	90504	5078	19	06037	33.86333387	-118.3265193	Los Angeles County
108532	Fee-for-Service	1235155938	1235155938	1	1	DOLAN, KRISTEN M	10/21/2004	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	68 E CENTRAL AVE	STE 1B	QUINCY	CA	95971	9718	32	06063	39.93638081	-120.9358748	Plumas County
108533	Fee-for-Service	1518344878	1518344878	1	1	DEGMETICH, SEAN MD	7/10/2023	2086S0127X	NA	General Surgery	026	PHYSICIANS	146573	None	None	0	In state provider	None	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
108541	Fee-for-Service	1508438532	1508438532	1	1	DOYLEY, MELISSA M	2/9/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
108548	Fee-for-Service	1184684219	1184684219	1	1	DIDDIE, KENNETH R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33939	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	None	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
108557	Fee-for-Service	1922514504	1922514504	1	1	DEGENAAR, DEIRDRE RN CNM	6/20/2022	163W00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1220 HEMLOCK WAY	200	SANTA ANA	CA	92707	3655	30	06059	33.70975375	-117.8842792	Orange County
108566	Fee-for-Service	1992752406	1992752406	1	1	DE LLANO, CARMEN	8/1/1989	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 CAMINO DEL RIO S	STE 335	SAN DIEGO	CA	92108	4002	37	06073	32.77756386	-117.1185135	San Diego County
108586	Fee-for-Service	1427079383	1427079383	1	1	DOMTEK MED & ALLIED SVCS	7/11/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DOMTECK MED & ALLIED	2930 WEST IMPERIAL HWY	SUITE 200-1	INGLEWOOD	CA	90303	3142	19	06037	33.93087352	-118.32534	Los Angeles County
108629	Fee-for-Service	1295974483	1295974483	1	1	DASTOURI, POUYA MD	12/3/2019	208600000X	NA	General Surgery	026	PHYSICIANS	142271	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
108636	Fee-for-Service	1366731960	1366731960	1	1	DIEHL, JOSEPH W MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124317	07	Dermatology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 450, 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
108691	Fee-for-Service	1700986908	1700986908	3	1	DIGGS, STEPHEN M PHD	10/1/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	572 RIO LINDO AVE	STE 108	CHICO	CA	95926	1851	04	06007	39.75508407	-121.8487933	Butte County
108711	Fee-for-Service	1255508123	1255508123	1	1	DINTYALA, VENKATA N K MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131454	01	General Practice	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92227	3221	33	06065	33.763572	-116.4056895	Riverside County
108716	Fee-for-Service	1457307084	1457307084	1	1	DROR, YAARA MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51335	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
108718	Fee-for-Service	1609166750	1609166750	1	1	DUELL-STEPHENS, DEBORAH LMFT	2/14/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	427 A ST	STE 400	LINCOLN	CA	95648	1976	31	06061	38.89076065	-121.2851473	Placer County
108757	Fee-for-Service	1225198617	1225198617	1	1	DOI, SUSAN C PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
108780	Fee-for-Service	1598732604	1598732604	1	1	DAHI, HOUMAN MD	6/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	98386	01	General Practice	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
108834	Fee-for-Service	1750407334	1750407334	1	1	DIVI, VASU MD	7/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121464	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
108852	Fee-for-Service	1649255332	1649255332	1	1	DOUGHERTY, SARA E MD	8/13/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69860	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
108909	Fee-for-Service	1558794909	1558794909	1	1	DESOUCY, RENEE D NP	11/24/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
108968	Fee-for-Service	1376801134	1376801134	1	1	DENNY, ASHLEIGH MD	10/14/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178084	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
108980	Fee-for-Service	1376699918	1376699918	1	1	DOAN, HUNG D MD	10/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	45781	01	General Practice	0	In state provider	None	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	19	06037	33.985584	-118.256433	Los Angeles County
109031	Fee-for-Service	1295325009	1295325009	1	1	DAMUS, MELANIE OT	10/31/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
109050	Fee-for-Service	1619130655	1619130655	1	1	DEMETERCO-BERGGREN,	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98629	40	Pediatrics	0	In state provider	CARLA MD	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
109057	Fee-for-Service	1447887807	1447887807	1	1	DE LA PENA EYE CLINIC, A MED	7/2/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	ICAL GROUP, INC	10942 RAMONA BLVD	STE A	EL MONTE	CA	91731	2644	19	06037	34.07199583	-118.0369162	Los Angeles County
109105	Fee-for-Service	1568593168	1568593168	1	2	DRAKE, MELINDA G LCSW	9/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13902 FIJI WAY	119	MARINA DEL REY	CA	90292	6922	19	06037	33.96998703	-118.4458222	Los Angeles County
109129	Fee-for-Service	1528045358	1528045358	1	1	DIBERNARDO, LOUIS M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73815	08	Family Practice	0	In state provider	None	1230 W 3RD ST	None	LOS ANGELES	CA	90017	1408	19	06037	34.05723342	-118.259093	Los Angeles County
109271	Fee-for-Service	1316647027	1316647027	1	1	DIAVATIS, NATALIA PSYD	8/22/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
109294	Fee-for-Service	1730590779	1730590779	1	1	DREYER, CYNTHIA A	4/3/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	28891 MOUNTAIN VIEW LANE	None	TRABUCO CANYON	CA	92679	1018	30	06059	33.68044961	-117.6268433	Orange County
109298	Fee-for-Service	1588070056	1588070056	1	1	DASYAM, SRAVYA MD	10/1/2017	207R00000X	NA	Other	026	PHYSICIANS	148113	41	Internal Medicine	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
109319	Fee-for-Service	1467417980	1467417980	1	1	DALL'ERA, MARIA C MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68468	83	Rheumatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109322	Fee-for-Service	1376897223	1376897223	1	1	DOBBINS, EMMA MD	8/30/2022	207R00000X	NA	Other	026	PHYSICIANS	177991	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
109337	Fee-for-Service	1962727156	1962727156	1	1	DAVOUDPOUR, RAMONA MD	6/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121397	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
109338	Fee-for-Service	1619130655	1619130655	1	1	DEMETERCO-BERGGREN,	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98629	67	Endocrinology	0	In state provider	CARLA MD	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
109345	Fee-for-Service	1447887807	1447887807	1	1	DE LA PENA EYE CLINIC, A MED	7/2/2020	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP, INC	10942 RAMONA BLVD	STE A	EL MONTE	CA	91731	2644	19	06037	34.07199583	-118.0369162	Los Angeles County
109378	Fee-for-Service	1164063400	1164063400	1	1	DELICATE CARE HOSPICE INC	12/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	417 ARDEN AVE	STE 115	GLENDALE	CA	91203	4048	19	06037	34.15847866	-118.2621835	Los Angeles County
109453	Fee-for-Service	1730644543	1730644543	1	1	DICKEY, BRANDY E LMFT	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1406 GIBSON AVE	None	CLOVIS	CA	93611	1416	10	06019	36.8258015	-119.690766	Fresno County
109477	Fee-for-Service	1275146219	1275146219	1	1	DELGARDO, AVRIL	7/7/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8504 FIRESTONE BLVD STE	380	DOWNEY	CA	90241	4926	19	06037	33.93808746	-118.1295242	Los Angeles County
109482	Fee-for-Service	1417454323	1417454323	1	1	DEL VALLE, MICHAEL B MD	8/17/2023	207P00000X	NA	Other	026	PHYSICIANS	187544	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
109507	Fee-for-Service	1881326015	1881326015	1	2	DE LUZ FAMILY COUNSELING CEN	5/18/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	TER	31569 CANYON ESTATES DR	SUITE 105	LAKE ELSINORE	CA	92532	0475	33	06065	33.6671373	-117.3012532	Riverside County
109518	Fee-for-Service	1336709278	1336709278	1	1	DIBIASE, FLORENCE A MD	9/15/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	188995	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
109521	Fee-for-Service	1922549880	1922549880	1	1	DOUBLE BLACK BUSINESS	6/28/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	VENTURES LLC	3535 FARQUHAR AVE	11	LOS ALAMITOS	CA	90720	3937	30	06059	33.7995055	-118.07109	Orange County
109577	Fee-for-Service	1730590779	1730590779	1	1	DREYER, CYNTHIA A	4/3/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	28891 MOUNTAIN VIEW LANE	None	TRABUCO CANYON	CA	92679	1018	30	06059	33.68044961	-117.6268433	Orange County
109609	Fee-for-Service	1467417980	1467417980	1	1	DALL'ERA, MARIA C MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68468	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109616	Fee-for-Service	1376129148	1376129148	1	1	DR.JENNIFER HUBERT, INC	6/20/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4357 MONTGOMERY DRIVE	SUITE G	SANTA ROSA	CA	95405	5304	49	06097	38.45727	-122.67216	Sonoma County
109623	Fee-for-Service	1649632878	1649632878	1	1	DEAVER, KENNETH A MD	3/30/2021	207R00000X	NA	Other	026	PHYSICIANS	167908	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
109637	Fee-for-Service	1346778032	1346778032	1	1	DE HERRERA JACOBO, CENYASEN	9/10/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	T PHD	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
109650	Fee-for-Service	1053809160	1053809160	1	1	DAHL, CHASE G DPM	1/23/2024	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 3100	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
109667	Fee-for-Service	1164063400	1164063400	1	1	DELICATE CARE HOSPICE INC	12/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	417 ARDEN AVE	STE 115	GLENDALE	CA	91203	4048	19	06037	34.15847866	-118.2621835	Los Angeles County
109670	Fee-for-Service	1841605334	1841605334	1	1	DE BERITTO, THEODORE MD	3/23/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	150192	40	Pediatrics	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
109716	Fee-for-Service	1023018850	1023018850	1	1	DURAN, ROBERT MD	6/25/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST MARY'S HOSPITAL	1601 W SAINT MARYS RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
109760	Fee-for-Service	1558406538	1558406538	1	1	DICK, MICHAEL S MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96147	30	Radiology	0	In state provider	None	6191 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.826362	-119.7831265	Fresno County
109803	Fee-for-Service	1376656405	1376656405	1	1	DAVID E TSONG MD INC	9/23/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	17822 BEACH BLVD	352	HUNTINGTON BEACH	CA	92647	7176	30	06059	33.70331388	-117.9890471	Orange County
109822	Fee-for-Service	1124015706	1124015706	1	1	DESAI, AJAY S MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85497	30	Radiology	0	In state provider	None	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
109827	Fee-for-Service	1578667093	1578667093	1	1	DIMUNDO, JULIE F DO	5/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8572	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
109863	Fee-for-Service	1083669170	1083669170	1	1	DAVIS, ALEXANDER A MD	5/20/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	67830	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95350	1159	50	06099	37.668645	-120.9756715	Stanislaus County
109873	Fee-for-Service	1770266298	1770266298	1	1	DURBIN, KELLY PHD	9/14/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
109884	Fee-for-Service	1760483317	1760483317	2	1	DUR ENTERPRISE INC	2/7/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5353 BALBOA BLVD	None	ENCINO	CA	91316	2804	19	06037	34.169067	-118.501128	Los Angeles County
109905	Fee-for-Service	1356370837	1356370837	1	1	DEAMANT, CATHERINE D MD	8/11/2017	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	88148	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
109911	Fee-for-Service	1487071312	1487071312	1	1	DAS, SHRUTEE BHATT AU	9/27/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	26726 CROWN VALLEY PKWY	STE 210	MISSION VIEJO	CA	92691	8006	30	06059	33.56385623	-117.6639538	Orange County
109914	Fee-for-Service	1548448970	1548448970	1	1	DUNN, ROBERTA J MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99540	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
109946	Fee-for-Service	1144497678	1144497678	1	4	DIGNITY HEALTH MEDICAL	9/12/2012	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
109997	Fee-for-Service	1912288432	1912288432	1	12	DIGNITY HEALTH MEDICAL FOUND	8/8/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	-NORTH STATE INC	2510 AIRPARK DR	STE 106	REDDING	CA	96001	2449	45	06089	40.57119566	-122.4016582	Shasta County
110020	Fee-for-Service	1346092830	1346092830	1	1	DUDA, OLENA BIRTH DOULA	3/13/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
110034	Fee-for-Service	1235103599	1235103599	1	1	DVA RENAL HEALTHCARE INC	1/1/1999	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3126 PROFESSIONAL DR	SUITE 100 & 150	AUBURN	CA	95603	2411	31	06061	38.94088683	-121.1007646	Placer County
110067	Fee-for-Service	1669406849	1669406849	1	1	DANHAUER, JEFFREY L PHD	8/15/1981	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	AUDIOLOGIST	8806 FRIENDSHIP AVE	None	PICO RIVERA	CA	90660	1623	19	06037	34.01772794	-118.0823434	Los Angeles County
110113	Fee-for-Service	1225063811	1225063811	1	1	DOMINGUEZ, DENNIS O MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	43179	01	General Practice	0	In state provider	None	505 N MOLLISON AVE	STE 201	EL CAJON	CA	92021	6159	37	06073	32.80048689	-116.9509459	San Diego County
110134	Fee-for-Service	1144661497	1144661497	1	1	DE LA TORRE, CHERYL I OD	9/16/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 NAGLEE RD	STE 8A	TRACY	CA	95304	7324	39	06077	37.75489119	-121.4665269	San Joaquin County
110243	Fee-for-Service	1720837065	1720837065	1	1	DERAS, LESLIE E	8/13/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	5138 GEARY BLVD	None	SAN FRANCISCO	CA	94118	2816	38	06075	37.78062909	-122.4746273	San Francisco County
110245	Fee-for-Service	1144497678	1144497678	1	4	DIGNITY HEALTH MEDICAL	1/27/2023	193400000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
110337	Fee-for-Service	1730189093	1730189093	1	1	DU, LETICIA Y MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	49363	40	Pediatrics	0	In state provider	None	41238 MARGARITA RD	STE 106	TEMECULA	CA	92591	5552	33	06065	33.52503669	-117.1490127	Riverside County
110341	Fee-for-Service	1265584965	1265584965	1	1	DE LARA, BARBARA K MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93535	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
110381	Fee-for-Service	1871516492	1871516492	1	1	DIAZ, NATALIE MD	12/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86649	None	None	0	In state provider	None	300 MEDICAL PLAZA STE B2	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
110389	Fee-for-Service	1154392421	1154392421	1	1	DEVEREAUX, ASHA V MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51614	41	Internal Medicine	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
110401	Fee-for-Service	1225063811	1225063811	1	1	DOMINGUEZ, DENNIS O MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	43179	08	Family Practice	0	In state provider	None	505 N MOLLISON AVE	STE 201	EL CAJON	CA	92021	6159	37	06073	32.80048689	-116.9509459	San Diego County
110458	Fee-for-Service	1942630173	1942630173	1	1	DERAKHSHANI, AHRYA F MD MPH	3/23/2020	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	167466	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
110476	Fee-for-Service	1013565258	1013565258	1	1	DHURI, SAYALI A PT	4/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6850 BROCKTON AVE	STE 212	RIVERSIDE	CA	92506	3808	33	06065	33.9493261	-117.3967206	Riverside County
110489	Fee-for-Service	1164079562	1164079562	1	1	DOCTORS MATTHEW ALPERT AND J	8/11/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2867 AGOURA RD	None	WESTLAKE VILLAGE	CA	91361	3218	56	06111	34.1501976	-118.8244431	Ventura County
110498	Fee-for-Service	1316365265	1316365265	1	1	DOWNING, ASIA D	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154671	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
110510	Fee-for-Service	1679641096	1679641096	1	1	DIXON-BROWN, MARILYN M CCC-A	5/25/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
110523	Fee-for-Service	1144497678	1144497678	1	4	DIGNITY HEALTH MEDICAL	3/21/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
110527	Fee-for-Service	1528018843	1528018843	1	2	DIXON, NEAL P MD	10/27/1988	208600000X	NA	General Surgery	026	PHYSICIANS	46609	02	General Surgery	0	In state provider	None	3901 LAS POSAS RD	STE 204	CAMARILLO	CA	93010	1505	56	06111	34.2415821	-119.0183756	Ventura County
110544	Fee-for-Service	1669509378	1669509378	1	1	DIXON, MITRA MD	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108692	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
110555	Fee-for-Service	1679930481	1679930481	1	1	DEVGAN, ARVIND P	5/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
110565	Fee-for-Service	1427240126	1427240126	1	1	DOLINSKY, DAVID M MD	6/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114860	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
110636	Fee-for-Service	1437867900	1437867900	1	1	DALIA DAWOUD MD INC	8/1/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	S	4200 CHINO HILLS PKWY	STE 800	CHINO HILLS	CA	91709	3785	36	06071	33.98274451	-117.7129305	San Bernardino County
110683	Fee-for-Service	1154392421	1154392421	1	1	DEVEREAUX, ASHA V MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51614	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92118	1943	37	06073	32.69409033	-117.1680508	San Diego County
110708	Fee-for-Service	1689367666	1689367666	1	1	DEL PORTILLO, CARLOS-MIGUEL	5/26/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
110822	Fee-for-Service	1235370107	1235370107	1	3	DEUS DIGNITAS INC	9/25/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22 LOWER RAGSDALE DR	SUITE B	MONTEREY	CA	93940	5775	27	06053	36.57430903	-121.8104339	Monterey County
110869	Fee-for-Service	1306904982	1306904982	1	1	DRAGO, ROSE A MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	63784	36	Psychiatry	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
110922	Fee-for-Service	1437867900	1437867900	1	1	DALIA DAWOUD MD INC	3/7/2025	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	S	4200 CHINO HILLS PKWY	STE 800	CHINO HILLS	CA	91709	3785	36	06071	33.98274451	-117.7129305	San Bernardino County
110931	Fee-for-Service	1861849093	1861849093	1	1	DEBENTZ INC	8/16/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	536 BARSTOW ROAD	None	BARSTOW	CA	92311	2908	36	06071	34.893666	-117.0229155	San Bernardino County
110939	Fee-for-Service	1396796371	1396796371	1	1	DO, KATRINA T	1/28/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11105 KNOTT AVE	STE A-B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
110940	Fee-for-Service	1144497678	1144497678	1	5	DIGNITY HEALTH MEDICAL	9/12/2012	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1321 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
110957	Fee-for-Service	1699980243	1699980243	1	1	DAVIS-NELSON,SHAREECE A MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97214	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
110971	Fee-for-Service	1750397691	1750397691	1	1	DOUNG, ANN TO DO	9/6/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4403 S VERMONT AVE	None	LOS ANGELES	CA	90037	2413	19	06037	34.00342736	-118.2915892	Los Angeles County
110979	Fee-for-Service	1790855955	1790855955	1	1	DANA, FARSHAD MD	6/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84390	41	Internal Medicine	0	In state provider	None	701 E CHANNEL ST	None	STOCKTON	CA	95202	2628	39	06077	37.95604528	-121.2821834	San Joaquin County
110984	Fee-for-Service	1598992000	1598992000	1	1	DUFFIELD, ADRIENNE B MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123978	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
110993	Fee-for-Service	1578192043	1578192043	1	1	DYAL, SIMRIT S MD	9/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188408	None	None	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
110999	Fee-for-Service	1811187685	1811187685	1	1	DUNHAM, PATTIE J LMFT	2/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
111054	Fee-for-Service	1467409250	1467409250	1	1	DASKALAKIS, THEODOROS MD	11/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90653	02	General Surgery	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
111060	Fee-for-Service	1952784860	1952784860	1	1	DOMINGUEZ, KRISTIN N DO	5/6/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	18080	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
111062	Fee-for-Service	1447290861	1447290861	1	1	DIMITROV, DRAGAN F MD	4/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82908	13	Neurology (M.D. only)	0	In state provider	None	12 UPPER RAGSDALE DR	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
111077	Fee-for-Service	1861952632	1861952632	1	1	DYKES, KAITLYN C	5/14/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	177929	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
111085	Fee-for-Service	1588127930	1588127930	1	1	DHILLON, SHELLEY MD	1/28/2025	207RR0500X	NA	Other	026	PHYSICIANS	179613	83	Rheumatology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
111108	Fee-for-Service	1881687960	1881687960	1	1	DIABETES AND ENDOCRINE	1/11/1995	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, INC.	8851 CENTER DR	STE 212	LA MESA	CA	91942	3046	37	06073	32.78189749	-117.0075062	San Diego County
111125	Fee-for-Service	1043272073	1043272073	1	1	DAVID M SCOVILL M.D.	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3623 LATROBE DR	STE 216	CHARLOTTE	NC	28211	2117	00	None	35.196597	-80.7973065	Mecklenburg County
111139	Fee-for-Service	1477645927	1477645927	1	1	DARBUN ENTERPRISES, INC	5/1/1980	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11810 SATICOY ST	None	NORTH HOLLYWOOD	CA	91605	2848	19	06037	34.20844849	-118.390698	Los Angeles County
111176	Fee-for-Service	1538652193	1538652193	1	1	DEL VALLE HERNANDEZ, JONATHA	9/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173742	None	None	0	In state provider	N MD	801 E STREET	None	PATTERSON	CA	95363	2670	50	06099	37.46668786	-121.1342171	Stanislaus County
111199	Fee-for-Service	1164008645	1164008645	1	1	DADABHOY, ARIBA A MD	4/17/2025	207R00000X	NA	Other	026	PHYSICIANS	192504	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
111203	Fee-for-Service	1265927578	1265927578	1	1	DEAN, MOENA OD	5/18/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
111210	Fee-for-Service	1437867900	1437867900	1	1	DALIA DAWOUD MD INC	8/1/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	S	4200 CHINO HILLS PKWY	STE 800	CHINO HILLS	CA	91709	3785	36	06071	33.98274451	-117.7129305	San Bernardino County
111219	Fee-for-Service	1477865053	1477865053	1	1	DAVIS, TIMOTHY M DO	11/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13438	41	Internal Medicine	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
111220	Fee-for-Service	1861849093	1861849093	1	1	DEBENTZ INC	8/16/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	536 BARSTOW ROAD	None	BARSTOW	CA	92311	2908	36	06071	34.893666	-117.0229155	San Bernardino County
111319	Fee-for-Service	1508240102	1508240102	1	1	DAVULURI, SRIJANA MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153640	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
111388	Fee-for-Service	1083692313	1083692313	1	1	DUONG, HUY T MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	93326	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
111394	Fee-for-Service	1881687960	1881687960	1	1	DIABETES AND ENDOCRINE	10/27/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	ASSOCIATES, INC.	8851 CENTER DR	STE 212	LA MESA	CA	91942	3046	37	06073	32.78189749	-117.0075062	San Diego County
111412	Fee-for-Service	1144497678	1144497678	1	7	DIGNITY HEALTH MEDICAL	9/20/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	2440 WEST COVELL BLVD	SUITE 100	DAVIS	CA	95616	5671	57	06113	38.56100062	-121.7811668	Yolo County
111413	Fee-for-Service	1962670463	1962670463	1	1	DR. RICHARD GUERRERO	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3280 JOE BATTLE BLVD	None	EL PASO	TX	79938	2622	00	None	31.790412	-106.2643545	El Paso County
111430	Fee-for-Service	1477645927	1477645927	1	1	DARBUN ENTERPRISES, INC	10/5/1995	314000000X	NA	Skilled Nursing Facility	065	PEDIATRIC SUBACUTE CARE/LTC	-	-	NOT APPLICABLE	0	In state provider	None	11810 SATICOY ST	None	NORTH HOLLYWOOD	CA	91605	2848	19	06037	34.20844849	-118.390698	Los Angeles County
111436	Fee-for-Service	1356429849	1356429849	1	1	DAVIS, ADAM R MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92078	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
111485	Fee-for-Service	1811291271	1811291271	1	1	DINSMORE, AMERICA A LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111515	Fee-for-Service	1144497678	1144497678	1	8	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1321 COTTONWOOD ST	STE 202	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
111572	Fee-for-Service	1760019210	1760019210	1	1	DODSON, CATHERINE K MD	2/11/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189199	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
111579	Fee-for-Service	1972603884	1972603884	1	1	DOOHAN, NOEMI C MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89396	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
111698	Fee-for-Service	1144497678	1144497678	1	7	DIGNITY HEALTH MEDICAL	9/20/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2440 WEST COVELL BLVD	SUITE 100	DAVIS	CA	95616	5671	57	06113	38.56100062	-121.7811668	Yolo County
111706	Fee-for-Service	1396720215	1396720215	1	1	DURU, LILIAN MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85134	None	None	0	In state provider	None	11000 OLSON DR	STE 100	RANCHO CORDOVA	CA	95670	5605	34	06067	38.595123	-121.2820155	Sacramento County
111714	Fee-for-Service	1033798780	1033798780	1	1	DE LA ROSA, JAVIER MD	3/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183852	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
111715	Fee-for-Service	1568550812	1568550812	1	1	DIAZ, JANET V MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75355	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5K1	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
111724	Fee-for-Service	1356429849	1356429849	1	1	DAVIS, ADAM R MD	6/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92078	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
111795	Fee-for-Service	1144497678	1144497678	1	2	DIGNITY HEALTH MEDICAL	4/28/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
111803	Fee-for-Service	1144497678	1144497678	1	8	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	FOUNDATION	1321 COTTONWOOD ST	STE 202	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
111858	Fee-for-Service	1760019210	1760019210	1	1	DODSON, CATHERINE K MD	2/11/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189199	09	Gynecology (D.O. only)	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
111886	Fee-for-Service	1346829314	1346829314	1	1	DUTTA, PRIYANKA A MD	7/2/2024	207R00000X	NA	Other	026	PHYSICIANS	191077	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
111933	Fee-for-Service	1427181007	1427181007	1	3	DIGNITY HEALTH	9/30/2001	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	610 FREDERICK ST	None	SANTA CRUZ	CA	95062	2203	44	06087	36.97965731	-122.0042799	Santa Cruz County
111940	Fee-for-Service	1275266744	1275266744	1	1	DUNCAN, ANA C NP	7/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	10	06019	36.834984	-119.7641925	Fresno County
111956	Fee-for-Service	1801882592	1801882592	2	1	DANG, PAUL T MD	1/11/2023	207R00000X	NA	Other	026	PHYSICIANS	54764	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
111958	Fee-for-Service	1528014404	1528014404	1	1	DYER, DIANA CNM	12/19/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	34	06067	38.572551	-121.4181585	Sacramento County
111965	Fee-for-Service	1285912840	1285912840	1	1	DECKER, GREG R PHD	2/25/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
111970	Fee-for-Service	1124474986	1124474986	1	1	DAHL, JOLIAN	9/3/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
111986	Fee-for-Service	1144497678	1144497678	1	7	DIGNITY HEALTH MEDICAL	9/20/2013	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2440 WEST COVELL BLVD	SUITE 100	DAVIS	CA	95616	5671	57	06113	38.56100062	-121.7811668	Yolo County
112004	Fee-for-Service	1568550812	1568550812	1	1	DIAZ, JANET V MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75355	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5K1	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
112010	Fee-for-Service	1154327518	1154327518	1	1	DEBRUIN, MARK I DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5579	08	Family Practice	0	In state provider	None	9352 MADISON AVE	STE 1	ORANGEVALE	CA	95662	4968	34	06067	38.671137	-121.2043095	Sacramento County
112011	Fee-for-Service	1649350786	1649350786	1	1	DIAMOND, CATHERINE A MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84863	77	Infectious Disease	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
112015	Fee-for-Service	1225667850	1225667850	1	1	DELLINGER, ELAINE MD	12/1/2023	207P00000X	NA	Other	026	PHYSICIANS	190620	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
112025	Fee-for-Service	1073150801	1073150801	1	1	DOCKTOR, ANDI CCC-SLP	6/25/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
112043	Fee-for-Service	1588748552	1588748552	1	1	DUNTON, JILL K MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79423	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
112053	Fee-for-Service	1578754206	1578754206	1	1	DONG HI YOON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7801 LAKEVIEW PKWY	STE 100	ROWLETT	TX	75088	0000	00	None	32.91397217	-96.52510773	Dallas County
112082	Fee-for-Service	1144497678	1144497678	1	2	DIGNITY HEALTH MEDICAL	4/28/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
112099	Fee-for-Service	1942302138	1942302138	1	1	DEMARCO, THERESA A MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	59874	30	Radiology	0	In state provider	None	2110 PROFESSIONAL DR	STE 100	ROSEVILLE	CA	95661	3752	31	06061	38.74234873	-121.2521259	Placer County
112144	Fee-for-Service	1801865563	1801865563	2	1	DHADWAL, JAGTAR S MD	11/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	47802	41	Internal Medicine	0	In state provider	None	250 WEST BONITA AVE	SUITE 250	POMONA	CA	91767	1863	19	06037	34.09664881	-117.751261	Los Angeles County
112162	Fee-for-Service	1366685091	1366685091	1	1	DAILEY, ERIN A PSYD	9/28/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	28134	-	NOT APPLICABLE	0	In state provider	None	280 E STANDLEY ST	None	UKIAH	CA	95482	4414	23	06045	39.15101964	-123.205602	Mendocino County
112169	Fee-for-Service	1700849122	1700849122	1	1	DUNCAN, DANA D MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73022	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
112172	Fee-for-Service	1689802712	1689802712	1	1	DEUTSCHER, MEREDITH M MD	12/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113640	77	Infectious Disease	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
112176	Fee-for-Service	1346829314	1346829314	1	1	DUTTA, PRIYANKA A MD	7/2/2024	207R00000X	NA	Other	026	PHYSICIANS	191077	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
112213	Fee-for-Service	1801281308	1801281308	1	1	DRUEDING, ROSS E MD	6/21/2019	207L00000X	NA	Other	026	PHYSICIANS	146281	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
112224	Fee-for-Service	1477995884	1477995884	1	1	DECENA, ASHLEY M LCSW	10/15/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
112253	Fee-for-Service	1477084572	1477084572	1	1	DONG, XUEZHI MD	6/25/2024	207L00000X	NA	Other	026	PHYSICIANS	159517	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
112261	Fee-for-Service	1013613090	1013613090	1	1	DAMASDI, ALYSSA N	11/13/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
112273	Fee-for-Service	1144497678	1144497678	1	7	DIGNITY HEALTH MEDICAL	9/20/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2440 WEST COVELL BLVD	SUITE 100	DAVIS	CA	95616	5671	57	06113	38.56100062	-121.7811668	Yolo County
112278	Fee-for-Service	1902120645	1902120645	1	1	DE VRY, DEREK J MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
112297	Fee-for-Service	1639123045	1639123045	1	1	DANIEL, HENRY M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	82 PUUHONU PL	STE 205	HILO	HI	96720	2010	00	None	19.71623056	-155.0978368	Hawaii County
112318	Fee-for-Service	1518945658	1518945658	1	1	DESRUISSEAU, ANDREW J MD	12/13/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	54607	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
112374	Fee-for-Service	1144497678	1144497678	1	2	DIGNITY HEALTH MEDICAL	4/28/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
112378	Fee-for-Service	1174733802	1174733802	1	1	DESAI, SHAUNAK MD	1/22/2025	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	107394	20	Orthopedic Surgery	0	In state provider	None	22 CORPORATE PLAZA DR	None	NEWPORT BEACH	CA	92660	7985	30	06059	33.607602	-117.876852	Orange County
112396	Fee-for-Service	1912965807	1912965807	1	1	DRASNER, KENNETH MD	5/31/1990	207L00000X	NA	Other	026	PHYSICIANS	49739	05	Anesthesiology	0	In state provider	None	203 WILLOW ST	STE 302	SAN FRANCISCO	CA	94109	7733	38	06075	37.78326038	-122.4212876	San Francisco County
112400	Fee-for-Service	1316175342	1316175342	1	1	DUFFY, MICHAEL S SR DO INC	12/13/2012	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1501 5TH AVENUE	STE 100	SAN DIEGO	CA	92101	3291	37	06073	32.72121489	-117.1601897	San Diego County
112420	Fee-for-Service	1427181007	1427181007	1	2	DIGNITY HEALTH	8/20/1984	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WEST MONTEREY BAY REGION	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
112431	Fee-for-Service	1689745655	1689745655	1	1	DANIAL, TAREK MD	8/22/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51023	22	Pathology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
112462	Fee-for-Service	1689802712	1689802712	1	1	DEUTSCHER, MEREDITH M MD	12/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113640	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
112491	Fee-for-Service	1588320741	1588320741	1	1	DIVINE TOUCH HOME HEALTH	11/9/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC.	5311 TOPANGA CANYON BLVD	UNIT 214	WOODLAND HILLS	CA	91364	1742	19	06037	34.166313	-118.6059365	Los Angeles County
112504	Fee-for-Service	1477636504	1477636504	1	1	DOW, ANDREW R	5/23/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	140359	-	NOT APPLICABLE	0	In state provider	None	4760 S SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	19	06037	34.00134941	-118.4039837	Los Angeles County
112513	Fee-for-Service	1982202602	1982202602	1	1	DELTA HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	514 N BRIDGE ST	None	VISALIA	CA	93291	5015	54	06107	36.334251	-119.288682	Tulare County
112519	Fee-for-Service	1417034372	1417034372	1	1	DELFS, RICHARD M MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54445	01	General Practice	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
112524	Fee-for-Service	1598965741	1598965741	1	1	DOUGLAS, GERALDINA P CNP	6/21/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	660 BAKER STREET	STE A-102	COSTA MESA	CA	92626	4407	30	06059	33.68014263	-117.8842009	Orange County
112539	Fee-for-Service	1114181401	1114181401	1	1	DAVIS, BRIAN M MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142546	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
112557	Fee-for-Service	1114939063	1114939063	1	1	DEPIPPO, PAUL A MD	1/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	88581	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
112597	Fee-for-Service	1801861893	1801861893	1	1	DVA HEALTHCARE RENAL	6/17/1991	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1499 WEBSTER ST	None	SAN FRANCISCO	CA	94115	3705	38	06075	37.78408269	-122.4311967	San Francisco County
112598	Fee-for-Service	1952401721	1952401721	1	1	DRUG THERAPY SYSTEMS CO	6/2/2004	1835P1200X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	251 COHASSET RD	STE 100	CHICO	CA	95926	2235	04	06007	39.75090044	-121.8522609	Butte County
112599	Fee-for-Service	1205092046	1205092046	1	1	DOBBS, SHANNON PSYD	6/9/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30833 THOUSAND OAKS BLVD	None	WESTLAKE VILLAGE	CA	91362	4039	19	06037	34.15511094	-118.7921436	Los Angeles County
112603	Fee-for-Service	1962559112	1962559112	1	1	DANIEL J LEONE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OBSIDIAN URGENT CARE	401 ADAMS AVE	None	LAGRANDE	OR	97850	0000	00	None	45.32981449	-118.103733	Union County
112614	Fee-for-Service	1053167064	1053167064	1	1	DE CHAINE, MARIE	8/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LANE	100	SAN BERNARDINO	CA	92408	3238	36	06071	34.0659135	-117.289215	San Bernardino County
112649	Fee-for-Service	1023347101	1023347101	1	1	DOYLE, DONALD R MD APC	4/8/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	42131	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1860 PENNSYLVANIA AVE	STE 300B	FAIRFIELD	CA	94533	3550	48	06095	38.261952	-122.0498745	Solano County
112660	Fee-for-Service	1144497678	1144497678	1	2	DIGNITY HEALTH MEDICAL	9/12/2012	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
112685	Fee-for-Service	1801914270	1801914270	1	1	DAS-DOUGLAS, MOUPALI MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91691	77	Infectious Disease	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
112758	Fee-for-Service	1952395832	1952395832	1	1	DACQUISTO, ROBERT W MD	12/31/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	35641	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
112774	Fee-for-Service	1528429784	1528429784	1	1	DAVIDSON, ALEXANDRA N PSYD	5/13/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2001 JUNIPERO SERRA BLVD	SUITE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
112867	Fee-for-Service	1083338172	1083338172	1	1	D & P HOMECARE LLC	11/3/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16136 E CLOVERMEAD ST	None	COVINA	CA	91722	2206	19	06037	34.09497264	-117.9309255	Los Angeles County
112878	Fee-for-Service	1477058451	1477058451	1	1	DORTON, SHANNON R MD	11/14/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173391	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
112905	Fee-for-Service	1578568366	1578568366	1	1	DUTTER, DARYL R MD	2/25/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57233	08	Family Practice	0	In state provider	None	150 VERA AVE	None	RIPON	CA	95366	2343	39	06077	37.7389707	-121.133029	San Joaquin County
112940	Fee-for-Service	1184859480	1184859480	1	1	DANG, BINH T MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107616	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
112967	Fee-for-Service	1154498913	1154498913	1	1	DIXON, PATRICIA A NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 IMPERIAL HWY	STE ABCD	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
112996	Fee-for-Service	1316910821	1316910821	1	1	DANIEL CRAWFORD TUBBESING,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 MADISON OAK DR	None	SAN ANTONIO	TX	78258	3913	00	None	29.62127927	-98.49119067	Bexar County
113036	Fee-for-Service	1780743898	1780743898	1	1	DINGLER, CHANCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 PARK RD	None	NOCONA	TX	76255	3616	00	None	33.7776247	-97.73161433	Montague County
113078	Fee-for-Service	1730615287	1730615287	1	1	DERAKHSHAN, ADEEB MD	10/1/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	188212	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
113111	Fee-for-Service	1619964368	1619964368	1	1	DO, MINH CANH MD	1/1/1996	207R00000X	NA	Other	026	PHYSICIANS	45092	45	Nephrology (Renal-Kidney)	0	In state provider	None	4718 WEST 1ST ST	STE 100	SANTA ANA	CA	92703	3106	30	06059	33.74505053	-117.932085	Orange County
113118	Fee-for-Service	1649203639	1649203639	1	2	DOUGHERTY, PAUL J MD INC	3/1/2024	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	321 N LARCHMONT BLVD	STE 1021	LOS ANGELES	CA	90004	6410	19	06037	34.0769016	-118.323663	Los Angeles County
113148	Fee-for-Service	1336685049	1336685049	1	1	DR. DANIEL SJOLUND AND DR. A	5/27/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	27335 TOURNEY RD	STE 180	SANTA CLARITA	CA	91355	2204	19	06037	34.41919917	-118.5789065	Los Angeles County
113175	Fee-for-Service	1134311509	1134311509	1	1	DEDIASHVILI, RUSUDAN DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CHIROPRACTIC CORP	4311 WILSHIRE BLVD	SUITE 308	LOS ANGELES	CA	90010	3714	19	06037	34.0617922	-118.3218639	Los Angeles County
113197	Fee-for-Service	1952689010	1952689010	1	1	DUMITRASCU, OANA M MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126747	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
113224	Fee-for-Service	1043444854	1043444854	1	1	DRYSDALE, JONATHAN R MD	6/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53570	01	General Practice	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
113268	Fee-for-Service	1477578128	1477578128	1	1	DODD, PHILIP A MD	6/30/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75059	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 200	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
113286	Fee-for-Service	1922520709	1922520709	1	1	DATEMA, JODI L	9/25/2017	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
113312	Fee-for-Service	1902847981	1902847981	1	1	DAWSON, ANNE K MD	11/30/1985	2085R0001X	NA	Other	026	PHYSICIANS	40923	32	Radiation Therapy (D.O. only)	0	In state provider	None	1702 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
113329	Fee-for-Service	1114293552	1114293552	1	1	DEAUGUSTINIS, KAROLINA P MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140550	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
113375	Fee-for-Service	1972539963	1972539963	1	1	DISANDRO, MICHAEL J MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70600	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
113392	Fee-for-Service	1619964368	1619964368	1	1	DO, MINH CANH MD	1/1/1996	207R00000X	NA	Other	026	PHYSICIANS	45092	41	Internal Medicine	0	In state provider	None	4718 WEST 1ST ST	STE 100	SANTA ANA	CA	92703	3106	30	06059	33.74505053	-117.932085	Orange County
113406	Fee-for-Service	1649203639	1649203639	1	2	DOUGHERTY, PAUL J MD INC	4/4/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	321 N LARCHMONT BLVD	STE 1021	LOS ANGELES	CA	90004	6410	19	06037	34.0769016	-118.323663	Los Angeles County
113415	Fee-for-Service	1275591596	1275591596	1	1	DUTIA, MRINAL P MD	5/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92209	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
113417	Fee-for-Service	1710079223	1710079223	2	1	DEGC ENTERPRISES US INC	7/29/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CCS MEDICAL	5464 E LA PALMA AVE	UNIT B	ANAHEIM	CA	92807	2023	30	06059	33.85981328	-117.7967308	Orange County
113435	Fee-for-Service	1255593299	1255593299	1	1	DE CASTRO, JACQUELINE G	7/18/2008	193400000X	NA	Other	026	PHYSICIANS	101754	08	Family Practice	0	In state provider	MD INC	1457 BAILEY DR	None	HANFORD	CA	93230	5943	16	06031	36.3272739	-119.6676118	Kings County
113465	Fee-for-Service	1649918210	1649918210	1	1	DOOR TO DOOR NON EMERGENCY M	6/28/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	MERGENCY MEDICAL TRANSPO	11522 JOSHUA RD	None	APPLE VALLEY	CA	92308	9287	36	06071	34.46122349	-117.1552413	San Bernardino County
113483	Fee-for-Service	1659471498	1659471498	2	1	DUQUETTE, JULIE G MD	4/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74262	None	None	0	In state provider	None	2043 WESTCLIFF DRIVE	SUITE 302	NEWPORT BEACH	CA	92660	5511	30	06059	33.62778819	-117.9079137	Orange County
113518	Fee-for-Service	1427158245	1427158245	1	1	DAVID, RICHARD D MD	6/30/1988	208800000X	NA	Other	026	PHYSICIANS	58038	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
113531	Fee-for-Service	1659354702	1659354702	1	1	DULEBA, ANTONI J MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52680	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
113542	Fee-for-Service	1275645285	1275645285	1	1	DANTO, JOAN M LCSW	12/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1480 S HARBOR BLVD	STE 9B	LA HABRA	CA	90631	7534	30	06059	33.91276851	-117.931697	Orange County
113584	Fee-for-Service	1093135725	1093135725	1	1	DILL, JAMES J MD	2/23/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
113619	Fee-for-Service	1336541937	1336541937	1	1	DUBINA, EMILY D MD	10/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138677	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
113623	Fee-for-Service	1144497678	1144497678	1	11	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1321 COTTONWOOD ST	3RD FL	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
113631	Fee-for-Service	1528299856	1528299856	1	1	DONAHOE-BEGGS, ALLISON A LCS	6/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
113668	Fee-for-Service	1518277656	1518277656	1	2	DE LEON FUENTES, CYNTHIA LM	7/28/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	10801 NATIONAL	256	LOS ANGELES	CA	90064	4139	19	06037	34.03101398	-118.4202342	Los Angeles County
113695	Fee-for-Service	1134290059	1134290059	1	1	DOMURAT, EDWARD S MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	56588	67	Endocrinology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
113718	Fee-for-Service	1861812950	1861812950	1	1	DEBBANEH, MAYA G MD	3/19/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	141818	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
113747	Fee-for-Service	1255329728	1255329728	1	1	DAUTERMAN, KENT MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	555 BLACK OAK DR	STE 200	MEDFORD	OR	97504	8491	00	None	42.318873	-122.835653	Jackson County
113756	Fee-for-Service	1508847765	1508847765	1	1	DUNNING, DENNIS W MD	2/4/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
113780	Fee-for-Service	1629572219	1629572219	1	1	DANOFF, JACOB S MD	8/1/2021	207P00000X	NA	Other	026	PHYSICIANS	173633	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
113788	Fee-for-Service	1932202132	1932202132	1	1	DO, THINH DUC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3533 E CHAPMAN AVE	STE H	ORANGE	CA	92869	3850	30	06059	33.78782653	-117.815661	Orange County
113828	Fee-for-Service	1760725394	1760725394	1	1	DICKEY, BRIANNE Z MD	12/1/2017	207N00000X	NA	Dermatology	026	PHYSICIANS	150132	07	Dermatology	0	In state provider	None	2725 MENDOCINO AVE	None	SANTA ROSA	CA	95403	2805	49	06097	38.46672	-122.720724	Sonoma County
113834	Fee-for-Service	1366508707	1366508707	1	1	DIEP, CLAIRE T MD	2/18/2020	207R00000X	NA	Other	026	PHYSICIANS	55900	41	Internal Medicine	0	In state provider	None	33509 WESTERN AVE	None	UNION CITY	CA	94587	3203	01	06001	37.59233528	-122.0347014	Alameda County
113846	Fee-for-Service	1730443177	1730443177	1	1	DONG, TIEN S MD	4/7/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	141712	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
113882	Fee-for-Service	1023248705	1023248705	1	1	DONCHEV, VLADIMIR B MD	7/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123668	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
113910	Fee-for-Service	1508050212	1508050212	1	1	DUMOUCHEL, JUSTIN P MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108411	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
113913	Fee-for-Service	1144497678	1144497678	1	11	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1321 COTTONWOOD ST	3RD FL	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
113937	Fee-for-Service	1518106137	1518106137	1	1	DHAR, BURHAN CPO	3/15/2002	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	14535 VALLEY VIEW AVE	STE U	SANTA FE SPRINGS	CA	90670	5234	19	06037	33.9002099	-118.0292228	Los Angeles County
113989	Fee-for-Service	1043646557	1043646557	1	1	DANIEL, UMOHCHIDI A	8/29/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
113993	Fee-for-Service	1518498245	1518498245	1	1	DORISMOND, VANESSA G MD	5/15/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181759	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
114007	Fee-for-Service	1043726979	1043726979	1	1	DOMINGUEZ, LAURA S LMFT	9/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
114019	Fee-for-Service	1912288432	1912288432	1	8	DIGNITY HEALTH MEDICAL FOUND	8/3/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	-NORTH STATE INC	2580 SISTER MARY COLUMBA	STE 200	RED BLUFF	CA	96080	4327	52	06103	40.14842672	-122.2180085	Tehama County
114066	Fee-for-Service	1902360936	1902360936	1	1	DAVIS, RICHARD E MD	2/13/2019	208600000X	NA	General Surgery	026	PHYSICIANS	159326	02	General Surgery	0	In state provider	None	328 S 1ST STREET	SUITES F AND G	ALHAMBRA	CA	91801	3789	19	06037	34.09104553	-118.1252904	Los Angeles County
114071	Fee-for-Service	1134179724	1134179724	1	1	DEWHIRST, AUDREY P	10/6/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2040 PACIFIC COAST HWY	None	LOMITA	CA	90717	2660	19	06037	33.78948351	-118.316493	Los Angeles County
114095	Fee-for-Service	1376563700	1376563700	1	1	DESAI, SUDHEN B MD	5/12/2023	2085R0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
114126	Fee-for-Service	1508095415	1508095415	1	1	DAYLE MCINTOSH CENTER FO	10/14/2009	251C00000X	NA	Other	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	501 N BROOKHURST ST	SUITE 102	ANAHEIM	CA	92801	5202	30	06059	33.8384428	-117.9590628	Orange County
114127	Fee-for-Service	1609316736	1609316736	1	1	DELA CRUZ, JUSTINE N NP	6/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
114128	Fee-for-Service	1235462656	1235462656	1	1	DUONG, NGHIA H MD	9/15/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109049	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
114182	Fee-for-Service	1013686823	1013686823	1	1	DREISBACH, EMILY F NP	10/1/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
114186	Fee-for-Service	1093009466	1093009466	1	1	DUPPER, MAEGEN V MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117047	08	Family Practice	0	In state provider	None	555 TECHEVAH DR	3W 105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
114200	Fee-for-Service	1194779710	1194779710	1	1	DE LA PENA, RONALD E MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	54034	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2230 LYNN RD	STE 200	THOUSAND OAKS	CA	91360	1900	56	06111	34.20894685	-118.885185	Ventura County
114202	Fee-for-Service	1144497678	1144497678	1	11	DIGNITY HEALTH MEDICAL	4/14/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	1321 COTTONWOOD ST	3RD FL	WOODLAND	CA	95695	5131	57	06113	38.66479566	-121.7933418	Yolo County
114229	Fee-for-Service	1689137747	1689137747	1	1	DINH, CHRISTINE U MD	4/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183303	None	None	0	In state provider	None	27303 SLEEPY HOLLOW	None	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
114270	Fee-for-Service	1033750617	1033750617	1	1	DIRECT OUTLOOK PSYCHOLOGICAL	1/1/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SERVICES INC.	750 TERRADO PLAZA	246	COVINA	CA	91723	3419	19	06037	34.07598226	-117.8892839	Los Angeles County
114344	Fee-for-Service	1710429006	1710429006	1	1	DREW, TONI L CRNA	2/9/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
114402	Fee-for-Service	1407845852	1407845852	1	2	DESHMUKH, RASHMI S MD	10/28/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	83933	36	Psychiatry	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
114431	Fee-for-Service	1487205175	1487205175	1	1	DESILVA, TAYLOR K PT	1/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
114447	Fee-for-Service	1225370133	1225370133	1	1	DUNKELMAN, ANDREA MD INC	8/29/2013	193400000X	NA	Other	026	PHYSICIANS	74127	02	General Surgery	0	In state provider	None	1001 NORTH TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
114476	Fee-for-Service	1093009466	1093009466	1	1	DUPPER, MAEGEN V MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117047	01	General Practice	0	In state provider	None	555 TECHEVAH DR	3W 105	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
114529	Fee-for-Service	1881816734	1881816734	1	1	DUCKWORTH-DAWSON, AMY L DPM	3/8/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
114550	Fee-for-Service	1194892042	1194892042	1	1	DAOUD, NELDA A MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	80911	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
114587	Fee-for-Service	1285889998	1285889998	1	1	DUNNE, QUENTIN L LMFT	9/1/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50452	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
114612	Fee-for-Service	1174598478	1174598478	1	1	DECHTER, MARK M MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	31615	08	Family Practice	0	In state provider	None	7325 MEDICAL CENTER DR	STE 300	WEST HILLS	CA	91307	4117	19	06037	34.20369349	-118.629837	Los Angeles County
114656	Fee-for-Service	1033840699	1033840699	1	1	DAVIS, MELISSA NP	3/4/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
114691	Fee-for-Service	1326337338	1326337338	1	1	DHAHBI, SALLY PHD	7/16/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	33	06065	33.95782448	-117.3904065	Riverside County
114729	Fee-for-Service	1821066325	1821066325	1	1	DAHHAN, GHASSAN S MD	3/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	38553	41	Internal Medicine	0	In state provider	None	44725 10TH ST W	None	LANCASTER	CA	93534	3033	19	06037	34.695693	-118.1480965	Los Angeles County
114741	Fee-for-Service	1376653790	1376653790	1	1	DAVIS, BRETT L DO	8/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1775 THOMPSON ROAD	None	COOS BAY	OR	97420	2125	00	None	43.383456	-124.2330435	Coos County
114751	Fee-for-Service	1558492520	1558492520	1	1	DABIRIAN, TANNAZ PHD	5/15/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
114765	Fee-for-Service	1023074317	1023074317	2	1	DANIELS, JASON MD	6/19/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	55058	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
114804	Fee-for-Service	1467854414	1467854414	1	1	DOUGLASS, REBECCA R	4/7/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DR	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
114822	Fee-for-Service	1578850327	1578850327	1	1	DEGRATI, CLAUDIA PHD	7/18/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
114851	Fee-for-Service	1669731964	1669731964	1	1	DANG, CHRISTOPHER L MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127265	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114857	Fee-for-Service	1477601342	1477601342	1	1	DERAMERIAN, KRIKOR MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70206	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
114870	Fee-for-Service	1487000683	1487000683	1	1	DUARTI, NELLY	5/11/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6935 LAGOON COURT	None	JURUPA, VALLEY	CA	91752	2783	33	06065	33.96217195	-117.5425376	Riverside County
114886	Fee-for-Service	1255435376	1255435376	1	1	DEVASIA, N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26378	41	Internal Medicine	0	In state provider	None	2323 16TH ST	STE 404	BAKERSFIELD	CA	93301	3454	15	06029	35.37238027	-119.0288508	Kern County
114920	Fee-for-Service	1578674255	1578674255	1	1	DULANTO, LUIGI MD	8/20/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	84734	36	Psychiatry	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
114929	Fee-for-Service	1104972702	1104972702	1	1	DEMETER, STEVEN MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	81879	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114937	Fee-for-Service	1437144318	1437144318	1	1	DR. CHRISTOPHER D PEREZ M.D.	11/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
114939	Fee-for-Service	1740691377	1740691377	1	1	DELLINGER, JOSEPH MD	9/20/2023	207R00000X	NA	Other	026	PHYSICIANS	136886	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
114955	Fee-for-Service	1932266103	1932266103	1	1	DELA CRUZ, MARK T MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93803	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
114974	Fee-for-Service	1932123247	1932123247	1	1	DALLAS CO HOSP DIST	1/19/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	PARKLAND MEMORIAL HOSP	5201 HARRY HINES BLVD	None	DALLAS	TX	75235	7708	00	None	32.81161328	-96.83715929	Dallas County
114984	Fee-for-Service	1093760472	1093760472	1	1	DAWSON, LAURIE MD	1/31/1986	207P00000X	NA	Other	026	PHYSICIANS	41282	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1905 MEMORIAL DR	None	CERES	CA	95307	1826	50	06099	37.60082294	-120.9610885	Stanislaus County
114994	Fee-for-Service	1568523777	1568523777	1	1	DUGAS, DENISE M LMFT	2/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
115006	Fee-for-Service	1962427153	1962427153	1	1	DUANE EDSON HARRISON, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 NEW SHACKLE ISLAND	RD	HENDERSONVLLE	TN	37075	2479	00	None	36.324738	-86.6229075	Sumner County
115080	Fee-for-Service	1649310608	1649310608	1	1	DIMALANTA, CYNTHIA A MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66468	40	Pediatrics	0	In state provider	None	2081 ATLANTIC AVE	None	LONG BEACH	CA	90806	4915	19	06037	33.795027	-118.1850555	Los Angeles County
115109	Fee-for-Service	1538114988	1538114988	1	1	DEMLOW,ANITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	0000	00	None	45.720117	-122.647986	Clark County
115131	Fee-for-Service	1477154995	1477154995	1	1	DOLCE VITA HOSPICE CARE INC	1/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17817 CHATSWORTH ST	UNIT 210	GRANADA HILLS	CA	91344	5612	19	06037	34.2649235	-118.5222015	Los Angeles County
115159	Fee-for-Service	1487000683	1487000683	1	1	DUARTI, NELLY	5/11/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6935 LAGOON COURT	None	JURUPA, VALLEY	CA	91752	2783	33	06065	33.96217195	-117.5425376	Riverside County
115176	Fee-for-Service	1962439372	1962439372	1	1	DARNALL, BETH D PHD	12/16/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115197	Fee-for-Service	1811423809	1811423809	1	1	DESERT VALLEY CHLF, INC	10/30/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	20721 SHOLIC RD	None	APPLE VALLEY	CA	92308	6332	36	06071	34.4891559	-117.2117117	San Bernardino County
115243	Fee-for-Service	1932266103	1932266103	1	1	DELA CRUZ, MARK T MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93803	38	Geriatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
115262	Fee-for-Service	1932123247	1932123247	1	1	DALLAS CO HOSP DIST	1/19/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	PARKLAND MEMORIAL HOSP	5201 HARRY HINES BLVD	None	DALLAS	TX	75235	7708	00	None	32.81161328	-96.83715929	Dallas County
115281	Fee-for-Service	1811990666	1811990666	1	1	DIXIT, RASHMI B MD	1/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77094	83	Rheumatology	0	In state provider	None	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
115370	Fee-for-Service	1720312879	1720312879	1	1	DELGADILLO, HERLINDA LMFT	7/5/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
115412	Fee-for-Service	1811213945	1811213945	1	1	DESTRO, LAURA M MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121227	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
115420	Fee-for-Service	1477154995	1477154995	1	1	DOLCE VITA HOSPICE CARE INC	1/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17817 CHATSWORTH ST	UNIT 210	GRANADA HILLS	CA	91344	5612	19	06037	34.2649235	-118.5222015	Los Angeles County
115449	Fee-for-Service	1598761413	1598761413	1	1	DENGERINK, DOUGLAS D DO	10/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9206	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
115458	Fee-for-Service	1174531859	1174531859	1	5	DIGNITY HEALTH MEDICAL FOUND	2/19/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2900 WHIPPLE AVE	STE 230	REDWOOD CITY	CA	94062	2852	41	06081	37.4783072	-122.2551089	San Mateo County
115462	Fee-for-Service	1578616538	1578616538	1	1	DUBAL, DENA B MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91507	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115473	Fee-for-Service	1649711912	1649711912	1	1	DAO, VINH A MD	6/7/2024	207R00000X	NA	Other	026	PHYSICIANS	156905	41	Internal Medicine	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
115496	Fee-for-Service	1942620067	1942620067	1	1	DESIMONE, CHRISTOPHER R DO	8/7/2019	208600000X	NA	General Surgery	026	PHYSICIANS	16210	02	General Surgery	0	In state provider	None	2911 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98821335	-121.978125	Santa Cruz County
115535	Fee-for-Service	1043562085	1043562085	1	1	DANA VITANOVSKI-PETROVSKI,NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	42557 WOODWARD AVE	STE 200	BLOOMFLD HLS	MI	48304	5206	00	None	42.6002658	-83.26130526	Oakland County
115547	Fee-for-Service	1326862392	1326862392	1	1	DAVDA, SUNIT MD	11/18/2024	2085P0229X	NA	Other	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
115584	Fee-for-Service	1902376775	1902376775	2	1	D & J HOME HEALTH INC	7/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	STE 204	NORTH HOLLYWOOD	CA	91601	2238	19	06037	34.17216449	-118.36017	Los Angeles County
115614	Fee-for-Service	1275987364	1275987364	1	1	DICKINSON, AILEEN M DO	10/29/2021	2080P0216X	NA	Other	026	PHYSICIANS	15248	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
115668	Fee-for-Service	1659508935	1659508935	1	1	DROFYAK, YURIY PT	9/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
115745	Fee-for-Service	1093030058	1093030058	1	1	DHAND, SABEEN MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135584	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
115756	Fee-for-Service	1467857714	1467857714	1	1	DEPAKAKIBO, ALLANA M D NP	5/9/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
115757	Fee-for-Service	1184120982	1184120982	1	1	DELGADO, NOEL MD	8/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
115762	Fee-for-Service	1619595857	1619595857	1	1	DOSANJH, RANDEEP K RCP	9/27/2020	2279P1005X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
115784	Fee-for-Service	1518966118	1518966118	1	1	DIER, GARY L MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
115794	Fee-for-Service	1376649889	1376649889	1	1	DUNST, MORADCAI N MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42987	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
115796	Fee-for-Service	1962540765	1962540765	1	1	DUONG, DAVID K MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103672	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
115800	Fee-for-Service	1790706240	1790706240	1	1	DUNCAN, LINNEA A LCSW	7/25/2014	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5910 CLARK RD	SUITE M	PARADISE	CA	95969	4859	04	06007	39.75749014	-121.6070408	Butte County
115804	Fee-for-Service	1124505797	1124505797	1	1	DISTINGUISHED CARE HOME	2/25/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	229 N CENTRAL AVE	STE 200	GLENDALE	CA	91203	3555	19	06037	34.14910181	-118.2579537	Los Angeles County
115835	Fee-for-Service	1689177826	1689177826	1	1	DUNNUM, ALEXANDER DO	9/5/2024	207L00000X	NA	Other	026	PHYSICIANS	22730	05	Anesthesiology	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
115854	Fee-for-Service	1770877979	1770877979	1	1	DAVENPORT, BIANCA M MD	5/20/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
115868	Fee-for-Service	1447308325	1447308325	1	1	DERAKHSHANI, MAYHAR MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84704	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
115890	Fee-for-Service	1609038181	1609038181	1	1	DUNNING, RUSSELL E	12/8/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2533 R STREET	None	SACRAMENTO	CA	95816	6887	34	06067	38.56599	-121.4761455	Sacramento County
115952	Fee-for-Service	1689615585	1689615585	1	1	DEL RIOS, MARINA	7/14/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
115976	Fee-for-Service	1770039844	1770039844	1	1	D4,INC.	4/28/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4541 N. FIGUEROA STREET	None	LOS ANGELES	CA	90065	3026	19	06037	34.09733223	-118.2062311	Los Angeles County
116079	Fee-for-Service	1578635397	1578635397	1	1	DEGUSTA, LINDA CATHERINE	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66410	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
116125	Fee-for-Service	1740364710	1740364710	1	1	DOOLITTLE, LAURIE M MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60968	40	Pediatrics	0	In state provider	None	104 LYNCH CREEK WAY	STE 11C	PETALUMA	CA	94954	2355	49	06097	38.25218808	-122.6339241	Sonoma County
116168	Fee-for-Service	1083933840	1083933840	1	1	DESERT ORTHOPEDIC TRAUMA	12/3/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	SERVICE	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4876	33	06065	33.838623	-116.542737	Riverside County
116177	Fee-for-Service	1013065473	1013065473	1	1	DINH, NGON H DO APC	9/1/1995	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	6290	None	None	0	In state provider	None	702 E SANTA CLARA ST	STE 2	SAN JOSE	CA	95112	1919	43	06085	37.34303477	-121.8760348	Santa Clara County
116252	Fee-for-Service	1598477655	1598477655	1	1	DAIR, ZACHARY	8/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
116312	Fee-for-Service	1598798076	1598798076	1	1	DIALYSIS CLINIC INC	12/24/2003	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	10294 ROCKINGHAM DR	None	SACRAMENTO	CA	95827	2515	34	06067	38.573631	-121.3074495	Sacramento County
116334	Fee-for-Service	1467660738	1467660738	1	1	DO, BAO H MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104179	30	Radiology	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
116357	Fee-for-Service	1952939720	1952939720	1	1	DOUTHIT, JESSICA MD	10/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182795	09	Gynecology (D.O. only)	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
116366	Fee-for-Service	1477991628	1477991628	1	1	DETRICK, AMY A LCSW	8/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
116387	Fee-for-Service	1750593109	1750593109	1	1	DINH, TINNY MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99539	18	Ophthalmology	0	In state provider	None	801 SOUTH CHEVY CHASE DR	SUITE 103	GLENDALE	CA	91205	4437	19	06037	34.136757	-118.2396195	Los Angeles County
116389	Fee-for-Service	1003156126	1003156126	1	1	DJERBAKA, JOHN G PT	3/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4342 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3573	30	06059	33.80294143	-118.057265	Orange County
116398	Fee-for-Service	1225177454	1225177454	1	1	DISSANAYAKE, RUWAN R MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97682	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
116424	Fee-for-Service	1508847187	1508847187	1	1	DANDILLAYA, RAMANAND MD	3/1/1983	207T00000X	NA	General Surgery	026	PHYSICIANS	35267	13	Neurology (M.D. only)	0	In state provider	None	210 S PALISADE DR	STE 203	SANTA MARIA	CA	93454	8900	42	06083	34.95169604	-120.4120907	Santa Barbara County
116428	Fee-for-Service	1679986970	1679986970	1	1	DE TABLAN, NAOMI R E DPM	6/30/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	108 LYNCH CREEK WAY	STE 3	PETALUMA	CA	94954	2310	49	06097	38.25209087	-122.6340827	Sonoma County
116461	Fee-for-Service	1033140421	1033140421	1	1	DEAN, JAMES E MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	19472	41	Internal Medicine	0	In state provider	None	1105 N DOUTY ST	None	HANFORD	CA	93230	3716	16	06031	36.33650511	-119.6460168	Kings County
116481	Fee-for-Service	1164466173	1164466173	1	1	DAY, AMY L MD	6/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71460	02	General Surgery	0	In state provider	None	754 MEDICAL CENTER CT	STE 203	CHULA VISTA	CA	91911	6656	37	06073	32.61778462	-117.0228924	San Diego County
116603	Fee-for-Service	1942230859	1942230859	1	1	DYSON, SENAIT W MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9094	07	Dermatology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	0000	30	06059	33.78674051	-117.8888713	Orange County
116644	Fee-for-Service	1952939720	1952939720	1	1	DOUTHIT, JESSICA MD	10/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182795	15	Obstetrics (D.O. only)	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
116658	Fee-for-Service	1083781983	1083781983	1	1	DODD, NANCY D MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42960	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
116673	Fee-for-Service	1679131668	1679131668	1	1	DIXIT, HONEY LMFT	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	36	06071	34.09544496	-117.5747968	San Bernardino County
116681	Fee-for-Service	1851785083	1851785083	1	1	DANISH, MOBEEN MD	2/14/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	149840	77	Infectious Disease	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
116702	Fee-for-Service	1235880824	1235880824	1	1	DAVIS, CHANTAL S CNM	3/2/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3101 TELEGRAPH AVE	None	BERKELEY	CA	94705	1984	01	06001	37.85361291	-122.2600247	Alameda County
116725	Fee-for-Service	1518581594	1518581594	1	1	DAVID, FRANCIS CCC-SLP	4/27/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
116727	Fee-for-Service	1568689149	1568689149	1	1	DRENNING-MANRIQUEZ, ROGELIO	12/1/1996	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	55833	None	None	0	In state provider	DOCTOR ROGELIO DRENNING	49167 CESAR CHAVEZ ST	SUITE B	COACHELLA	CA	92236	1535	33	06065	33.68947673	-116.1824924	Riverside County
116748	Fee-for-Service	1871816785	1871816785	1	1	DEITCH, HEIDI L DO	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11120	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5412	37	06073	33.03623896	-117.2837308	San Diego County
116768	Fee-for-Service	1386792281	1386792281	1	1	DEVINE, ANNE M OD	2/7/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3851 SHAW RIDGE RD	None	SAN DIEGO	CA	92130	2807	37	06073	32.93516088	-117.2297377	San Diego County
116802	Fee-for-Service	1922462159	1922462159	1	1	DUNN, HENRY M MD	8/23/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	150932	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
116821	Fee-for-Service	1912288432	1912288432	1	13	DIGNITY HEALTH MEDICAL FOUND	6/6/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ATION	2380 BECHELLI LANE	None	REDDING	CA	96002	0144	45	06089	40.57299	-122.3628155	Shasta County
116846	Fee-for-Service	1306026505	1306026505	1	1	DUNHAM, MIRIAM E MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97051	08	Family Practice	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
116852	Fee-for-Service	1437320785	1437320785	1	1	DAVIS, MICHAEL J MD	6/1/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	111866	18	Ophthalmology	0	In state provider	None	301 W HUNTINGTON DR	STE 107	ARCADIA	CA	91007	3400	19	06037	34.13481053	-118.0425638	Los Angeles County
116861	Fee-for-Service	1245256056	1245256056	2	1	DE UNAMUNO, MELISSA M	9/6/2006	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3575 BEACON AVE	None	FREMONT	CA	94538	1407	01	06001	37.54913518	-121.9816504	Alameda County
116863	Fee-for-Service	1942750815	1942750815	1	1	DOBBINS, SARAH K NP	10/23/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
116903	Fee-for-Service	1285005249	1285005249	1	1	DO, STEVEN P NP	2/9/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
116908	Fee-for-Service	1336463223	1336463223	1	1	DELF, EMILY L MD	12/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113830	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
116941	Fee-for-Service	1790894509	1790894509	1	1	DIPMAN, RICHARD P LCSW	1/3/2006	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	716 S MAIN ST	None	WILLITS	CA	95490	3914	23	06045	39.40478625	-123.3521037	Mendocino County
116947	Fee-for-Service	1083781983	1083781983	1	1	DODD, NANCY D MD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42960	77	Infectious Disease	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
116964	Fee-for-Service	1184036279	1184036279	1	1	DR. HOPE BURKETT	7/8/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
116968	Fee-for-Service	1851785083	1851785083	1	1	DANISH, MOBEEN MD	2/14/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	149840	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
117022	Fee-for-Service	1952763401	1952763401	1	1	DAVID, MARGARITA MD	1/12/2024	207SG0202X	NA	Other	026	PHYSICIANS	191736	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
117024	Fee-for-Service	1821185224	1821185224	1	1	DIGIACOMO, MICHAEL DPM INC	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	445 30TH ST	None	OAKLAND	CA	94609	3301	01	06001	37.8191601	-122.2656731	Alameda County
117046	Fee-for-Service	1184045528	1184045528	1	1	DAVIS-MASSEY, NIESHA M LCSW	9/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
117071	Fee-for-Service	1629343736	1629343736	1	1	DHOLARIA, KEVIN MD	1/3/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	161629	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
117076	Fee-for-Service	1245514579	1245514579	1	1	DY, HEATHER M CNM	3/20/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
117087	Fee-for-Service	1518200443	1518200443	1	1	DINEEN, ELIZABETH H DO	6/3/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	15438	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
117121	Fee-for-Service	1639240559	1639240559	1	1	DO, THAI T MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45662	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
117185	Fee-for-Service	1003935685	1003935685	1	1	DONAHUE, JEANNE H LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
117228	Fee-for-Service	1316154362	1316154362	1	1	DOW, DIANE R MD	10/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78594	40	Pediatrics	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
117277	Fee-for-Service	1447410766	1447410766	1	1	DAVULURI, VIJAY MD	8/2/2023	390200000X	NA	Other	026	PHYSICIANS	170702	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
117339	Fee-for-Service	1114696226	1114696226	1	1	DOUGLAS, RACHEL K LMFT	3/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
117378	Fee-for-Service	1124200407	1124200407	1	1	DEB, ARJUN MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55836	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	STE # 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
117389	Fee-for-Service	1578573358	1578573358	1	1	DILL, SARA W MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99121	07	Dermatology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
117432	Fee-for-Service	1063591709	1063591709	1	1	DESAI, BELA G MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54476	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
117440	Fee-for-Service	1609824945	1609824945	1	1	DILLON, BECKY M MD	5/21/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	43112 N 15TH W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
117476	Fee-for-Service	1376569194	1376569194	1	1	DEWENTER, SCOTT M DPM	7/4/1997	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	600 CENTRAL AVE	STE G	LAKE ELSINORE	CA	92530	2740	33	06065	33.689503	-117.340376	Riverside County
117508	Fee-for-Service	1912288432	1912288432	1	10	DIGNITY HEALTH MEDICAL FOUND	7/27/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-NORTH STATE INC	2336 COURT ST	None	REDDING	CA	96001	2526	45	06089	40.57502148	-122.3925875	Shasta County
117576	Fee-for-Service	1114486149	1114486149	1	1	DHARIA, DIVYA H DO	8/25/2023	207L00000X	NA	Other	026	PHYSICIANS	21196	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
117588	Fee-for-Service	1275953911	1275953911	1	1	DUVALL, JAROD K MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141545	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
117591	Fee-for-Service	1053804450	1053804450	1	1	DONTHI, NISHA MD	7/29/2021	208M00000X	NA	Other	026	PHYSICIANS	173569	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
117682	Fee-for-Service	1124200407	1124200407	1	1	DEB, ARJUN MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55836	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE # 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
117691	Fee-for-Service	1184808750	1184808750	1	1	DHAM, SHEFALI MD	11/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113435	41	Internal Medicine	0	In state provider	None	5725 WEST LAS POSITAS	STE 210	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
117710	Fee-for-Service	1952391401	1952391401	1	1	DAVENPORT, WILLIAM W MD	9/13/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	138480	None	None	0	In state provider	None	74785 US HIGHWAY 111	STE 101	INDIAN WELLS	CA	92210	7129	33	06065	33.72131925	-116.360116	Riverside County
117715	Fee-for-Service	1740719681	1740719681	1	1	DEL ROSA HOME HEALTH INC	8/30/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	400 S RAMONA AVE	SUITE 120	CORONA	CA	92879	1442	36	06071	33.87678898	-117.5650086	Riverside County
117736	Fee-for-Service	1154767770	1154767770	1	1	DESHMUKH, ANJALI D MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135388	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
117807	Fee-for-Service	1023280179	1023280179	1	1	DAVIS, PUCHNA PT	8/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3620 LONG BEACH BLVD	STE C11	LONG BEACH	CA	90807	6016	19	06037	33.822837	-118.1893245	Los Angeles County
117814	Fee-for-Service	1457653719	1457653719	1	1	DAVIS, KYLE P MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126984	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
117856	Fee-for-Service	1922414796	1922414796	1	1	DARYA, KAUROON M DO	3/11/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	16208	None	None	0	In state provider	None	729 SUNRISE AVE	616	ROSEVILLE	CA	95661	4548	31	06061	38.73444822	-121.2720033	Placer County
117907	Fee-for-Service	1508208802	1508208802	1	1	DESERPA, KIMBERLY A LCSW	8/22/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
117983	Fee-for-Service	1184808750	1184808750	1	1	DHAM, SHEFALI MD	11/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113435	67	Endocrinology	0	In state provider	None	5725 WEST LAS POSITAS	STE 210	PLEASANTON	CA	94588	4007	01	06001	37.688107	-121.8861427	Alameda County
118002	Fee-for-Service	1720585342	1720585342	1	1	DAVIES, MARYANN J DO	7/1/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	17809	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
118023	Fee-for-Service	1952426421	1952426421	1	1	DELOREFICE, GUY MD	1/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	68918	01	General Practice	0	In state provider	None	1083 VINE ST	# 281	HEALDSBURG	CA	95448	4830	49	06097	38.60916261	-122.8717947	Sonoma County
118041	Fee-for-Service	1548949878	1548949878	1	1	DSN TRANSPORTATION LLC	9/2/2023	342000000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	312 CALDERWOOD LN	None	BAKERSFIELD	CA	93307	7324	15	06029	35.28322052	-119.0064285	Kern County
118063	Fee-for-Service	1578980652	1578980652	1	1	DOWRAY, SUNAINA R MD	8/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137966	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
118107	Fee-for-Service	1770942831	1770942831	1	1	DIAMOND, DANIEL M MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134320	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
118111	Fee-for-Service	1174531859	1174531859	1	6	DIGNITY HEALTH MEDICAL FOUND	3/4/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	2950 WHIPPLE AVE	STE 3	REDWOOD CITY	CA	94062	2842	41	06081	37.4783159	-122.2550908	San Mateo County
118130	Fee-for-Service	1568593168	1568593168	1	1	DRAKE, MELINDA G LCSW	8/13/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	68954	-	NOT APPLICABLE	0	In state provider	None	5870 ARLINGTON AVE	SUITE 103	RIVERSIDE	CA	92504	2037	33	06065	33.94592702	-117.4313099	Riverside County
118161	Fee-for-Service	1558472233	1558472233	1	1	DAVIS, SANFORD I MD	5/6/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	87448	None	None	0	In state provider	None	5330 CARROLL CANYON RD	140	SAN DIEGO	CA	92121	3758	37	06073	32.8917216	-117.1927751	San Diego County
118172	Fee-for-Service	1467534313	1467534313	1	1	DOMINGUEZ, JESSE S DO	1/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8942	01	General Practice	0	In state provider	None	280 N RIVERSIDE AVE	None	RIALTO	CA	92376	5924	36	06071	34.10384154	-117.370545	San Bernardino County
118180	Fee-for-Service	1558709600	1558709600	1	1	DIGIOIA, STACI J J PSYD	7/24/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
118224	Fee-for-Service	1376990424	1376990424	1	1	DOSS, LINDEN R MD	7/16/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168820	18	Ophthalmology	0	In state provider	None	1513 S GRAND AVE	STE 200	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
118317	Fee-for-Service	1073983177	1073983177	1	1	DIAZ, HORTENCIA SOLEDAD LMFT	8/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	73550 ALESSANDRO DR	STE 200	PALM DESERT	CA	92226	3613	33	06065	33.72240897	-116.381407	Riverside County
118323	Fee-for-Service	1407261118	1407261118	1	1	DING, NINGYUAN MD	1/8/2020	390200000X	NA	Other	026	PHYSICIANS	154972	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
118328	Fee-for-Service	1639143332	1639143332	1	1	DVA RENAL HEALTHCARE INC	6/28/2001	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	MERCED DIALYSIS	3393 G ST	SUITE A	MERCED	CA	95340	0964	24	06047	37.32623794	-120.4692707	Merced County
118401	Fee-for-Service	1174531859	1174531859	1	6	DIGNITY HEALTH MEDICAL FOUND	3/4/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	2950 WHIPPLE AVE	STE 3	REDWOOD CITY	CA	94062	2842	41	06081	37.4783159	-122.2550908	San Mateo County
118410	Fee-for-Service	1992853824	1992853824	1	1	DOANE, GREGORY C MD	1/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	79473	26	Psychiatry (child)	0	In state provider	None	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	19	06037	34.22817313	-118.4636497	Los Angeles County
118420	Fee-for-Service	1669715512	1669715512	1	1	DEMARTINI, JEREMY M MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133611	41	Internal Medicine	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
118465	Fee-for-Service	1841298908	1841298908	1	1	DEBRA LYNN DEMPSEY CRNP	12/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12500 WILLOWBROOK RD	None	CUMBERLAND	MD	21502	6393	00	None	39.65565692	-78.7316876	Allegany County
118469	Fee-for-Service	1558996579	1558996579	1	1	DRORBAUGH, NATALIE NP	1/31/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
118499	Fee-for-Service	1811945082	1811945082	1	1	DURON, PAUL A MD	3/28/2018	207R00000X	NA	Other	026	PHYSICIANS	50452	41	Internal Medicine	0	In state provider	None	1141 N BRAND BLVD	SUITE 400	GLENDALE	CA	91202	2973	19	06037	34.162983	-118.2550855	Los Angeles County
118504	Fee-for-Service	1700848793	1700848793	1	1	DEURDULIAN, CORINNE MD	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54985	30	Radiology	0	In state provider	None	1520 SAN PABLO	LL 1600	LOS ANGELES	CA	90033	5317	19	06037	34.06269295	-118.2030006	Los Angeles County
118653	Fee-for-Service	1518981232	1518981232	1	1	DEORIO, JOSEPH J MD	10/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	75800	34	Urology and Urological Surgery	0	In state provider	None	11480 BROOKSHIRE AVE	#201	DOWNEY	CA	90241	5022	19	06037	33.93622932	-118.1311752	Los Angeles County
118679	Fee-for-Service	1164655569	1164655569	1	1	DEJESUS-CORTEZ, ALFREDO NP	10/31/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118687	Fee-for-Service	1174531859	1174531859	1	6	DIGNITY HEALTH MEDICAL FOUND	3/4/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	FOUNDATION	2950 WHIPPLE AVE	STE 3	REDWOOD CITY	CA	94062	2842	41	06081	37.4783159	-122.2550908	San Mateo County
118698	Fee-for-Service	1992853824	1992853824	1	1	DOANE, GREGORY C MD	1/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	79473	36	Psychiatry	0	In state provider	None	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	19	06037	34.22817313	-118.4636497	Los Angeles County
118706	Fee-for-Service	1669715512	1669715512	1	1	DEMARTINI, JEREMY M MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133611	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
118755	Fee-for-Service	1508328972	1508328972	1	1	DURST-WEISMAN, LEESA LCSW	3/18/2025	104100000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
118780	Fee-for-Service	1356420038	1356420038	1	1	DOEPKE, LAURA R MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90389	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
118785	Fee-for-Service	1588171987	1588171987	1	1	DEVIKA PHARMA INC	6/14/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1241 BEAR MOUNTAIN BLVD	STE E	ARVIN	CA	93203	1201	15	06029	35.20896713	-118.8386509	Kern County
118879	Fee-for-Service	1811019854	1811019854	1	1	DUNCAN,ANGLEA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM	None	LITTLE ROCK	AR	72225	0000	00	None	34.749009	-92.320101	Pulaski County
118936	Fee-for-Service	1053312652	1053312652	1	1	D DANZ & SONS INC	4/23/1981	335E00000X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	6741 N WILLOW AVE	STE 101	FRESNO	CA	93710	5955	10	06019	36.834615	-119.7301145	Fresno County
118955	Fee-for-Service	1013206648	1013206648	1	1	DOOLEY, SEAN MD	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135857	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
118978	Fee-for-Service	1649354549	1649354549	1	1	DAVID A HARTEMINK	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7850 VANCE DR	STE 225	ARVADA	CO	80003	2133	00	None	39.83949082	-105.0793741	Jefferson County
118998	Fee-for-Service	1871878413	1871878413	1	1	DROWN, JENNIFER A	5/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
119006	Fee-for-Service	1134274780	1134274780	1	2	DR EUGENE GREEN OPTOMETRY	5/31/1990	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY INC	1818 S WESTERN AVE	STE 101	LOS ANGELES	CA	90006	5862	19	06037	34.0412168	-118.3089894	Los Angeles County
119063	Fee-for-Service	1679734891	1679734891	1	1	DAVIS, TYLER L MD	6/22/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	177562	None	None	0	In state provider	None	34490 BOB HOPE	None	RANCHO MIRAGE	CA	92270	1713	33	06065	33.79844194	-116.40586	Riverside County
119099	Fee-for-Service	1811210412	1811210412	1	1	DAGANZO, SALLY M MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107615	41	Internal Medicine	0	In state provider	None	1033 THIRD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
119113	Fee-for-Service	1548408776	1548408776	1	1	DUNHAM, ROBERT H MD INC	11/17/2008	208600000X	NA	General Surgery	026	PHYSICIANS	74484	02	General Surgery	0	In state provider	None	3434 VILLA LANE	SUITE 260	NAPA	CA	94558	6415	28	06055	38.32515937	-122.2938358	Napa County
119154	Fee-for-Service	1669561536	1669561536	1	1	DANA, ALI-PARDIS MD	11/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111309	None	None	0	In state provider	None	1200 W GONZALES RD	STE 300	OXNARD	CA	93036	3075	56	06111	34.21910561	-119.1919869	Ventura County
119194	Fee-for-Service	1487762092	1487762092	1	1	DAHNKE, MATTHEW H MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64801	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	RM 1002	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
119377	Fee-for-Service	1033434923	1033434923	1	1	DUNCAN, PARKER A MD	6/1/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	118268	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 LOMBARDI CT	None	SANTA ROSA	CA	95407	6798	49	06097	38.427804	-122.7493035	Sonoma County
119440	Fee-for-Service	1457430191	1457430191	1	1	DESAI, MAYURI MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66750	22	Pathology (M.D. only)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
119444	Fee-for-Service	1972739035	1972739035	1	1	DIAZ, IVONNE MD	10/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115601	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
119449	Fee-for-Service	1194492777	1194492777	1	1	DEL ROSARIO, YVONNE SONJA N	11/17/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
119454	Fee-for-Service	1528497385	1528497385	1	1	DULAY, JOTI K CRNA	4/16/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
119464	Fee-for-Service	1326225905	1326225905	1	1	DALVE-ENDRES, ANDREA MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102357	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
119514	Fee-for-Service	1285412007	1285412007	1	1	DE LA PENA EYE CLINIC, A MED	1/15/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1760 TERMINO AVE	SUITE 306	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
119539	Fee-for-Service	1720193006	1720193006	1	1	DHILLION, JASPREET K MD	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149434	78	Neoplastic Diseases/Oncology	0	In state provider	None	2 MEDICAL PLAZA	SUITE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
119585	Fee-for-Service	1306055231	1306055231	1	1	DERBY, RYAN E MD	9/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121797	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119602	Fee-for-Service	1962065037	1962065037	1	1	DERAKHSHANIAN-JONES, SAHAR	4/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	MD	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
119604	Fee-for-Service	1154667095	1154667095	1	1	DIAZ, LISA M MD INC	8/14/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51213	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	361 HOSPITAL RD	SUITE 223	NEWPORT BEACH	CA	92663	3509	30	06059	33.62579141	-117.9299554	Orange County
119609	Fee-for-Service	1356352561	1356352561	1	1	DENNIS, CAROLINE C MD	1/1/1998	207L00000X	NA	Other	026	PHYSICIANS	81310	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
119611	Fee-for-Service	1396434874	1396434874	1	1	DE CASTRO, LEOCARLO NP	9/7/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2221 LINCOLN PARK	None	LOS ANGELES	CA	90031	2920	19	06037	34.07105982	-118.202527	Los Angeles County
119620	Fee-for-Service	1114940145	1114940145	1	1	DE LA ROSA, PEDRO MD	3/1/1997	207R00000X	NA	Other	026	PHYSICIANS	46457	None	None	0	In state provider	None	3780 WOODRUFF AVE	STE C	LONG BEACH	CA	90808	2144	19	06037	33.828102	-118.1165525	Los Angeles County
119638	Fee-for-Service	1144262668	1144262668	1	1	DAVID W MCNAUL MD	11/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9850 ST LUKES DR	None	NAMPA	ID	83687	7912	00	None	43.618383	-116.5904145	Canyon County
119677	Fee-for-Service	1437184157	1437184157	1	1	DEMER, LINDA L MD	1/1/1995	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	43709	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
119679	Fee-for-Service	1366526352	1366526352	1	1	DESKY, AUDREY B MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45387	07	Dermatology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
119715	Fee-for-Service	1770790347	1770790347	1	1	DURPHY, MICHAEL L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	28170	36	Psychiatry	0	In state provider	None	412 RED HILL AVE	STE 5	SAN ANSELMO	CA	94960	2468	21	06041	37.97656446	-122.55876	Marin County
119773	Fee-for-Service	1750531836	1750531836	1	1	DE LAY, JEANA M LMFT	6/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	404 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3325	19	06037	33.83797097	-118.3841093	Los Angeles County
119787	Fee-for-Service	1184150633	1184150633	1	1	DAVIS, WILLIAM B MD	10/9/2020	207R00000X	NA	Other	026	PHYSICIANS	160799	41	Internal Medicine	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
119795	Fee-for-Service	1619919735	1619919735	1	1	D'AGOSTINO, JOSEPH C DO	10/15/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	7531	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
119801	Fee-for-Service	1285412007	1285412007	1	1	DE LA PENA EYE CLINIC, A MED	1/15/2024	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1760 TERMINO AVE	SUITE 306	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
119828	Fee-for-Service	1720193006	1720193006	1	1	DHILLION, JASPREET K MD	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149434	68	Hematology	0	In state provider	None	2 MEDICAL PLAZA	SUITE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
119837	Fee-for-Service	1336178565	1336178565	1	1	DICHEN ZHAO	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 JOHNSON FERRY RD	None	ATLANTA	GA	30342	1606	00	None	33.90791732	-84.3540509	Fulton County
119860	Fee-for-Service	1669613642	1669613642	1	1	DA PENA, EILEEN PSYD	6/23/2020	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
119895	Fee-for-Service	1851546600	1851546600	1	1	DI LORENZO, DANIEL J	5/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153466	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
119909	Fee-for-Service	1114275344	1114275344	1	1	D'SOUZA, TREVOR N	8/17/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3633 CAMINO DEL RIO S	STE 300	SAN DIEGO	CA	92108	4014	37	06073	32.77798059	-117.1163142	San Diego County
119922	Fee-for-Service	1356832737	1356832737	1	1	DRAKE, JENNIFER B LAC	10/10/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	45011 CALPELLA ST	None	MENDOCINO	CA	95460	0000	23	06045	39.30680353	-123.7989207	Mendocino County
119940	Fee-for-Service	1609826338	1609826338	1	1	DELGADO, JULIAN L MD	12/1/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55334	08	Family Practice	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2155	06	06011	39.20737704	-122.0004043	Colusa County
120034	Fee-for-Service	1104110204	1104110204	1	1	DUKES, TADONISHA S	7/24/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	807 BROKEN ARROW AVENUE	None	BAKERSFIELD	CA	93307	7687	15	06029	35.36058189	-118.94147	Kern County
120136	Fee-for-Service	1700978905	1700978905	1	1	DONAHUE, KRISTIN N LMFT	6/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
120151	Fee-for-Service	1932664893	1932664893	1	1	DILLON, JESSICA M NP	9/1/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
120160	Fee-for-Service	1386654168	1386654168	1	1	DALMENDRAY, ALINA A MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48599	41	Internal Medicine	0	In state provider	None	1400 EAST CHURCH AVE	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
120163	Fee-for-Service	1598454563	1598454563	1	1	DESTA, MERON CNP	6/28/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25880 MCBEAN PKWY	None	SANTA CLARITA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
120179	Fee-for-Service	1366462756	1366462756	1	1	DUENSING, ROBERT A MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	81880	02	General Surgery	0	In state provider	None	24411 HEALTH CENTER DR	SUITE 350	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
120189	Fee-for-Service	1235228867	1235228867	1	1	DUONG, JOLENE M MD	10/18/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80312	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
120211	Fee-for-Service	1750610804	1750610804	1	1	DIELUBANZA, ELODI MD	2/26/2024	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
120214	Fee-for-Service	1700861762	1700861762	1	1	DAVIS, HELEN A MD	12/3/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	164968	18	Ophthalmology	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
120242	Fee-for-Service	1780615542	1780615542	1	1	DEVIREDDY, KARTHIKEYA MD	7/14/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35184	41	Internal Medicine	0	In state provider	INC	311 W I ST	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
120311	Fee-for-Service	1831402775	1831402775	1	1	DIROCCO, ANGELA LCSW	8/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
120316	Fee-for-Service	1427181007	1427181007	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
120325	Fee-for-Service	1104110204	1104110204	1	1	DUKES, TADONISHA S	7/24/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	807 BROKEN ARROW AVENUE	None	BAKERSFIELD	CA	93307	7687	15	06029	35.36058189	-118.94147	Kern County
120339	Fee-for-Service	1629339304	1629339304	1	1	DUONG, MAI T MD	11/9/2023	207R00000X	NA	Other	026	PHYSICIANS	127798	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
120347	Fee-for-Service	1720184666	1720184666	1	1	DONZIS, PAUL B MD INC	2/23/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	4644 LINCOLN BLVD	STE 102	MARINA DEL REY	CA	90292	6374	19	06037	33.98210351	-118.4405172	Los Angeles County
120351	Fee-for-Service	1881676302	1881676302	1	1	DUA, CESAR L MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62556	40	Pediatrics	0	In state provider	None	3946 NORWOOD AVE	None	SACRAMENTO	CA	95838	3300	34	06067	38.639952	-121.456359	Sacramento County
120361	Fee-for-Service	1184938839	1184938839	1	1	DABU, KRISTINE J	4/14/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
120364	Fee-for-Service	1265520233	1265520233	1	1	DARC, BRENT W MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80390	20	Orthopedic Surgery	0	In state provider	None	4444 MAGNOLIA AVE	None	RIVERSIDE	CA	92301	4136	33	06065	33.97614344	-117.3797664	Riverside County
120452	Fee-for-Service	1528462488	1528462488	1	1	DODD, MICHELE LCSW	6/26/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	550 W ALLUVIAL AVE	STE 108	FRESNO	CA	93711	5857	10	06019	36.84447289	-119.8025883	Fresno County
120456	Fee-for-Service	1891350997	1891350997	1	1	DAO, AMY N NP	4/21/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
120471	Fee-for-Service	1639125362	1639125362	1	1	DALY CITY PODIATRY GROUP	10/1/1998	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1800 SULLIVAN AVE	RM 106	DALY CITY	CA	94015	2227	41	06081	37.68077723	-122.4728941	San Mateo County
120488	Fee-for-Service	1144767534	1144767534	1	1	DOAN, DOMINIQUE GIA-GIA APMC	4/2/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38598	02	General Surgery	0	In state provider	None	323 W VALLEY BLVD	None	SAN GABRIEL	CA	91776	3726	19	06037	34.07955234	-118.1047349	Los Angeles County
120511	Fee-for-Service	1114516945	1114516945	1	1	DASKALAKIS, ZAFIRIS J MD	3/18/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171261	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
120522	Fee-for-Service	1669530861	1669530861	1	1	DIEHL, DAVID R MD INC	5/2/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36513	05	Anesthesiology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
120531	Fee-for-Service	1548276454	1548276454	1	1	DANG, VIET V MD	4/30/2012	207W00000X	NA	Ophthalmology	026	PHYSICIANS	48829	18	Ophthalmology	0	In state provider	None	10301 BOLSA AVE	STE 104	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
120545	Fee-for-Service	1023669942	1023669942	1	1	DOMINIC DIZON MEDICAL CORPOR	12/5/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ATION	2066 E COPPER AVE	STE 104	FRESNO	CA	93730	5409	10	06019	36.89569948	-119.7455119	Fresno County
120570	Fee-for-Service	1912938085	1912938085	1	1	DE PALA, ARMANDO JR MD	12/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52324	40	Pediatrics	0	In state provider	None	1550A PROFESSIONAL DR	None	PETALUMA	CA	94954	6628	49	06097	38.25596038	-122.6308056	Sonoma County
120603	Fee-for-Service	1427181007	1427181007	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
120613	Fee-for-Service	1427040732	1427040732	1	1	DENNY, KEVIN J MD	8/1/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	44848	18	Ophthalmology	0	In state provider	None	711 VAN NESS AVE.	STE 300	SAN FRANCISCO	CA	94102	3286	38	06075	37.78218473	-122.4208156	San Francisco County
120619	Fee-for-Service	1043841737	1043841737	1	1	DIMAS SEBASTIAN, LIZETH	8/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
120645	Fee-for-Service	1629232715	1629232715	1	1	DILLON, MAYRA M MD	6/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112571	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
120646	Fee-for-Service	1619077799	1619077799	1	1	DECLERCK, YVES A MD	12/17/1996	2080P0207X	NA	Hematology	026	PHYSICIANS	32094	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
120647	Fee-for-Service	1538243522	1538243522	1	1	DUCHYNSKI, ROBERT M MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64892	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
120648	Fee-for-Service	1639733314	1639733314	1	1	DO-NGUYEN, AMY D MD	2/24/2023	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
120682	Fee-for-Service	1720147655	1720147655	1	1	DIAS, MARIA M	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
120694	Fee-for-Service	1295052322	1295052322	1	1	DAWA, JOSEPH E DO	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
120696	Fee-for-Service	1285776161	1285776161	1	1	DHILLON, GUNDEEP S MD	12/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51712	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120813	Fee-for-Service	1669530861	1669530861	1	1	DIEHL, DAVID R MD INC	5/2/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	36513	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
120815	Fee-for-Service	1376620229	1376620229	1	1	DENG, HAIYAN H MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76202	07	Dermatology	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
120833	Fee-for-Service	1023669942	1023669942	1	1	DOMINIC DIZON MEDICAL CORPOR	12/5/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ATION	2066 E COPPER AVE	STE 104	FRESNO	CA	93730	5409	10	06019	36.89569948	-119.7455119	Fresno County
120856	Fee-for-Service	1841346442	1841346442	1	1	DAVIDS, HEATHER R MD	3/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106707	05	Anesthesiology	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
120861	Fee-for-Service	1558568865	1558568865	1	1	DAVAE, UMEE A DO	2/8/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	13509	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
120892	Fee-for-Service	1427181007	1427181007	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
120927	Fee-for-Service	1447308366	1447308366	1	1	DAVISON, MARC J MD	2/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87575	33	Thoracic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
120930	Fee-for-Service	1881646289	1881646289	1	1	DAVID KUSH M.D.	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	STE 142	PHOENIX	AZ	85013	3449	00	None	33.49179	-112.07844	Maricopa County
120933	Fee-for-Service	1619077799	1619077799	1	1	DECLERCK, YVES A MD	12/17/1996	2080P0207X	NA	Hematology	026	PHYSICIANS	32094	47	Miscellaneous	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
120952	Fee-for-Service	1962969212	1962969212	1	1	DANELA S ESCUETA MD A PROFES	8/7/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	SIONAL CORPORATION	207 W LEGION ROAD	None	BRAWLEY	CA	92227	2423	13	06025	32.95809	-115.5537045	Imperial County
120981	Fee-for-Service	1912962705	1912962705	1	1	DAVIS, JOHN CLAIR JR MD	6/1/1998	207RR0500X	NA	Other	026	PHYSICIANS	72915	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
120985	Fee-for-Service	1285776161	1285776161	1	1	DHILLON, GUNDEEP S MD	12/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51712	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120995	Fee-for-Service	1679532477	1679532477	1	1	DEWEESE, STEVEN G MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
120999	Fee-for-Service	1750456653	1750456653	1	1	DING, QIN LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	19753 VALLEY BLVD	None	WALNUT	CA	91789	2136	19	06037	34.00385566	-117.8699417	Los Angeles County
121137	Fee-for-Service	1619175502	1619175502	1	1	DODSON, TIMOTHY J	6/13/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
121152	Fee-for-Service	1508019746	1508019746	1	1	DELRAHIM, SOHEILA MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104853	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
121157	Fee-for-Service	1619675485	1619675485	1	1	DEEPTHI CULL MD PC	5/19/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	5001 COMMERCE DR	None	BAKERSFIELD	CA	93309	0648	15	06029	35.36784468	-119.0578744	Kern County
121189	Fee-for-Service	1831312099	1831312099	1	1	DAVIS, ERIC MD	11/26/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	156642	30	Radiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
121206	Fee-for-Service	1972577914	1972577914	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BCH DIALYSIS	16892 BOLSA CHICA AVE	SUITE 100	HUNTINGTN BCH	CA	92649	3571	30	06059	33.71658507	-118.0413189	Orange County
121213	Fee-for-Service	1316393671	1316393671	1	1	DIERINGER, THOMAS D MD	7/19/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	162050	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121271	Fee-for-Service	1114216850	1114216850	1	1	DIGNITY HEALTH	5/3/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9500 STOCKDALE HWY	SUITE 109	BAKERSFIELD	CA	93311	3621	15	06029	35.35452448	-119.1074625	Kern County
121277	Fee-for-Service	1548343395	1548343395	1	1	DESERT ROSE MEDICAL SUPPLIES	11/28/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	LLC	3400 SIRIUS AVE	STE A	LAS VEGAS	NV	89102	8310	00	None	36.13368425	-115.1861587	Clark County
121295	Fee-for-Service	1013116003	1013116003	1	1	DARA H CHRISTANTE	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	217 W CATALDO AVE	None	SPOKANE	WA	99201	2217	00	None	47.665782	-117.4152105	Spokane County
121313	Fee-for-Service	1710391479	1710391479	1	1	DOSS, ERIKA L MD	2/7/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	150483	None	None	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 2400	LOS ANGELES	CA	90033	2474	19	06037	34.05101259	-118.217259	Los Angeles County
121351	Fee-for-Service	1467440743	1467440743	1	1	DEBORAH HEART AND LUNG CENTE	9/10/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	R	200 TRENTON RD	None	BROWNS MILLS	NJ	08015	1705	00	None	39.97694153	-74.58595059	Burlington County
121399	Fee-for-Service	1457117798	1457117798	1	1	DEVADAS MOSES, A PROFESSIONA	11/5/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L MEDICAL CORPORATION.	701 HIGHLAND SPRINGS AVE	#5	BEAUMONT	CA	92223	2550	33	06065	33.93142778	-116.946913	Riverside County
121423	Fee-for-Service	1659637999	1659637999	1	1	DUFOUR, DAVID I DC	1/5/2023	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
121437	Fee-for-Service	1912501883	1912501883	2	1	DESERT GRIT PROFESSIONAL CLI	6/19/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	22025 OTOE ROAD	None	APPLE VALLEY	CA	92307	1857	36	06071	34.5439755	-117.1836655	San Bernardino County
121488	Fee-for-Service	1609840347	1609840347	1	1	DVA HLTHCARE RENAL CARE	8/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2111 N GAREY AVE	None	POMONA	CA	91767	2328	19	06037	34.08606018	-117.7512819	Los Angeles County
121495	Fee-for-Service	1952634412	1952634412	1	1	DY-FERRER, JOY V	5/18/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
121505	Fee-for-Service	1659787877	1659787877	1	1	DELA PENA, PRINCESS P MD	9/14/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149269	40	Pediatrics	0	In state provider	None	1144 NORMAN DRIVE	SUITE 203B	MANTECA	CA	95336	5960	39	06077	37.79425166	-121.1998524	San Joaquin County
121508	Fee-for-Service	1679093355	1679093355	1	1	DUPART, EVAN L MD	9/27/2021	207R00000X	NA	Other	026	PHYSICIANS	173837	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
121587	Fee-for-Service	1184669285	1184669285	1	1	DA ROZA, RICHARDO MD	11/10/1993	207RX0202X	NA	Oncology	026	PHYSICIANS	41444	41	Internal Medicine	0	In state provider	None	20406 REDWOOD RD	STE G	CASTRO VALLEY	CA	94546	4317	01	06001	37.697319	-122.073922	Alameda County
121633	Fee-for-Service	1467440743	1467440743	1	1	DEBORAH HEART AND LUNG CENTE	9/10/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	R	200 TRENTON RD	None	BROWNS MILLS	NJ	08015	1705	00	None	39.97694153	-74.58595059	Burlington County
121675	Fee-for-Service	1821050642	1821050642	1	1	DUDEJA, DEEP R MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	83764	18	Ophthalmology	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
121684	Fee-for-Service	1518124726	1518124726	1	1	DUNCAN, ROBERT C DO	5/6/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10205	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	None	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
121725	Fee-for-Service	1912501883	1912501883	2	1	DESERT GRIT PROFESSIONAL CLI	6/19/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	22025 OTOE ROAD	None	APPLE VALLEY	CA	92307	1857	36	06071	34.5439755	-117.1836655	San Bernardino County
121726	Fee-for-Service	1942480199	1942480199	1	1	DOLINSKY, BRAD M MD	11/8/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	149818	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
121727	Fee-for-Service	1144306655	1144306655	1	1	DOURSOUNIAN, MHEIR MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72718	34	Urology and Urological Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
121732	Fee-for-Service	1992784235	1992784235	1	1	DUGDALE, WILLIAM R MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	11043	08	Family Practice	0	In state provider	None	5290 ELVAS AVE	None	SACRAMENTO	CA	95819	2332	34	06067	38.57589	-121.435218	Sacramento County
121754	Fee-for-Service	1215950647	1215950647	1	1	DZHANASHVILI, RAMAZ R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45389	01	General Practice	0	In state provider	None	17777 VENTURA BLVD	SUITE 250	ENCINO	CA	91316	3717	19	06037	34.16286556	-118.5200521	Los Angeles County
121803	Fee-for-Service	1699461012	1699461012	1	1	DUNN, CHRISTOPHER J CRNA	5/9/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
121857	Fee-for-Service	1093800229	1093800229	1	2	DINER, MARAT	9/26/2006	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY	2480 MISSION ST	STE 217	SAN FRANCISCO	CA	94110	2485	38	06075	37.75745685	-122.418984	San Francisco County
121863	Fee-for-Service	1891253852	1891253852	1	1	DIGNITONIC HOME CARE LLC	12/1/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2600 WEST OLIVE AVE	STE 535	BURBANK	CA	91505	4549	19	06037	34.15993924	-118.3307814	Los Angeles County
121908	Fee-for-Service	1881112381	1881112381	1	1	DEMATTEO, NATALIA F NP	10/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121958	Fee-for-Service	1922683796	1922683796	1	1	DAVIDSON DONNA DRIVE LLC	7/29/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1110 E DONNA DR	None	MERCED	CA	95340	0678	24	06047	37.32848417	-120.457734	Merced County
122018	Fee-for-Service	1902954712	1902954712	1	1	DAVID, RAYMUNDO M MD	11/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53950	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
122019	Fee-for-Service	1992784235	1992784235	1	1	DUGDALE, WILLIAM R MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	11043	01	General Practice	0	In state provider	None	5290 ELVAS AVE	None	SACRAMENTO	CA	95819	2332	34	06067	38.57589	-121.435218	Sacramento County
122035	Fee-for-Service	1386765121	1386765121	1	1	DOLAN, JUSTINE CCC-SLP	4/5/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
122044	Fee-for-Service	1407904287	1407904287	1	1	DIONYSIAN, EMIL	1/31/1993	204D00000X	NA	Other	026	PHYSICIANS	65376	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
122095	Fee-for-Service	1912288432	1912288432	1	11	DIGNITY HEALTH MEDICAL FOUND	8/4/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	-NORTH STATE INC	2510 AIRPARK DR	STE 104	REDDING	CA	96001	2449	45	06089	40.57119566	-122.4016582	Shasta County
122097	Fee-for-Service	1467660670	1467660670	2	1	DOWNEY CARE HOMES INC	5/8/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7943 7TH STREET	None	DOWNEY	CA	90241	2211	19	06037	33.94894896	-118.1353217	Los Angeles County
122118	Fee-for-Service	1720065253	1720065253	1	1	DOUGLAS G HARRISON MD	8/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2020 W 16TH ST	None	SAFFORD	AZ	85546	4026	00	None	32.82194836	-109.7332636	Graham County
122127	Fee-for-Service	1043275621	1043275621	1	1	DALLALZADEH, SAIED MD	11/14/2008	207P00000X	NA	Other	026	PHYSICIANS	48942	40	Pediatrics	0	In state provider	PEDIATRIC GASTROENTEROLO	16661 VENTURA BLVD	STE 613	ENCINO	CA	91436	1985	19	06037	34.15820737	-118.496492	Los Angeles County
122128	Fee-for-Service	1801390893	1801390893	1	1	DWYER, RYAN MD	2/28/2025	207P00000X	NA	Other	026	PHYSICIANS	185154	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
122139	Fee-for-Service	1013931179	1013931179	1	2	DELGADO, JOSE D MD	11/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43559	01	General Practice	0	In state provider	None	5240 E. BEVERLY BLVD.	None	LOS ANGELES	CA	90022	2002	19	06037	34.03136608	-118.1524713	Los Angeles County
122151	Fee-for-Service	1962501429	1962501429	2	1	DIMMETTE, PATTIE J	8/31/1990	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	66939	None	None	0	In state provider	None	25405 HANCOCK AVE	STE 101	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
122156	Fee-for-Service	1043571847	1043571847	1	1	DELA CRUZ, JEFFREY W MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
122179	Fee-for-Service	1447278122	1447278122	1	1	DORMAN, BRIAN W MD	10/1/1980	208800000X	NA	Other	026	PHYSICIANS	24506	34	Urology and Urological Surgery	0	In state provider	None	2504 HARRISON AVE	STE C	EUREKA	CA	95501	3221	12	06023	40.785408	-124.139668	Humboldt County
122220	Fee-for-Service	1194954925	1194954925	1	1	DESAI, TORAL S MD	3/24/2022	207R00000X	NA	Other	026	PHYSICIANS	145832	None	None	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
122223	Fee-for-Service	1689069874	1689069874	1	1	DAVIDSON, JOHN A DPM	2/3/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	345 F STREET	STE 100	CHULA VISTA	CA	91910	2632	37	06073	32.64088085	-117.081699	San Diego County
122231	Fee-for-Service	1407896194	1407896194	1	1	DRUMMOND, JOHN C MD	4/30/1982	207L00000X	NA	Other	026	PHYSICIANS	36469	05	Anesthesiology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
122248	Fee-for-Service	1154068070	1154068070	1	1	DR. HOANGNHAN LE, O.D., INC.	6/17/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5811 BEACH BLVD	None	BUENA PARK	CA	90621	2021	30	06059	33.875883	-117.998376	Orange County
122288	Fee-for-Service	1750762993	1750762993	1	1	DUBIN, IRAM T MD	4/7/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145938	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
122306	Fee-for-Service	1548272917	1548272917	1	1	DAT MANH NGUYENMD APC	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36056	None	None	0	In state provider	None	14536 BROOKHURST ST	SUITE 102	WESTMINSTER	CA	92683	5787	30	06059	33.751737	-117.9548845	Orange County
122322	Fee-for-Service	1265610273	1265610273	1	2	DOUGLAS, PAULETTE LMFT	12/31/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23800 SUNNYMEAD BLVD	SUITE D	MORENO VALLEY	CA	92553	7731	33	06065	33.93901947	-117.2473637	Riverside County
122413	Fee-for-Service	1043275621	1043275621	1	1	DALLALZADEH, SAIED MD	11/14/2008	207P00000X	NA	Other	026	PHYSICIANS	48942	66	Emergency Medicine (Urgent Care)	0	In state provider	PEDIATRIC GASTROENTEROLO	16661 VENTURA BLVD	STE 613	ENCINO	CA	91436	1985	19	06037	34.15820737	-118.496492	Los Angeles County
122414	Fee-for-Service	1740535152	1740535152	1	1	DUBE, BIANCA P MD	10/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	172036	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
122420	Fee-for-Service	1346465168	1346465168	1	1	DIERKSHEIDE, JULIE E MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128857	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
122437	Fee-for-Service	1720194111	1720194111	1	1	DUFFNER, DAVID W MD	3/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87277	20	Orthopedic Surgery	0	In state provider	A MEDICAL CORP	1180 N INDIAN CANYON DR	STE W201	PALM SPRINGS	CA	92262	4876	33	06065	33.839505	-116.5455735	Riverside County
122494	Fee-for-Service	1518511930	1518511930	1	1	DEZA, MARTIN J LMFT	1/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
122499	Fee-for-Service	1245242197	1245242197	1	1	DONNER, CHARLES C MD	1/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	49701	67	Endocrinology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
122501	Fee-for-Service	1649299702	1649299702	1	1	DOUNG, CHRISTINE A MD	10/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83806	41	Internal Medicine	0	In state provider	None	1998 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92405	4116	36	06071	34.1334	-117.289677	San Bernardino County
122570	Fee-for-Service	1821010257	1821010257	1	1	DIETZ, JEFFREY W MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	39610	08	Family Practice	0	In state provider	None	1101 SMITH LN	None	ROSEVILLE	CA	95661	4103	31	06061	38.73801017	-121.2748212	Placer County
122636	Fee-for-Service	1801070214	1801070214	1	1	DHAND, S MD INC	8/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	37505	08	Family Practice	0	In state provider	None	1535 WEST MERCED AVENUE	#308	WEST COVINA	CA	91790	3402	19	06037	34.06295577	-117.9482872	Los Angeles County
122711	Fee-for-Service	1922169036	1922169036	1	1	DECKERT, PATRICIA K DO	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	6289	08	Family Practice	0	In state provider	None	1328 E MADISON AVE	None	EL CAJON	CA	92021	8501	37	06073	32.80022298	-116.9346487	San Diego County
122717	Fee-for-Service	1013248335	1013248335	1	1	DARANCARE HEALTH CORPORATION	1/28/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2486 N PONDEROSA DR	STE D-217	CAMARILLO	CA	93010	2472	56	06111	34.24266768	-119.0228157	Ventura County
122733	Fee-for-Service	1073556635	1073556635	1	1	DEGENHARDT, THOMAS C MD	10/20/1979	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	25938	36	Psychiatry	0	In state provider	None	1405 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4557	49	06097	38.44377	-122.699016	Sonoma County
122735	Fee-for-Service	1609807973	1609807973	1	1	DEMEESTER, STEVEN R MD	2/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	82268	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
122810	Fee-for-Service	1033101118	1033101118	1	1	D'ANDREA, AUDREY	8/31/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60885	08	Family Practice	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
122910	Fee-for-Service	1245855717	1245855717	1	1	DUARTE, GEORGE T LMFT	2/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
122912	Fee-for-Service	1780611723	1780611723	1	1	DENNIS, CHRISTOPHER J DO	12/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11852	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
122930	Fee-for-Service	1912119413	1912119413	1	1	DULA, BRIAN D MD	6/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95218	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3100	01	06001	37.819368	-122.263902	Alameda County
122987	Fee-for-Service	1649987207	1649987207	1	1	DR. ANI BARONI, O.D., INC	1/25/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2027 VERDUGO BLVD	STE A	MONTROSE	CA	91020	1626	19	06037	34.20482174	-118.2208331	Los Angeles County
123044	Fee-for-Service	1336293406	1336293406	1	1	DAYANI, POUYA N MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109451	18	Ophthalmology	0	In state provider	None	1127 WILSHIRE BLVD	# 1620	LOS ANGELES	CA	90017	4007	19	06037	34.05270508	-118.2641005	Los Angeles County
123108	Fee-for-Service	1760411870	1760411870	1	1	DECHERNEY, ALAN H MD	9/1/1995	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83312	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 UCLA MEDICAL PLZ	STE 430	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
123154	Fee-for-Service	1316182488	1316182488	1	1	DERAS, JACQUELINE M LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123159	Fee-for-Service	1205066776	1205066776	1	1	DO, DIEMTHANH H CRNA	7/12/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
123160	Fee-for-Service	1851928915	1851928915	1	1	DOWNEY, JORDAN P DO	9/12/2023	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
123172	Fee-for-Service	1952863060	1952863060	1	1	DER MUGRDECHIAN, ALYSSA MD	9/21/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180049	None	None	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
123183	Fee-for-Service	1750312351	1750312351	1	1	DEVOE, MONIQUE H MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66852	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
123188	Fee-for-Service	1467560599	1467560599	2	2	DIGNITY COMMUNITY CARE	5/7/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8151 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2300	34	06067	38.461554	-121.4167635	Sacramento County
123208	Fee-for-Service	1477044295	1477044295	1	1	DENNIS, JESSICA L LCSW	12/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
123267	Fee-for-Service	1306032537	1306032537	1	1	DIAZ, CHRISTINE T MD	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101088	25	Physical Medicine and Rehabilitation	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123322	Fee-for-Service	1033360771	1033360771	1	1	DE OLIVEIRA, SATIRO N MD	8/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100262	40	Pediatrics	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
123328	Fee-for-Service	1295189421	1295189421	1	1	DIAMOND, ALEXANDRA DO MD	5/5/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14601	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
123334	Fee-for-Service	1275191249	1275191249	1	1	DUBEY, ANKIT MD	8/31/2022	207R00000X	NA	Other	026	PHYSICIANS	177522	None	None	0	In state provider	None	4520 BUSINESS CENTER DR	200	FAIRFIELD	CA	94534	6888	48	06095	38.22519621	-122.1327459	Solano County
123339	Fee-for-Service	1801493101	1801493101	1	1	DREAM CARE HOME LLC	12/31/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11838 163RD ST	None	NORWALK	CA	90650	7234	19	06037	33.88365395	-118.0809868	Los Angeles County
123363	Fee-for-Service	1972127850	1972127850	1	1	DR. SUSAN BUCHAN, PHD, PSYCH	5/12/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	OLOGIST INC.	838 W 19TH ST	None	MERCED	CA	95340	4609	24	06047	37.30539882	-120.4875986	Merced County
123394	Fee-for-Service	1760411870	1760411870	1	1	DECHERNEY, ALAN H MD	9/1/1995	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	83312	67	Endocrinology	0	In state provider	None	200 UCLA MEDICAL PLZ	STE 430	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
123422	Fee-for-Service	1487613410	1487613410	1	1	DEL PIERRO, KATIE MD	11/6/2008	207R00000X	NA	Other	026	PHYSICIANS	87079	41	Internal Medicine	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
123431	Fee-for-Service	1265719918	1265719918	1	1	DHHS PHS IHS PHOENIX AREA	11/17/2011	261Q00000X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	401 PICACHO ROAD	None	WINTERHAVEN	CA	92283	0000	13	06025	32.7364143	-114.6186113	Imperial County
123452	Fee-for-Service	1538736194	1538736194	1	1	DEGROOTE, MAYA MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	182880	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
123454	Fee-for-Service	1942513882	1942513882	1	1	DISTEFANO, JAMES G JR MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	103423	20	Orthopedic Surgery	0	In state provider	None	1411 EAST 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
123534	Fee-for-Service	1487108957	1487108957	1	1	DELLA FAVE, JUSTINE E NP	11/25/2020	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
123575	Fee-for-Service	1720432669	1720432669	1	1	DUTCHER, DANIEL MD	5/6/2022	208M00000X	NA	Other	026	PHYSICIANS	151536	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
123592	Fee-for-Service	1811975642	1811975642	1	1	DHUDSHIA, NEEL V MD	7/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	3131 LA CANADA ST	STE 217	LAS VEGAS	NV	89109	2579	00	None	36.13267814	-115.132162	Clark County
123599	Fee-for-Service	1760081210	1760081210	1	1	DEDICATED HOME HEALTH CARE	12/2/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	17815 VENTURA BLVD	SUITE 211	ENCINO	CA	91316	3610	19	06037	34.16304434	-118.5206593	Los Angeles County
123612	Fee-for-Service	1033360771	1033360771	1	1	DE OLIVEIRA, SATIRO N MD	8/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100262	68	Hematology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
123614	Fee-for-Service	1891083473	1891083473	1	1	DIABLO PROSTHETICS AND	10/12/2012	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	5601 NORRIS CANYON ROAD	SUITE 320	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
123643	Fee-for-Service	1083658470	1083658470	1	1	DAVIS, JAY M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	30021	08	Family Practice	0	In state provider	STUDENT HEALTH CENTER	PLAZA AVE	None	ARCATA	CA	95521	4742	12	06023	40.87718316	-124.0811195	Humboldt County
123647	Fee-for-Service	1760469209	1760469209	1	2	DIGESTIVE AND LIVER DISEASE	2/28/2022	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPECIALISTS A MEDICAL GR	14350 WHITTIER BLVD	225	WHITTIER	CA	90605	2142	19	06037	33.95501294	-118.0185665	Los Angeles County
123658	Fee-for-Service	1073017257	1073017257	1	1	DANG, KIMBERLY MD	5/27/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	175143	None	None	0	In state provider	None	11318 NATIONAL BLVD	None	LOS ANGELES	CA	90064	3727	19	06037	34.02583378	-118.4321226	Los Angeles County
123713	Fee-for-Service	1730455973	1730455973	1	1	DUNHAM, JEANNE MSW LCSW	8/14/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1633 E. FOURTH STREET	STE. 150	SANTA ANA	CA	92701	5170	30	06059	33.7481375	-117.846441	Orange County
123714	Fee-for-Service	1740348226	1740348226	1	1	DOUGHTEN, JOEL D MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	45021	08	Family Practice	0	In state provider	None	4435 BROCKTON AVE	None	RIVERSIDE	CA	92501	4004	33	06065	33.97779042	-117.3837878	Riverside County
123720	Fee-for-Service	1265719918	1265719918	1	1	DHHS PHS IHS PHOENIX AREA	11/17/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	401 PICACHO ROAD	None	WINTERHAVEN	CA	92283	0000	13	06025	32.7364143	-114.6186113	Imperial County
123725	Fee-for-Service	1316790983	1316790983	1	1	DHILLON, MOHNI NP	4/22/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
123760	Fee-for-Service	1487157210	1487157210	1	1	DENG, TAYLOR A MD	10/12/2022	207L00000X	NA	Other	026	PHYSICIANS	166636	None	None	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
123785	Fee-for-Service	1013981455	1013981455	1	1	DVA HEALTHCARE RENAL	12/12/2003	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1590 SCENIC AVE	None	COSTA MESA	CA	92626	1400	30	06059	33.69938956	-117.9245876	Orange County
123840	Fee-for-Service	1760566160	1760566160	1	1	DONNELLY, JOHN G MD	1/31/1994	2084P0800X	NA	Psychiatry	026	PHYSICIANS	48716	36	Psychiatry	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
123882	Fee-for-Service	1538248166	1538248166	1	1	DOMINGO, MIGUEL I MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53766	40	Pediatrics	0	In state provider	None	512 S GLENDORA	STE B	WEST COVINA	CA	91790	3022	19	06037	34.06561213	-117.927192	Los Angeles County
123887	Fee-for-Service	1669993564	1669993564	1	1	DAISLEY, ALICIA C MD	9/16/2020	208M00000X	NA	Other	026	PHYSICIANS	169849	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
123897	Fee-for-Service	1033360771	1033360771	1	1	DE OLIVEIRA, SATIRO N MD	8/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100262	78	Neoplastic Diseases/Oncology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
123931	Fee-for-Service	1083658470	1083658470	1	1	DAVIS, JAY M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	30021	41	Internal Medicine	0	In state provider	STUDENT HEALTH CENTER	PLAZA AVE	None	ARCATA	CA	95521	4742	12	06023	40.87718316	-124.0811195	Humboldt County
123939	Fee-for-Service	1316905466	1316905466	1	1	DUBEY, SARITA MD	1/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93770	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
124045	Fee-for-Service	1538272885	1538272885	1	1	DABU, DIONISIO F MD	7/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53647	08	Family Practice	0	In state provider	None	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
124051	Fee-for-Service	1073790036	1073790036	1	1	DOUGHTY, BONNIE K LMFT	2/24/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
124060	Fee-for-Service	1679534622	1679534622	1	1	DURAMED HOMECARE SERVICE	2/2/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	861 MERIDIAN ST	None	IRWINDALE	CA	91010	3588	19	06037	34.12183092	-117.9869109	Los Angeles County
124069	Fee-for-Service	1952375982	1952375982	1	1	DAVENPORT, TODD E	8/1/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
124078	Fee-for-Service	1801000393	1801000393	1	1	DEKAY, JOHANNA W MD	5/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	155 HWY 50	None	STATELINE	NV	89449	0000	00	None	38.96860553	-119.9356859	Douglas County
124094	Fee-for-Service	1326275868	1326275868	1	1	DARROUJ, JAMIL MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149402	41	Internal Medicine	0	In state provider	None	43112 15TH STREET W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
124161	Fee-for-Service	1558437152	1558437152	1	1	DIXON, THOMAS M MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	22051	18	Ophthalmology	0	In state provider	None	181 ANDRIEUX ST	STE 100	SONOMA	CA	95476	6920	49	06097	38.28809911	-122.4613026	Sonoma County
124163	Fee-for-Service	1205298924	1205298924	1	1	DURISETI, SAI K MD	11/22/2021	2085R0001X	NA	Other	026	PHYSICIANS	174391	None	None	0	In state provider	None	27235 TOURNEY RD	1500	VALENCIA	CA	91355	5904	19	06037	34.41755702	-118.5772646	Los Angeles County
124171	Fee-for-Service	1538248166	1538248166	1	1	DOMINGO, MIGUEL I MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53766	01	General Practice	0	In state provider	None	512 S GLENDORA	STE B	WEST COVINA	CA	91790	3022	19	06037	34.06561213	-117.927192	Los Angeles County
124174	Fee-for-Service	1982705547	1982705547	1	1	DILLINGER, DANIEL L OD	9/7/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3211 FORTUNE CT	STE A	AUBURN	CA	95602	9245	31	06061	38.94234896	-121.1015805	Placer County
124221	Fee-for-Service	1083658470	1083658470	1	1	DAVIS, JAY M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	30021	66	Emergency Medicine (Urgent Care)	0	In state provider	STUDENT HEALTH CENTER	PLAZA AVE	None	ARCATA	CA	95521	4742	12	06023	40.87718316	-124.0811195	Humboldt County
124248	Fee-for-Service	1336467596	1336467596	1	1	DUFFY, CARRIE M DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11174	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	365 HAWTHRONE AVE	STE 301	OAKLAND	CA	94609	3113	01	06001	37.82079728	-122.2633226	Alameda County
124285	Fee-for-Service	1427365337	1427365337	1	1	DORIN, JASON C PSYD	2/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
124288	Fee-for-Service	1356364889	1356364889	1	1	DUONG, JOHN T MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	66685	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	400	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
124349	Fee-for-Service	1407871478	1407871478	1	1	DANG, THUY-TRANG	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70598	77	Infectious Disease	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
124374	Fee-for-Service	1417937467	1417937467	1	1	DUMONT, CHRISTINE H	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8575	None	None	0	In state provider	None	1760 TERMINO AVE	STE 222	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
124379	Fee-for-Service	1578900205	1578900205	1	1	DO, JIUN L MD	7/3/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	132436	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
124383	Fee-for-Service	1134393648	1134393648	1	1	D'SA, STEVEN J MD	11/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120036	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
124422	Fee-for-Service	1275978330	1275978330	1	1	DESAI, CHIRAG K MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132829	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
124524	Fee-for-Service	1457498263	1457498263	2	1	DOUWENGA, DEBRA LMFT	12/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LLNESS	77564 COUNTRY CLUB DRIVE	SUITE 210A	PALM DESERT	CA	92211	6248	33	06065	33.75833451	-116.3114325	Riverside County
124525	Fee-for-Service	1588921241	1588921241	1	1	DE ANGULO, GUILLERMO A MD	6/18/2020	207PP0204X	NA	Other	026	PHYSICIANS	168544	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124538	Fee-for-Service	1811259443	1811259443	1	1	DEL ROSARIO, EUNICE C MD	8/21/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	154530	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
124547	Fee-for-Service	1477755262	1477755262	1	1	DEMPSTER,KATHERINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
124550	Fee-for-Service	1316576630	1316576630	1	1	DARIOOSH, ROYA P DO	7/17/2023	208M00000X	NA	Other	026	PHYSICIANS	21165	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
124558	Fee-for-Service	1952477275	1952477275	1	1	DHILLON, SURISHAM MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51651	13	Neurology (M.D. only)	0	In state provider	VALENCIA NEUROLOGY	23928 LYONS AVE	STE 204	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
124581	Fee-for-Service	1659301646	1659301646	1	1	DURISETI, RAM SREE	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65651	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124610	Fee-for-Service	1609037340	1609037340	1	1	DAVID AARON BEHRMANN MD	9/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
124638	Fee-for-Service	1962452565	1962452565	1	1	DANESHRAD, SHAUN S MD	8/15/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70241	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 1405	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
124661	Fee-for-Service	1043958572	1043958572	1	1	DEL MAR PARK LLC	7/7/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	990 E DEL MAR BLVD	None	PASADENA	CA	91106	3252	19	06037	34.14092015	-118.1298765	Los Angeles County
124690	Fee-for-Service	1588124903	1588124903	1	1	DOSHI, KOSHA DO	9/23/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19945	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
124740	Fee-for-Service	1487640207	1487640207	1	1	DISTRICT HOSPITAL PARTNERS L	1/27/2021	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SITY HOSPITAL	900 23RD ST NW	None	WASHINGTON	DC	20037	2327	00	None	38.901582	-77.0503365	District of Columbia
124757	Fee-for-Service	1306323662	1306323662	1	1	DEMENEZES, LAUREN LMFT	10/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
124771	Fee-for-Service	1669815098	1669815098	1	1	DENTON, BRIAN P MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136525	05	Anesthesiology	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
124780	Fee-for-Service	1568085074	1568085074	1	1	DJOUMESSI, OLIVIER B CNP	11/27/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
124781	Fee-for-Service	1770788051	1770788051	1	1	DAVIS, JOY B PHD	4/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
124789	Fee-for-Service	1508891227	1508891227	1	1	DANIEL LOES, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
124814	Fee-for-Service	1588921241	1588921241	1	1	DE ANGULO, GUILLERMO A MD	6/18/2020	207PP0204X	NA	Other	026	PHYSICIANS	168544	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124835	Fee-for-Service	1720012495	1720012495	1	1	DEMPSEY, DENIS P	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
124848	Fee-for-Service	1821484775	1821484775	1	1	DUQUETTE, ERIN M MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154220	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124905	Fee-for-Service	1407820699	1407820699	1	1	DENTE, JOHN J MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83803	30	Radiology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
124910	Fee-for-Service	1902837164	1902837164	1	1	DOBKE, MAREK K.	11/30/1987	208200000X	NA	General Surgery	026	PHYSICIANS	44301	24	Plastic Surgery	0	In state provider	UCSD PLASTIC SURGERY	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
124922	Fee-for-Service	1962452565	1962452565	1	1	DANESHRAD, SHAUN S MD	8/15/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70241	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2080 CENTURY PARK E	STE 1405	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
124950	Fee-for-Service	1619124765	1619124765	1	1	DHINGRA, SANDHYA V	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123293	30	Radiology	0	In state provider	None	1516 COTNER AVENUE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
124969	Fee-for-Service	1053531467	1053531467	1	1	DAGHER, NADHIM MD	8/1/2007	207R00000X	NA	Other	026	PHYSICIANS	98565	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
124974	Fee-for-Service	1962539304	1962539304	1	2	DEY, CYNTHIA A LMFT	2/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9220 HAVEN AVENUE	SUITE 100	RANCHO CUCAMONGA	CA	91730	8551	36	06071	34.08525	-117.5758875	San Bernardino County
125026	Fee-for-Service	1487640207	1487640207	1	1	DISTRICT HOSPITAL PARTNERS L	1/27/2021	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SITY HOSPITAL	900 23RD ST NW	None	WASHINGTON	DC	20037	2327	00	None	38.901582	-77.0503365	District of Columbia
125064	Fee-for-Service	1356997316	1356997316	1	1	DE MESA, RHEA A NP	1/3/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
125065	Fee-for-Service	1508090234	1508090234	1	1	DESAI, CHAITANYA R MD	8/18/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	9125 S PULASKI RD	None	EVERGREEN PARK	IL	60805	1441	00	None	41.72743423	-87.721616	Cook County
125067	Fee-for-Service	1497138804	1497138804	1	1	DANILEVICH, MAXIM MD	8/20/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	168900	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
125106	Fee-for-Service	1104116235	1104116235	1	1	DAVIS, JOHN P MD	1/5/2024	2086S0102X	NA	General Surgery	026	PHYSICIANS	191797	None	None	0	In state provider	None	838 NORDAHL RD	SUITE 270	SAN MARCOS	CA	92069	3513	37	06073	33.13569751	-117.1191477	San Diego County
125138	Fee-for-Service	1578830212	1578830212	1	1	DOUGLAS, FAITH C NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17140 BERNARDO CENTER DR	STE 100	SAN DIEGO	CA	92128	2088	37	06073	33.0249487	-117.0758524	San Diego County
125153	Fee-for-Service	1275566648	1275566648	1	1	DATTA, SANDIP K MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65249	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125155	Fee-for-Service	1053002360	1053002360	1	1	DAVIES-UPPAL, ALLISON M NP	4/26/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
125190	Fee-for-Service	1922080209	1922080209	1	1	DR. ALAN COOPER	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
125234	Fee-for-Service	1144425687	1144425687	1	1	DICKS, BRIAN M MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100413	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125248	Fee-for-Service	1679860290	1679860290	1	1	DESAI, KINJAL A MD	5/10/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	148074	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125270	Fee-for-Service	1447665112	1447665112	1	1	DVORQUEZ MONCAYO, DENISE MD	10/8/2021	207R00000X	NA	Other	026	PHYSICIANS	170758	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
125344	Fee-for-Service	1740807080	1740807080	1	1	DIANA KATSMAN MD PHD INC	8/14/2020	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	3640 LOMITA BLVD.	SUITE 209	TORRANCE	CA	90505	3981	19	06037	33.81475516	-118.3486533	Los Angeles County
125347	Fee-for-Service	1972340842	1972340842	1	1	DANFORTH, AMANDA N DOULA	7/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	29	06057	0	0	None
125370	Fee-for-Service	1932851888	1932851888	1	1	DELTA HEALTH SERVICES INC	5/10/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12722 RIVERSIDE DR	STE 201A	VALLEY VILLAGE	CA	91607	3326	19	06037	34.15758454	-118.410318	Los Angeles County
125379	Fee-for-Service	1184943730	1184943730	1	1	DAHIYA, SAURABH MD	5/4/2022	207RX0202X	NA	Oncology	026	PHYSICIANS	140273	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125380	Fee-for-Service	1871519082	1871519082	1	1	DOMENICO CASTALDO MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
125391	Fee-for-Service	1528144995	1528144995	1	1	DASARI, PADMA MD	5/1/2024	207R00000X	NA	Other	026	PHYSICIANS	191135	None	None	0	In state provider	None	2333 MOWRY AVE	STE 300	FREMONT	CA	94538	1602	01	06001	37.55614438	-121.9822469	Alameda County
125412	Fee-for-Service	1649292913	1649292913	1	1	DANG, QUAN Q MD	11/7/2001	207L00000X	NA	Other	026	PHYSICIANS	63215	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
125423	Fee-for-Service	1013301308	1013301308	1	1	DRAGON PHARMACY CORP	5/5/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5839 WESTMINSTER BLVD	SUITE A	WESTMINSTER	CA	92683	9107	30	06059	33.75910437	-118.0272372	Orange County
125456	Fee-for-Service	1922044908	1922044908	1	1	DARRAGH, PHILLIP E DPM	2/8/2015	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	REDOND BCH PODIA GRP INC	2850 ARTESIA BLVD	STE 204	REDONDO BEACH	CA	90278	3413	19	06037	33.87277554	-118.357191	Los Angeles County
125467	Fee-for-Service	1073853537	1073853537	1	1	DUYA, ABIGAIL R	4/22/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 EUCLID ST	None	GARDEN GROVE	CA	92840	3304	30	06059	33.786882	-117.9410535	Orange County
125487	Fee-for-Service	1568420214	1568420214	1	1	DAVIS, KRISTI K OD	3/13/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	37333 STATE HIGHWAY 299	None	BURNEY	CA	96013	4371	45	06089	40.88580347	-121.6567571	Shasta County
125495	Fee-for-Service	1265690705	1265690705	1	1	DIU, MICHELLE MD	7/15/2024	207LP3000X	NA	Other	026	PHYSICIANS	161400	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
125515	Fee-for-Service	1124512454	1124512454	1	1	DERIDDER, PHILLIPS R MD	11/28/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180003	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
125527	Fee-for-Service	1437588084	1437588084	1	1	DREW, TERRI J NP	10/24/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	480 B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	49	06097	38.449557	-122.7357315	Sonoma County
125531	Fee-for-Service	1043473986	1043473986	1	1	DANIEL, VIJAI J MD	8/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6181 N THESTA	STE 104	FRESNO	CA	93710	8604	10	06019	36.826191	-119.7831295	Fresno County
125540	Fee-for-Service	1174531859	1174531859	1	2	DIGNITY HEALTH MEDICAL FOUND	3/26/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2900 WHIPPLE AVE	STE 140	REDWOOD CITY	CA	94062	2844	41	06081	37.4783072	-122.2551089	San Mateo County
125592	Fee-for-Service	1508095282	1508095282	1	1	DONAHUE, KATHERINE A PHD	4/10/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD ROAD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
125598	Fee-for-Service	1639411093	1639411093	1	1	DESAI, ANGEL N MD	7/16/2020	207R00000X	NA	Other	026	PHYSICIANS	169140	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
125606	Fee-for-Service	1720440951	1720440951	1	1	DIGIOVANNI, RYAN M MD	8/6/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	170145	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
125645	Fee-for-Service	1235492943	1235492943	1	1	DIAZ, MATTHEW P MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12957	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
125650	Fee-for-Service	1588650675	1588650675	1	1	DEVINENI, VENKATARAMANA	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54340	41	Internal Medicine	0	In state provider	None	12408 HESPERIA RD	STE 7	VICTORVILLE	CA	92395	5839	36	06071	34.47685861	-117.291289	San Bernardino County
125703	Fee-for-Service	1700327871	1700327871	1	1	DAWAR, SHAILKA OD	4/14/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15923 BEAR VALLEY ROAD	SUITE B-100	HESPERIA	CA	92345	1762	36	06071	34.47065953	-117.316035	San Bernardino County
125712	Fee-for-Service	1972003770	1972003770	1	1	DICKERSON, MORGAN E LCSW	2/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
125751	Fee-for-Service	1952083933	1952083933	1	1	DIXON, LAUREN C	4/17/2025	172V00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	44	06087	0	0	None
125799	Fee-for-Service	1386609337	1386609337	1	1	DILLON, WILLIAM P MD	10/31/1985	207T00000X	NA	General Surgery	026	PHYSICIANS	47564	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	# L371	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
125883	Fee-for-Service	1639411093	1639411093	1	1	DESAI, ANGEL N MD	7/16/2020	207R00000X	NA	Other	026	PHYSICIANS	169140	77	Infectious Disease	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
125891	Fee-for-Service	1376248211	1376248211	1	1	D'SOUZA, ANGELA PT	10/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
125918	Fee-for-Service	1528242583	1528242583	1	1	DAVU, SIMI MD	2/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101335	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
125940	Fee-for-Service	1588650675	1588650675	1	1	DEVINENI, VENKATARAMANA	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54340	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12408 HESPERIA RD	STE 7	VICTORVILLE	CA	92395	5839	36	06071	34.47685861	-117.291289	San Bernardino County
125963	Fee-for-Service	1225271893	1225271893	1	1	DERKACS, JESSICA H MD	2/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118476	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
125966	Fee-for-Service	1063448728	1063448728	1	1	DUANE A LUNDEBERG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
126044	Fee-for-Service	1487855938	1487855938	1	1	DAVID GREENBERG MD	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
126060	Fee-for-Service	1316567464	1316567464	1	1	DIOP, MOHAMED MD	8/12/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	189062	84	Surgery-Head and Neck	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
126061	Fee-for-Service	1811007644	1811007644	1	1	DEROO, DANIEL B MD	12/1/2003	207L00000X	NA	Other	026	PHYSICIANS	49163	05	Anesthesiology	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
126086	Fee-for-Service	1558612952	1558612952	1	1	DOUCETTE, STEPHANIE C LAC	9/4/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1139 ADDISON ST	STE 2	BERKELEY	CA	94702	1651	01	06001	37.86840483	-122.2901167	Alameda County
126101	Fee-for-Service	1578609327	1578609327	1	1	DIAMOND RESPIRATORY CARE	12/6/2005	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	, INC	1403 PALMYRITA AVE	None	RIVERSIDE	CA	92507	1600	33	06065	34.00481011	-117.3413792	Riverside County
126138	Fee-for-Service	1821427303	1821427303	1	1	DOSSEY, AMY C	12/24/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
126140	Fee-for-Service	1841647443	1841647443	1	1	DHALIWAL, RAVNEET MD	11/9/2023	208M00000X	NA	Other	026	PHYSICIANS	178053	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
126156	Fee-for-Service	1104237106	1104237106	1	1	DANHAUSEN, KATHLEEN CNM	12/9/2024	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
126161	Fee-for-Service	1013976612	1013976612	1	1	DUBOIS, SUJA MD	10/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86651	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
126184	Fee-for-Service	1710365671	1710365671	1	1	DUBOW, BYRON P MD	8/8/2022	208800000X	NA	Other	026	PHYSICIANS	170114	None	None	0	In state provider	None	1310 LAS TABLAS RD	STE 201	TEMPLETON	CA	93465	9747	40	06079	35.55442349	-120.722643	San Luis Obispo County
126186	Fee-for-Service	1710180575	1710180575	1	1	DECHAMBEAU, AMBER N DO	1/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14879	30	Radiology	0	In state provider	None	7901 FROST STREET	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
126192	Fee-for-Service	1407085665	1407085665	1	1	DEMIRDJIAN, MIRNA MD FACOG	10/12/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162232	None	None	0	In state provider	None	2501 E CHAPMAN AVE	UNIT 107	FULLERTON	CA	92831	3135	30	06059	33.87431052	-117.8869896	Orange County
126193	Fee-for-Service	1407513278	1407513278	1	1	DEANNA'S PLACE INC	12/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	951 E ALLUVIAL AVE	None	FRESNO	CA	93720	2516	10	06019	36.84431906	-119.766808	Fresno County
126233	Fee-for-Service	1932474087	1932474087	1	1	DOWDESWELL, AMANDA C LMFT	4/26/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
126247	Fee-for-Service	1134156649	1134156649	1	1	DOUGLASS, RACHELLE J MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104586	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
126263	Fee-for-Service	1962551713	1962551713	1	1	DUKE FACILITIES, INC #3	1/19/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	403 GOYA DR	None	STOCKTON	CA	95207	2246	39	06077	38.01840945	-121.3059555	San Joaquin County
126290	Fee-for-Service	1285768234	1285768234	1	1	DONALD, KEITH PHILLIP	10/31/1992	208600000X	NA	General Surgery	026	PHYSICIANS	76641	02	General Surgery	0	In state provider	None	5196 HILL RD E	STE 201	LAKEPORT	CA	95453	6362	17	06033	39.10527946	-122.9080599	Lake County
126305	Fee-for-Service	1114091105	1114091105	1	1	DANA, JOHN A JR MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76791	25	Physical Medicine and Rehabilitation	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
126348	Fee-for-Service	1699280362	1699280362	1	1	DELL HOME HEALTH CARE INC	3/6/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3043 FOOTHILL BLVD	SUITE 8	LA CRESCENTA	CA	91214	2769	19	06037	34.22785231	-118.2458632	Los Angeles County
126437	Fee-for-Service	1093863912	1093863912	1	1	DAMEFF, ELIZABETH M MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86980	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
126441	Fee-for-Service	1912288432	1912288432	1	9	DIGNITY HEALTH MEDICAL FOUND	3/4/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	-NORTH STATE INC	2624 EDITH	None	REDDING	CA	96001	3043	45	06089	40.57136027	-122.397513	Shasta County
126449	Fee-for-Service	1013976612	1013976612	1	1	DUBOIS, SUJA MD	10/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86651	10	Gastroenterology (M.D. only)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
126451	Fee-for-Service	1629584115	1629584115	1	1	DECOOK, RYAN LCSW	2/24/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8355 CHURCH ST	None	GILROY	CA	95020	4406	43	06085	37.01873743	-121.5768381	Santa Clara County
126462	Fee-for-Service	1386986487	1386986487	1	1	DECKER, JESSICA E	12/22/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
126472	Fee-for-Service	1396811873	1396811873	1	1	DHAPOLA, BABITA MD	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90364	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
126474	Fee-for-Service	1871992552	1871992552	1	1	DAMBRA-SANCHEZ, BRITNEY NP	8/24/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
126517	Fee-for-Service	1225205651	1225205651	1	1	DENICOLA, NATHANIEL G MD	11/11/2020	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170127	None	None	0	In state provider	None	1110 W LA PALMA AVE	STE 4	ANAHEIM	CA	92801	2823	30	06059	33.84712953	-117.9320355	Orange County
126544	Fee-for-Service	1306927454	1306927454	1	1	DEBORAH ANN ELDER	8/27/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
126616	Fee-for-Service	1114153376	1114153376	1	1	DEJEAN, CAROLINE N MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131166	05	Anesthesiology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
126636	Fee-for-Service	1417028481	1417028481	1	1	DOUCET, ROBERTA L MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	78109	05	Anesthesiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
126672	Fee-for-Service	1790700532	1790700532	1	1	DUCKETT, THOMAS MD	4/15/2008	208800000X	NA	Other	026	PHYSICIANS	58176	30	Radiology	0	In state provider	None	500 DOYLE PARK DR	STE 303	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
126681	Fee-for-Service	1568771251	1568771251	1	1	DUNNICK, PATRICIA L	8/19/2011	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11105 KNOTT AVE	STE B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
126696	Fee-for-Service	1952765141	1952765141	1	1	DUNN, BRANDYN MD	11/28/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	153021	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
126793	Fee-for-Service	1801242953	1801242953	1	1	DUJARI, SHEFALI MD	6/22/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	153524	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126798	Fee-for-Service	1942549068	1942549068	2	1	DIAGNOSTIC PATHOLOGY	3/18/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	SERVICES OF THE CENTRAL	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
126928	Fee-for-Service	1407336563	1407336563	1	1	DENTON, THERESA M LMFT	12/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
126953	Fee-for-Service	1518461011	1518461011	1	1	DOI, CHRISTOPHER OT	5/27/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
126956	Fee-for-Service	1134274780	1134274780	1	1	DR EUGENE GREEN OPTOMETRY	7/11/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	9838 FLOWER ST	None	BELLFLOWER	CA	90706	5436	19	06037	33.8820357	-118.123453	Los Angeles County
127049	Fee-for-Service	1578896536	1578896536	1	1	DUENAS, HUGO N LCSW	10/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
127089	Fee-for-Service	1043493042	1043493042	1	1	DESOUZA, RYANN L LMFT	12/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1150 BRICKYARD COVE RD	STE B12	RICHMOND	CA	94801	4181	07	06013	37.91011662	-122.377585	Contra Costa County
127321	Fee-for-Service	1447386073	1447386073	1	1	DANG, TONY N OD	10/16/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
127325	Fee-for-Service	1053806067	1053806067	1	1	D'ASSUMPCAO, CARLOS M MD	5/23/2023	390200000X	NA	Other	026	PHYSICIANS	173741	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
127365	Fee-for-Service	1669826913	1669826913	1	1	DUDLEY, KACI MD	9/2/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158974	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
127381	Fee-for-Service	1114162682	1114162682	1	1	DE SILVA, MAHESH S MD	1/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104079	05	Anesthesiology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
127466	Fee-for-Service	1801292701	1801292701	1	1	DANIEL, VIJAI J MD INC	2/24/2016	207RP1001X	NA	Pulmonology	026	PHYSICIANS	55861	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1660 E HERNDON AVE	STE 101	FRESNO	CA	93720	3346	10	06019	36.8375615	-119.7575595	Fresno County
127467	Fee-for-Service	1558554162	1558554162	1	1	DAWES, CRISTINA L LMFT	10/15/2015	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2500 VIA CABRILLO MARINA	SUITE 200A-1	SAN PEDRO	CA	90731	7224	19	06037	33.719931	-118.2828535	Los Angeles County
127477	Fee-for-Service	1376563957	1376563957	1	2	DAKAK, CHAFIK MD	11/20/2020	193400000X	NA	Other	026	PHYSICIANS	42844	40	Pediatrics	0	In state provider	None	3301 BEECHWOOD AVE	None	LYNWOOD	CA	90262	3301	19	06037	33.92961073	-118.2111703	Los Angeles County
127484	Fee-for-Service	1457436685	1457436685	1	1	DEOLARTE, GLORIA MD	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	35537	24	Plastic Surgery	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
127500	Fee-for-Service	1952691941	1952691941	1	1	DEL ROSARIO, PAMELA G MD	3/30/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	142139	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
127515	Fee-for-Service	1184692006	1184692006	1	1	DE LEON, MARY JEANNE S MD	12/5/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	164320	67	Endocrinology	0	In state provider	None	2510 DOUGLAS BLVD	#300	ROSEVILLE	CA	95661	3300	31	06061	38.74412472	-121.2400335	Placer County
127520	Fee-for-Service	1972099588	1972099588	1	1	DHAR, PRATHANA OD	8/31/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	SUITE P-25	SAN GABRIEL	CA	91776	1145	19	06037	34.10072807	-118.1066296	Los Angeles County
127544	Fee-for-Service	1851313597	1851313597	1	1	DEVINE, JOSEPH A MD	9/20/2007	207L00000X	NA	Other	026	PHYSICIANS	44910	01	General Practice	0	In state provider	None	21235 HAWTHORNE BLVD	STE 200	TORRANCE	CA	90503	5525	19	06037	33.83505386	-118.3554946	Los Angeles County
127599	Fee-for-Service	1427300839	1427300839	1	1	DO, TRIEU MD	10/1/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
127606	Fee-for-Service	1114038221	1114038221	1	1	DHILLON, HARPREET S MD	6/7/2008	207R00000X	NA	Other	026	PHYSICIANS	71150	41	Internal Medicine	0	In state provider	None	1900 MOWRY AVE	STE 104	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
127612	Fee-for-Service	1881199016	1881199016	1	1	DAGGETT, ANTHONY M	8/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164331	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
127626	Fee-for-Service	1801159967	1801159967	1	1	DAVIS, JULIAN R MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	136956	78	Neoplastic Diseases/Oncology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
127627	Fee-for-Service	1669469136	1669469136	1	1	DEREL FINCH MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	515 MINOR AVE	None	SEATTLE	WA	98104	2120	00	None	47.60657404	-122.3211141	King County
127645	Fee-for-Service	1558398347	1558398347	1	1	DRUGAS, GEORGE T MD	9/24/2021	2086S0120X	NA	General Surgery	026	PHYSICIANS	56485	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
127700	Fee-for-Service	1366761496	1366761496	1	1	DEFELICE, NATHANIEL R MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129005	41	Internal Medicine	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
127733	Fee-for-Service	1831194323	1831194323	1	1	DEBOLD, LORI A MD	3/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	66467	40	Pediatrics	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
127752	Fee-for-Service	1801292701	1801292701	1	1	DANIEL, VIJAI J MD INC	2/24/2016	207RP1001X	NA	Pulmonology	026	PHYSICIANS	55861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1660 E HERNDON AVE	STE 101	FRESNO	CA	93720	3346	10	06019	36.8375615	-119.7575595	Fresno County
127753	Fee-for-Service	1558554162	1558554162	1	1	DAWES, CRISTINA L LMFT	7/1/2009	101YM0800X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2500 VIA CABRILLO MARINA	SUITE 200A-1	SAN PEDRO	CA	90731	7224	19	06037	33.719931	-118.2828535	Los Angeles County
127806	Fee-for-Service	1558122754	1558122754	1	1	DUMAS, TRACY L	2/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
127835	Fee-for-Service	1851313597	1851313597	1	1	DEVINE, JOSEPH A MD	9/20/2007	207L00000X	NA	Other	026	PHYSICIANS	44910	05	Anesthesiology	0	In state provider	None	21235 HAWTHORNE BLVD	STE 200	TORRANCE	CA	90503	5525	19	06037	33.83505386	-118.3554946	Los Angeles County
127853	Fee-for-Service	1497220487	1497220487	1	1	DYJAK, ANDREW OT	11/10/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9828 GARDEN GROVE BLVD	STE 110	GARDEN GROVE	CA	92844	1655	30	06059	33.77397547	-117.960813	Orange County
127872	Fee-for-Service	1558067355	1558067355	1	1	DESERT COTTAGES LLC	3/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	43745 PETTIROSSO ST	None	INDIO	CA	92203	2825	33	06065	33.73131709	-116.1909276	Riverside County
127875	Fee-for-Service	1992816268	1992816268	1	1	DO, CUONG-DUNG T MD INC	6/20/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83887	18	Ophthalmology	0	In state provider	None	9061 BOLSA AVENUE	SUITE 105	WESTMINSTER	CA	92683	5558	30	06059	33.74494462	-117.9711164	Orange County
127898	Fee-for-Service	1811970973	1811970973	1	1	DAI, JENNY MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82609	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
127913	Fee-for-Service	1801159967	1801159967	1	1	DAVIS, JULIAN R MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	136956	68	Hematology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
127949	Fee-for-Service	1881988921	1881988921	2	1	DUKAS-JANAKOS, SHEILA J	11/20/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1432 BURLINGAME	None	BURLINGAME	CA	94010	4111	41	06081	37.5773244	-122.3488915	San Mateo County
127978	Fee-for-Service	1780094862	1780094862	1	1	DOTEN, ELIZABETH LMFT	1/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD.,	SUITE 3400	WHITTIER	CA	90605	0000	19	06037	33.9505367	-118.0054552	Los Angeles County
128000	Fee-for-Service	1801811617	1801811617	1	1	DELHOMME, MELISSA PHD	2/1/1999	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
128045	Fee-for-Service	1023673167	1023673167	1	1	DIAGNOSTIC PATHOLOGY MEDICAL	10/28/2020	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
128056	Fee-for-Service	1891702122	1891702122	1	1	DEV, VIPUL R MD	7/21/2021	208200000X	NA	General Surgery	026	PHYSICIANS	63639	None	None	0	In state provider	None	2901 SILLECT AVE.	201	BAKERSFIELD	CA	93308	6373	15	06029	35.38611256	-119.0393796	Kern County
128076	Fee-for-Service	1396372629	1396372629	1	1	DHALIWAL, JABERPREET DO	1/31/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	19518	36	Psychiatry	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
128079	Fee-for-Service	1851494231	1851494231	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
128088	Fee-for-Service	1275676363	1275676363	1	1	DEL RIVERO-YAMUY, ADA E	6/14/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	83694	01	General Practice	0	In state provider	None	3831 HUGHES AVE	STE 101	CULVER CITY	CA	90232	2751	19	06037	34.02243278	-118.3981492	Los Angeles County
128095	Fee-for-Service	1598779332	1598779332	1	1	DOWNEY ANESTHESIA	1/17/2002	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	11500 BROOKSHIRE AVENUE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
128177	Fee-for-Service	1659682367	1659682367	1	1	DIEUJUSTE, JEREMIAH E LMFT	5/16/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 105	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
128208	Fee-for-Service	1518011519	1518011519	1	1	DIGGINS, LEE OD	8/1/1993	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
128215	Fee-for-Service	1164796793	1164796793	1	1	DUSIG, MAXINE J LMFT	9/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3201 WILSHIRE BOULEVARD	203	SANTA MONICA	CA	90403	2337	19	06037	34.04063728	-118.4717816	Los Angeles County
128222	Fee-for-Service	1790262210	1790262210	1	1	DRZYMALSKI, MONIKA DO	3/29/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19474	08	Family Practice	0	In state provider	None	10605 SCRIPPS POWAY PKWY	SUITE B AND C	SAN DIEGO	CA	92131	3925	37	06073	32.93714729	-117.0990446	San Diego County
128245	Fee-for-Service	1700972072	1700972072	1	1	DONATTO, KEITH C.	3/31/1992	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	50573	20	Orthopedic Surgery	0	In state provider	None	237 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4725	01	06001	37.72538644	-122.1544221	Alameda County
128262	Fee-for-Service	1497705289	1497705289	1	1	DUONG, VAN HONG MD	1/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41278	08	Family Practice	0	In state provider	None	11028 LOWER AZUSA RD	None	EL MONTE	CA	91731	1440	19	06037	34.09193387	-118.0251713	Los Angeles County
128357	Fee-for-Service	1780600841	1780600841	1	1	DAVIS, SUSAN STANIK MD	2/1/1984	207RE0101X	NA	Endocrinology	026	PHYSICIANS	31244	67	Endocrinology	0	In state provider	UCLA CTR F/T HLTH SCIENC	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
128359	Fee-for-Service	1477906717	1477906717	1	1	DANG, PHUC MD CORPORATION	7/24/2017	193400000X	NA	Other	026	PHYSICIANS	117592	20	Orthopedic Surgery	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
128363	Fee-for-Service	1750726964	1750726964	1	1	DIMITRY DANOVICH, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
128375	Fee-for-Service	1164490744	1164490744	1	1	DANGARAN, JEFFREY R MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	81583	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
128379	Fee-for-Service	1265990113	1265990113	1	1	DELIVER MY MEDS CORP	12/1/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1100 BUSINESS PKWY	STE 185	RICHARDSON	TX	75081	5073	00	None	32.93872883	-96.73759616	Dallas County
128425	Fee-for-Service	1194251710	1194251710	1	1	DO, TIFFANIE MD	8/25/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	157687	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
128456	Fee-for-Service	1043380439	1043380439	1	1	DO, TERESA G OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY	6731 WESTMINSTER BLVD	STE 102	WESTMINSTER	CA	92683	3792	30	06059	33.75912651	-118.010655	Orange County
128555	Fee-for-Service	1184741647	1184741647	1	1	DE BOOY, DAVID P MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32706	None	None	0	In state provider	UKIAH ADVENTIST HOSPITAL	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
128595	Fee-for-Service	1811284391	1811284391	1	1	DIAMOND DE PORRAS, JILL	8/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	27715 JEFFERSON AVE	STE 112	TEMECULA	CA	92590	2631	33	06065	33.51272967	-117.1590194	Riverside County
128596	Fee-for-Service	1386665503	1386665503	1	1	DONALD STALLMAN MD	4/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 2ND AVE NE	None	JAMESTOWN	ND	58401	3373	00	None	46.91115	-98.7070725	Stutsman County
128602	Fee-for-Service	1659162675	1659162675	1	1	DOULA WINSOME LLC	5/16/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
128610	Fee-for-Service	1477671535	1477671535	1	2	DIGNITY HEALTH	6/1/1983	282N00000X	NEMT Provider	Hospitals	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	CLAIRMONT HEIGHTS	None	REDDING	CA	96001	2509	45	06089	0	0	None
128724	Fee-for-Service	1033885371	1033885371	1	1	DHILLON, NAVJOT CNP	8/2/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1350 FLORIN RD	None	SACRAMENTO	CA	95822	4202	34	06067	38.495232	-121.505409	Sacramento County
128736	Fee-for-Service	1417408709	1417408709	1	1	DORSETT, MEGAN CCC-SLP	12/19/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
128879	Fee-for-Service	1891240602	1891240602	1	1	DESERT GROUP SERVICES PC	9/30/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	6601 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
128888	Fee-for-Service	1629275912	1629275912	1	1	DE CASTRO-MARCEAU, DAWN M K	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132200	18	Ophthalmology	0	In state provider	None	342 F STREET	None	CHULA VISTA	CA	91910	2625	37	06073	32.64073026	-117.0815293	San Diego County
128906	Fee-for-Service	1033435383	1033435383	1	1	DALHOUMI, SARAH MD	7/26/2019	207R00000X	NA	Other	026	PHYSICIANS	121861	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
128937	Fee-for-Service	1508042631	1508042631	1	1	DIKRANIAN ARMEN H MD	2/13/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	INC	901 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08588	-118.123089	Los Angeles County
128945	Fee-for-Service	1639300528	1639300528	1	1	DAVENPORT, CHRIS E MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117513	08	Family Practice	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
128947	Fee-for-Service	1811994478	1811994478	1	1	DAUGHERTY, BRUCE C MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	40455	02	General Surgery	0	In state provider	2209 SOUTH AVENUE	PO BOX 7529	None	SOUTH LAKE TAHOE	CA	96158	0529	09	06017	0	0	None
128954	Fee-for-Service	1235138868	1235138868	1	1	DIAGNOSTIC PATH MED GRP	3/1/1980	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
129011	Fee-for-Service	1457416836	1457416836	1	1	DAO OPTOMETRIC GROUP INC	4/7/2014	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31878 DEL OBISPO STREET	SUITE 122	SAN JUAN CAPISTRA	CA	92675	3253	30	06059	33.49835844	-117.6608148	Orange County
129052	Fee-for-Service	1396809323	1396809323	1	1	DESIGN FOR LIVING	10/3/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	104 EAST AVENUE K-4	SUITE B	LANCASTER	CA	93535	4678	19	06037	34.6749357	-118.1299994	Los Angeles County
129098	Fee-for-Service	1528032166	1528032166	1	1	DRAZNIN, MICHELLE MD	11/19/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	82779	07	Dermatology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
129125	Fee-for-Service	1699751487	1699751487	1	1	DOUGHERTY, RAYMOND MD	5/25/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78906	30	Radiology	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
129151	Fee-for-Service	1396057147	1396057147	1	1	DESHMUKH, SANAA K MD	1/12/2021	207RE0101X	NA	Endocrinology	026	PHYSICIANS	170466	None	None	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
129153	Fee-for-Service	1700617412	1700617412	1	1	DISCOVERY CHARTER	10/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	51 E BEVERLY PLACE	None	TRACY	CA	95376	3191	39	06077	37.74526345	-121.4244421	San Joaquin County
129155	Fee-for-Service	1982936068	1982936068	1	1	DAVIS, LAURA M NP	12/7/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
129165	Fee-for-Service	1891240602	1891240602	1	1	DESERT GROUP SERVICES PC	9/30/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	6601 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
129212	Fee-for-Service	1699926220	1699926220	1	1	DR. FAITH A SLATER MD	9/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
129238	Fee-for-Service	1235138868	1235138868	1	1	DIAGNOSTIC PATH MED GRP	5/1/1982	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
129256	Fee-for-Service	1578792800	1578792800	1	1	DUFOUR, MARTIN	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141556	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
129264	Fee-for-Service	1689203176	1689203176	1	1	DAWSON, DEANNA L MD	10/14/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
129269	Fee-for-Service	1902875982	1902875982	1	1	DUBAN, MARILYN L MD	2/22/2016	207L00000X	NA	Other	026	PHYSICIANS	76592	05	Anesthesiology	0	In state provider	None	16453 SOUTH COLORADO AVE	None	PARAMOUNT	CA	90723	5011	19	06037	33.8848803	-118.1614216	Los Angeles County
129302	Fee-for-Service	1790014405	1790014405	1	1	DELAND, MIKEL C PT	3/31/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
129308	Fee-for-Service	1568087740	1568087740	1	1	DIVINE HOSPICE AND	6/30/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	3721 W BURBANK BLVD	STE B	BURBANK	CA	91505	2240	19	06037	34.17444805	-118.3510762	Los Angeles County
129336	Fee-for-Service	1649294273	1649294273	1	1	DHAWAN, ARCHANA N MD	12/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83916	45	Nephrology (Renal-Kidney)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
129347	Fee-for-Service	1316486129	1316486129	1	1	DITTMAN, KATHERINE DO	1/13/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	20768	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
129366	Fee-for-Service	1114244894	1114244894	1	1	DISSANAYAKE, SUMUDU N MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118966	30	Radiology	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
129388	Fee-for-Service	1073206975	1073206975	1	1	DESIRED CHANGE THERAPEUTIC S	12/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	OLUTIONS A LICENSED CL	822 S BREDEN LN	None	RIALTO	CA	92376	7829	36	06071	34.087212	-117.3758175	San Bernardino County
129390	Fee-for-Service	1962989095	1962989095	1	1	DRUMMOND, JULIA E CCC-SLP	8/13/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
129400	Fee-for-Service	1033349485	1033349485	1	1	DAO, BAO D MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137125	68	Hematology	0	In state provider	None	6380 CLARKE AVE	None	DUBLIN	CA	94568	3036	01	06001	37.70451998	-121.9205494	Alameda County
129411	Fee-for-Service	1629399514	1629399514	1	1	DUARTE, LYDIA LCSW	1/14/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1431 W. ELLERY WAY	None	FRESNO	CA	93711	1903	10	06019	36.82820662	-119.8180593	Fresno County
129468	Fee-for-Service	1861565772	1861565772	1	1	DICKSON, AGNES C PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CARE	2030 E FOURTH ST	STE 140 F	SANTA ANA	CA	92705	3969	30	06059	33.74808045	-117.8378273	Orange County
129484	Fee-for-Service	1598098386	1598098386	1	1	DUONG, DAVID T MD PHD	6/7/2010	208800000X	NA	Other	026	PHYSICIANS	96060	34	Urology and Urological Surgery	0	In state provider	None	909 HYDE STREET	STE 222	SAN FRANCISCO	CA	94109	4845	38	06075	37.78939387	-122.4170945	San Francisco County
129562	Fee-for-Service	1952486565	1952486565	1	1	DIAGNOSTIC PATH MED GRP	7/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
129565	Fee-for-Service	1457523607	1457523607	1	1	DANIELLE CARROLL,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
129577	Fee-for-Service	1386720712	1386720712	1	1	DOSHI,BELLA A MD	1/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	69048	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
129587	Fee-for-Service	1891138442	1891138442	1	1	DUBE, SOPHIA MD	10/3/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
129594	Fee-for-Service	1568087740	1568087740	1	1	DIVINE HOSPICE AND	6/30/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	3721 W BURBANK BLVD	STE B	BURBANK	CA	91505	2240	19	06037	34.17444805	-118.3510762	Los Angeles County
129621	Fee-for-Service	1649294273	1649294273	1	1	DHAWAN, ARCHANA N MD	12/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83916	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
129635	Fee-for-Service	1174608848	1174608848	1	1	DESAI, SUNIL H MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	51233	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
129675	Fee-for-Service	1023601275	1023601275	1	1	DJM MEDICAL TRANSPORT LLC	1/2/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	247 CATALINA DR	None	HERCULES	CA	94547	2072	07	06013	37.99134624	-122.2305556	Contra Costa County
129688	Fee-for-Service	1033349485	1033349485	1	1	DAO, BAO D MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137125	78	Neoplastic Diseases/Oncology	0	In state provider	None	6380 CLARKE AVE	None	DUBLIN	CA	94568	3036	01	06001	37.70451998	-121.9205494	Alameda County
129731	Fee-for-Service	1245483700	1245483700	1	1	DILANCHIYAN, EDVIN MD	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126746	41	Internal Medicine	0	In state provider	None	1310 W STEWART DRIVE	SUITE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
129761	Fee-for-Service	1659640977	1659640977	1	1	DURAN, VANESSA E MD	2/23/2023	207P00000X	NA	Other	026	PHYSICIANS	178802	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
129769	Fee-for-Service	1639311905	1639311905	1	1	DORFMAN, MOLLY V MD	5/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116267	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
129773	Fee-for-Service	1619749041	1619749041	1	1	DEMESSIE, RAHEL NP	2/12/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
129824	Fee-for-Service	1053552075	1053552075	1	1	DUCHICELA, KEEGAN A MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106408	01	General Practice	0	In state provider	None	455 O'CONNOR DRIVE	None	SAN JOSE	CA	95128	1633	43	06085	37.326654	-121.939897	Santa Clara County
129850	Fee-for-Service	1760706667	1760706667	1	1	DOWNTOWN MEDICAL EQUIPMENT	3/21/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DOWNTOWN MEDICAL EQUIP	137 E THIRD STREET	None	LOS ANGELES	CA	90013	1301	19	06037	34.04873264	-118.245056	Los Angeles County
129871	Fee-for-Service	1528445210	1528445210	1	1	DOAN, JOSEPH MD	5/13/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	670 SIERRA ROSE DR	None	RENO	NV	89511	2072	00	None	39.4735137	-119.7995156	Washoe County
129877	Fee-for-Service	1639310675	1639310675	1	1	DEBNATH, SHAMEER MD	8/26/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	136475	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	180 S LAKE AVE	SUITE 615	PASADENA	CA	91101	4763	19	06037	34.14274552	-118.1322395	Los Angeles County
129919	Fee-for-Service	1275505380	1275505380	1	1	D'AMICO, DANIEL M MD	10/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	18825	20	Orthopedic Surgery	0	In state provider	None	7551 TIMBERLAKE WAY	STE 200	SACRAMENTO	CA	95823	5420	34	06067	38.466225	-121.415958	Sacramento County
129931	Fee-for-Service	1831196641	1831196641	1	1	DR. VINOD CHAUHAN MD	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	615 N MICHIGAN ST	None	SOUTH BEND	IN	46601	1033	00	None	41.68395312	-86.2505452	St. Joseph County
129937	Fee-for-Service	1306241435	1306241435	1	1	DOMINGUEZ, ALICIA E MSW LCSW	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	83413	-	NOT APPLICABLE	0	In state provider	None	1200 NORTH MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3640	30	06059	33.755175	-117.8676195	Orange County
129951	Fee-for-Service	1275925836	1275925836	1	1	DUMITRIU, PAULA CCC-SLP	7/8/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2180 GRANT LINE RD	201	TRACY	CA	95377	7342	39	06077	37.75399789	-121.4571561	San Joaquin County
129987	Fee-for-Service	1609922541	1609922541	1	1	DUGGER, WALTER R MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	63647	01	General Practice	0	In state provider	None	4934 VERDUGO WAY	None	CAMARILLO	CA	93012	8631	56	06111	34.21594032	-119.0048014	Ventura County
130069	Fee-for-Service	1558320705	1558320705	1	1	DAPRA, GINA R MD	6/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	932 RYLAND STREET	None	RENO	NV	89502	1605	00	None	39.52380293	-119.7998835	Washoe County
130122	Fee-for-Service	1154795946	1154795946	1	1	DAULTON, MELANIE R MD	7/28/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	188143	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130126	Fee-for-Service	1275553414	1275553414	1	1	DARRACQ, MICHAEL A MD	1/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	92362	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
130130	Fee-for-Service	1073963138	1073963138	1	1	DVH HOSPITAL ALLIANCE, LLC	5/29/2020	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	None	36.214524	-116.025615	Nye County
130131	Fee-for-Service	1669624219	1669624219	1	1	DEMIRJIAN, MARINE MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111311	03	Allergy	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
130139	Fee-for-Service	1457330680	1457330680	1	1	DAWSON, TEDD E MD INC	5/15/1984	208600000X	NA	General Surgery	026	PHYSICIANS	38007	02	General Surgery	0	In state provider	None	1196 S MAIN ST	None	WILLITS	CA	95490	4304	23	06045	39.3999805	-123.3497005	Mendocino County
130150	Fee-for-Service	1811351646	1811351646	1	1	DESAI, ANUJ S MD	7/5/2022	208800000X	NA	Other	026	PHYSICIANS	177938	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
130164	Fee-for-Service	1730201294	1730201294	1	1	DELOS SANTOS, LISA M OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
130176	Fee-for-Service	1932141454	1932141454	1	1	DOMUSH, ROBERT B MD	1/31/1987	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17693	01	General Practice	0	In state provider	None	660 LOMBARD ST	None	SAN FRANCISCO	CA	94133	2315	38	06075	37.8029268	-122.4123799	San Francisco County
130178	Fee-for-Service	1336132273	1336132273	1	1	DINSMORE, MAHNEE L MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	160161	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 SIERRA COLLEGE DR	STE 115	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
130198	Fee-for-Service	1619243763	1619243763	1	1	D&R ORTHOTICS & PROSTHETICS	7/2/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 W LODI AVE	STE H	LODI	CA	95242	3037	39	06077	38.13001447	-121.289931	San Joaquin County
130209	Fee-for-Service	1275505380	1275505380	1	1	D'AMICO, DANIEL M MD	10/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	18825	01	General Practice	0	In state provider	None	7551 TIMBERLAKE WAY	STE 200	SACRAMENTO	CA	95823	5420	34	06067	38.466225	-121.415958	Sacramento County
130271	Fee-for-Service	1417584079	1417584079	1	1	DYNAMIC IMAGING ASSOCIATES O	4/14/2021	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OMEN'S IMAGING	1125 E SPRUCE AVE	STE #103	FRESNO	CA	93720	3385	10	06019	36.839817	-119.7616905	Fresno County
130293	Fee-for-Service	1891867636	1891867636	1	1	DEOL, AMANJOT K MD	4/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83523	36	Psychiatry	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
130298	Fee-for-Service	1538236476	1538236476	1	1	DALE, CYNTHIA J MD	9/1/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	77644	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	246 PERKINS ST	None	SONOMA	CA	95476	6954	49	06097	38.2891423	-122.4629004	Sonoma County
130300	Fee-for-Service	1134256696	1134256696	1	1	DUROUSSEAU, WILBURN P MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	9498	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3660 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2653	19	06037	33.93178635	-118.2019603	Los Angeles County
130359	Fee-for-Service	1366535353	1366535353	1	1	DANG, MINH-TIN D MD	1/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95212	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
130414	Fee-for-Service	1104944255	1104944255	1	2	DIGNITY HEALTH	12/3/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	635 LASSEN LANE	None	MOUNT SHASTA	CA	96067	9003	47	06093	41.31928889	-122.3275083	Siskiyou County
130417	Fee-for-Service	1073963138	1073963138	1	1	DVH HOSPITAL ALLIANCE, LLC	5/29/2020	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	None	36.214524	-116.025615	Nye County
130418	Fee-for-Service	1194803783	1194803783	1	1	DOUGLAS, PETER R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36654	02	General Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
130465	Fee-for-Service	1932141454	1932141454	1	1	DOMUSH, ROBERT B MD	1/31/1987	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17693	19	Dentists (DMD)	0	In state provider	None	660 LOMBARD ST	None	SAN FRANCISCO	CA	94133	2315	38	06075	37.8029268	-122.4123799	San Francisco County
130482	Fee-for-Service	1518134485	1518134485	1	2	DIAMOND HOME HEALTH INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5530 CORBIN AVE	SUITE 336	TARZANA	CA	91356	6042	19	06037	34.171812	-118.5621935	Los Angeles County
130514	Fee-for-Service	1114594777	1114594777	1	1	DOSHI, KUNAL MD	12/18/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	11776 MARIPOSA ROAD	101, 103, & 104	HESPERIA	CA	92345	1622	36	06071	34.46463128	-117.3491141	San Bernardino County
130524	Fee-for-Service	1346328135	1346328135	1	1	DURZINSKY, DENNIS S MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	50110	02	General Surgery	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
130544	Fee-for-Service	1750657177	1750657177	1	1	DELSMAN, ERICA A MD	8/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129141	01	General Practice	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
130548	Fee-for-Service	1699069930	1699069930	1	1	DR. DONOVAN D WILLIAMS MD	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
130611	Fee-for-Service	1760510937	1760510937	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MARIAN MEDICAL CENTER	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
130625	Fee-for-Service	1437164993	1437164993	1	1	DAVID DOEZEMA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNM MEDICAL GROUP	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
130635	Fee-for-Service	1326106501	1326106501	1	1	DON M ENDRESS, MD	7/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CFP FAMILY PRACTICE CTR	12700 WELCH ST	None	WATERFORD	CA	95386	8765	50	06099	37.63957828	-120.7603281	Stanislaus County
130644	Fee-for-Service	1275761371	1275761371	1	1	DEL RE, ANGELO M MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129572	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
130649	Fee-for-Service	1366717563	1366717563	1	1	DOUGHTY, REECE R MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129102	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
130712	Fee-for-Service	1669436879	1669436879	1	1	DANG, CHUC BINH DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15444 BROOKHURST ST	None	WESTMINSTER	CA	92683	7057	30	06059	33.7382955	-117.9547231	Orange County
130739	Fee-for-Service	1508325564	1508325564	1	1	DAO, TRINA MD	8/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	176987	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
130751	Fee-for-Service	1932141454	1932141454	1	1	DOMUSH, ROBERT B MD	1/31/1987	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	17693	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	660 LOMBARD ST	None	SAN FRANCISCO	CA	94133	2315	38	06075	37.8029268	-122.4123799	San Francisco County
130761	Fee-for-Service	1538547302	1538547302	1	1	DOAN, NGUYEN T MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148066	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
130764	Fee-for-Service	1235766445	1235766445	1	1	DIAZ, ELVIN K DO	8/10/2022	207P00000X	NA	Other	026	PHYSICIANS	19969	None	None	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
130839	Fee-for-Service	1548566284	1548566284	1	1	DEITS, RICHARD M MD	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50307	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
130874	Fee-for-Service	1982913844	1982913844	1	1	DE FERAUDY, SEBASTIEN M MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118148	22	Pathology (M.D. only)	0	In state provider	None	3700 CALIFORNIA STREET	4TH FLOOR	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
130894	Fee-for-Service	1558369603	1558369603	1	1	DAI AN CORP	5/10/2002	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PEC HEALTHCARE	10507 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1128	30	06059	33.77417854	-117.9492568	Orange County
130898	Fee-for-Service	1760510937	1760510937	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MARIAN MEDICAL CENTER	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
130909	Fee-for-Service	1891187456	1891187456	1	1	DUPREE, NICOLE D NP	1/5/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95002089	-	NOT APPLICABLE	0	In state provider	None	9890 COUNTY FARM ROAD	BLDG 2	RIVERSIDE	CA	92503	3598	33	06065	33.92009951	-117.4574475	Riverside County
130923	Fee-for-Service	1609497221	1609497221	1	1	DEVANAGONDI, SHILPA MD MPH	11/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191017	None	None	0	In state provider	None	8933 ACTIVITY RD	None	SAN DIEGO	CA	92126	4427	37	06073	32.89637448	-117.133497	San Diego County
130926	Fee-for-Service	1326106501	1326106501	1	1	DON M ENDRESS, MD	7/1/1997	208D00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CFP FAMILY PRACTICE CTR	12700 WELCH ST	None	WATERFORD	CA	95386	8765	50	06099	37.63957828	-120.7603281	Stanislaus County
130929	Fee-for-Service	1265406045	1265406045	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	HI DESERT DIALYSIS	58457 29 PALMS HWY	STE 102	YUCCA VALLEY	CA	92284	5879	36	06071	34.13247642	-116.3885551	San Bernardino County
130981	Fee-for-Service	1326579319	1326579319	1	1	DYBAS, MATTHEW MD	5/1/2023	207P00000X	NA	Other	026	PHYSICIANS	185089	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
130992	Fee-for-Service	1487642377	1487642377	1	1	DESHMUKH, SANJAY V MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65424	25	Physical Medicine and Rehabilitation	0	In state provider	None	900 S MAIN ST	STE 204	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
131106	Fee-for-Service	1841614427	1841614427	1	1	DIBBLE, AMY L NP	1/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
131115	Fee-for-Service	1295913614	1295913614	1	1	DO, AN H MD	8/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104278	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
131160	Fee-for-Service	1821600420	1821600420	1	1	DIAZ DIAZ, HIRAM CRNA	12/7/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
131222	Fee-for-Service	1427070010	1427070010	1	1	DURAZO, FRANCISCO A MD	9/30/1996	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	44612	41	Internal Medicine	0	In state provider	None	27800 MEDICAL CENTER RD	STE 114	MISSION VIEJO	CA	92691	6407	30	06059	33.55952733	-117.6645199	Orange County
131243	Fee-for-Service	1447502588	1447502588	1	1	DOMINGO, MARIA ELOISA S MD	10/10/2019	2080P0210X	NA	Nephrology	026	PHYSICIANS	136427	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
131261	Fee-for-Service	1255470480	1255470480	1	1	DUVVURI, VIKAS MD	8/30/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	99706	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
131273	Fee-for-Service	1295873065	1295873065	1	1	DERAITA, PAMELA A	2/8/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	HEARING HEALTH CARE	934 4TH ST	None	CRESCENT CITY	CA	95531	4001	08	06015	41.75354168	-124.1972599	Del Norte County
131277	Fee-for-Service	1053379263	1053379263	1	1	DA-WEI LIAO MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1112 E MCDOWELL RD	None	PHOENIX	AZ	85006	2611	00	None	33.466041	-112.0577625	Maricopa County
131349	Fee-for-Service	1003379702	1003379702	1	1	DUONG, CHANAN MD	9/15/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	185670	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
131350	Fee-for-Service	1972701068	1972701068	1	1	DAVILA, EMA C PHD	6/16/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
131380	Fee-for-Service	1124052428	1124052428	1	1	DANIELS, STEWART A	4/30/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52733	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
131411	Fee-for-Service	1962539304	1962539304	1	1	DEY, CYNTHIA A LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
131419	Fee-for-Service	1205212487	1205212487	1	1	DE JONK, SANDRA G LMFT	9/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
131421	Fee-for-Service	1063827087	1063827087	1	1	DUONG, JENNIFER H MD	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138280	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
131505	Fee-for-Service	1639548308	1639548308	1	1	DRAGONFRUIT HOLDINGS LLC	11/3/2015	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	180 N JACKSON AVE	None	SAN JOSE	CA	95116	1907	43	06085	37.36244769	-121.84739	Santa Clara County
131530	Fee-for-Service	1063542314	1063542314	1	1	DE LA TORRE, STEPHANIE LMFT	10/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15300 VENTURA BLVD	STE 410	SHERMAN OAKS	CA	91403	3103	19	06037	34.15387425	-118.4666626	Los Angeles County
131540	Fee-for-Service	1477671535	1477671535	1	8	DIGNITY HEALTH	8/25/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2175 ROSALINE AVE	STE B	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
131629	Fee-for-Service	1386065001	1386065001	1	1	DE GUZMAN, NORBERT J MD	1/8/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	136118	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
131694	Fee-for-Service	1053503979	1053503979	1	1	DANG, VIN OD	1/16/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
131701	Fee-for-Service	1427577519	1427577519	1	1	DANLEY, MEGAN E PT	3/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
131725	Fee-for-Service	1336858026	1336858026	1	1	DEAN, SAMINA CNP	12/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2455 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1601	07	06013	37.77494737	-121.9771019	Contra Costa County
131739	Fee-for-Service	1588246425	1588246425	1	1	DESERT VALLEY MEDICAL GROUP,	6/30/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	5450 JEFFERSON AVE	SUITE 3	CHINO	CA	91710	3522	36	06071	34.0247326	-117.6862355	San Bernardino County
131817	Fee-for-Service	1750888665	1750888665	1	1	DE CASTRO, OLIVER LMFT	4/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
131842	Fee-for-Service	1669614079	1669614079	1	1	DALLAS, TORIJAUN D MD	9/27/2018	207L00000X	NA	Other	026	PHYSICIANS	154019	05	Anesthesiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
131880	Fee-for-Service	1568472389	1568472389	1	1	DRAKE, KEVIN K MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35245	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
131892	Fee-for-Service	1831277508	1831277508	1	1	DAO, STELLA H MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
131903	Fee-for-Service	1407205735	1407205735	1	1	DOW, TANIA S LMFT	9/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	24520 HAWTHORNE BLVD.	220	TORRANCE	CA	90505	6848	19	06037	33.79879508	-118.3510187	Los Angeles County
132020	Fee-for-Service	1184670226	1184670226	1	1	DANIELS, NICHOLAS A MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60278	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
132021	Fee-for-Service	1487802732	1487802732	1	1	DE COGAIN, MITRA R MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131241	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
132043	Fee-for-Service	1659969590	1659969590	1	1	DERRICK TINT MD, CORPORATION	1/22/2021	261QM2500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	341 MAGNOLIA AVE	STE 206	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
132112	Fee-for-Service	1730146937	1730146937	1	1	DANG, SANDEEP S MD	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79958	45	Nephrology (Renal-Kidney)	0	In state provider	None	17150 EUCLID ST	STE 200	FOUNTAIN VALLEY	CA	92708	4092	30	06059	33.714171	-117.9369905	Orange County
132138	Fee-for-Service	1720665771	1720665771	1	1	DEWHITT, DENISE L MD	5/29/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
132153	Fee-for-Service	1619472982	1619472982	1	1	DIENES, KARA	12/2/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
132178	Fee-for-Service	1043577323	1043577323	1	1	DHILLON, SONIA K MD	5/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141300	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
132179	Fee-for-Service	1447396874	1447396874	1	1	DARNELL, MELISSA C MFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	35869	-	NOT APPLICABLE	0	In state provider	None	11776 MARIPOSA ROAD	SUITE 103	HESPERIA	CA	92345	1622	36	06071	34.46463128	-117.3491141	San Bernardino County
132202	Fee-for-Service	1427217512	1427217512	1	1	DIMICELI, KATHRYN C MD	5/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133901	18	Ophthalmology	0	In state provider	None	5275 CLAREMONT AVE	None	OAKLAND	CA	94618	1032	01	06001	37.8391822	-122.260841	Alameda County
132205	Fee-for-Service	1063436731	1063436731	1	1	DIPERNA, COSTANZO A MD	1/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70764	33	Thoracic Surgery	0	In state provider	None	5 MEDICAL PLAZA DRIVE	STE 140	ROSEVILLE	CA	95661	2886	31	06061	38.76604411	-121.2466761	Placer County
132236	Fee-for-Service	1689630436	1689630436	1	1	DONNA L. BEESON, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
132281	Fee-for-Service	1710091491	1710091491	1	1	DANG, SALLY H OD	1/24/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PACIFIC OPT. GROUP INC	12302 GARDEN GROVE BLVD	STE 6	GARDEN GROVE	CA	92843	1802	30	06059	33.77428392	-117.9181185	Orange County
132302	Fee-for-Service	1922239797	1922239797	1	1	DAVID, GINA R PSYD	6/13/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
132342	Fee-for-Service	1962964635	1962964635	1	1	DIGRANDE, KYLE F MD	9/9/2022	207R00000X	NA	Other	026	PHYSICIANS	181123	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
132361	Fee-for-Service	1154365872	1154365872	1	1	DELBAKHSH, ALI MD	2/26/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	105158	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 606	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
132371	Fee-for-Service	1265449607	1265449607	1	2	DREXLER, BRAD MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	55235	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	431 MARCH AVE	STE A	HEALDSBURG	CA	95448	3368	49	06097	38.62594274	-122.8653122	Sonoma County
132402	Fee-for-Service	1730146937	1730146937	1	1	DANG, SANDEEP S MD	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	79958	41	Internal Medicine	0	In state provider	None	17150 EUCLID ST	STE 200	FOUNTAIN VALLEY	CA	92708	4092	30	06059	33.714171	-117.9369905	Orange County
132431	Fee-for-Service	1356340426	1356340426	1	1	DENNIS CUNNINGHAM	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PEDIATRIC ACADEMIC ASSOC	555 S 18TH STREET	None	COLUMBUS	OH	43205	0000	00	None	39.95323846	-82.9765048	Franklin County
132516	Fee-for-Service	1497779011	1497779011	1	1	DIAGNOSTIC HEART CENTER	8/8/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	624 W DUARTE RD	STE 207	ARCADIA	CA	91007	9265	19	06037	34.12637452	-118.0527313	Los Angeles County
132548	Fee-for-Service	1861939928	1861939928	1	1	DEDICATED HOME HEALTH	5/16/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	4104 1/2 VERDUGO RD	None	LOS ANGELES	CA	90065	3821	19	06037	34.12526872	-118.2317042	Los Angeles County
132586	Fee-for-Service	1386862001	1386862001	1	1	DAVARI, SHAHRIAR B MD	5/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92183	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92808	3028	30	06059	33.85429563	-117.8166478	Orange County
132650	Fee-for-Service	1154365872	1154365872	1	1	DELBAKHSH, ALI MD	2/26/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	105158	41	Internal Medicine	0	In state provider	None	5525 GROSSMONT CENTER DR	STE 606	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
132657	Fee-for-Service	1821191222	1821191222	1	1	DUNCAN, ERIN S OD	5/5/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1246 E ARROW HWY	STE A	UPLAND	CA	91786	4955	36	06071	34.09974849	-117.634842	San Bernardino County
132666	Fee-for-Service	1326254541	1326254541	1	1	DAVIS, ROBIN J DO	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10722	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
132676	Fee-for-Service	1477016772	1477016772	1	1	DECALUWE, ASHLEY M DO	11/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23130	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
132698	Fee-for-Service	1548499957	1548499957	1	1	DEL RE, AMANDA M MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129568	40	Pediatrics	0	In state provider	None	1107 S MISSION RD	None	FALLBROOK	CA	92028	3224	37	06073	33.37242711	-117.2534301	San Diego County
132705	Fee-for-Service	1083077697	1083077697	1	1	DENG, LIN MD	5/13/2019	207R00000X	NA	Other	026	PHYSICIANS	161866	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
132736	Fee-for-Service	1811416027	1811416027	1	1	DESAUTELS, KENYA CPO	11/6/2017	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 SECRET RAVINE PKWY	SUITE 100	ROSEVILLE	CA	95661	6042	31	06061	38.76424823	-121.2440842	Placer County
132759	Fee-for-Service	1710041371	1710041371	1	1	DEN, WEI-FEN NP	7/9/2020	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
132768	Fee-for-Service	1083208045	1083208045	1	1	DOMALAOG, EILEEN M CCC-SLP	10/18/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	THOLOGY	47 SAN MIGUEL AVE,	STE3	SALINAS	CA	93901	3058	27	06053	36.65942136	-121.6574008	Monterey County
132773	Fee-for-Service	1992031942	1992031942	1	1	DANDEKAR, APARNA S MD	4/19/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	111407	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
132804	Fee-for-Service	1487614962	1487614962	1	1	DUGGLEBY,DANIEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 NORTH MAIN	None	TOOELE	UT	84074	2794	00	None	40.56668579	-112.2959013	Tooele County
132818	Fee-for-Service	1255570198	1255570198	1	1	DAVIS, ALLYSON P MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112227	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
132853	Fee-for-Service	1578507679	1578507679	1	1	DEL MAR, RAOUL B MD	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89166	None	None	0	In state provider	None	6555 COYLE AVE	STE 200	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
132882	Fee-for-Service	1942229182	1942229182	1	1	DIALYSIS CLINIC INC	1/5/2005	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	180 NORTHPOINT DR	None	REDDING	CA	96003	2510	45	06089	40.6130167	-122.377436	Shasta County
132889	Fee-for-Service	1518192079	1518192079	1	1	DELTA MEDICAL GROUP OF	4/2/2013	207ZP0102X	NA	Other	026	PHYSICIANS	52482	22	Pathology (M.D. only)	0	In state provider	PATHOLOGISTS INC	975 S FAIRMONT AVE	CONRAD BLDG	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
132968	Fee-for-Service	1730548231	1730548231	1	1	DO, NHAN H MD	7/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
132976	Fee-for-Service	1598278467	1598278467	1	2	DANIEL RANSON, LICENSED CLIN	3/21/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	D CONSULTING, INC.	549 OLD MAMMOTH RD.	SUITE 204	MAMMOTH LAKES	CA	93546	3813	26	06051	37.63801502	-118.9665687	Mono County
132989	Fee-for-Service	1003968801	1003968801	1	1	DHARMASENA, VAJIRAMALA R	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62475	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
133016	Fee-for-Service	1871942268	1871942268	1	1	DAWSON, MARGARET R LCSW	11/29/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
133050	Fee-for-Service	1598889263	1598889263	1	1	DOANE, CHRISTOPHER A	2/8/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3009 HUBBARD LN	STE B	EUREKA	CA	95501	4801	12	06023	40.78115142	-124.1302872	Humboldt County
133053	Fee-for-Service	1497853857	1497853857	1	1	DAVID M NIEBRUEGGE MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	615 S NEW BALLAS RD	None	SAINT LOUIS	MO	63141	8221	00	None	38.644902	-90.4462065	St. Louis County
133066	Fee-for-Service	1912288432	1912288432	1	6	DIGNITY HEALTH MEDICAL FOUND	5/3/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2780 EUREKA WAY	None	REDDING	CA	96001	0223	45	06089	40.58585835	-122.4124086	Shasta County
133104	Fee-for-Service	1992857379	1992857379	1	1	DOUGHERTY, COLIN M MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91002	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
133144	Fee-for-Service	1316937261	1316937261	1	1	DURKIN, ELIZABETH MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132628	08	Family Practice	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
133148	Fee-for-Service	1295709418	1295709418	1	1	DAULAT, GAUTAM DO	5/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	4880 WYNN ROAD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
133153	Fee-for-Service	1841405925	1841405925	1	1	DINU, DANIELA MD	1/1/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
133162	Fee-for-Service	1053384487	1053384487	1	1	DURICK, JANET E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	STE 3950	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
133177	Fee-for-Service	1588367304	1588367304	1	1	DIETZ, KATHRYN LMFT	11/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1845 BUSINESS CENTER DR	215	SAN BERNARDINO	CA	92408	3467	36	06071	34.06865027	-117.2832038	San Bernardino County
133178	Fee-for-Service	1083677074	1083677074	1	1	DEAMANT, FRANK D MD	3/31/1991	207ZP0105X	NA	Other	026	PHYSICIANS	66653	22	Pathology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
133262	Fee-for-Service	1598278467	1598278467	1	2	DANIEL RANSON, LICENSED CLIN	3/21/2025	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	D CONSULTING, INC.	549 OLD MAMMOTH RD.	SUITE 204	MAMMOTH LAKES	CA	93546	3813	26	06051	37.63801502	-118.9665687	Mono County
133268	Fee-for-Service	1184403149	1184403149	1	1	DOORNBOS, TAYLOR NP	11/16/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
133301	Fee-for-Service	1740236868	1740236868	1	1	DUDDALWAR, VINAY A MD	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96588	30	Radiology	0	In state provider	None	1441 E LAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
133356	Fee-for-Service	1104314400	1104314400	1	1	DUNCAN, KATHLEEN	1/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25020 LAS BRISAS RD	207	MURRIETA	CA	92562	4064	33	06065	33.57370977	-117.1829111	Riverside County
133394	Fee-for-Service	1578577656	1578577656	1	1	D ERIC WESTBERG M.D.	1/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 BECKER AVE SW	None	WILLMAR	MN	56201	3302	00	None	45.1205233	-95.04619753	Kandiyohi County
133434	Fee-for-Service	1871886721	1871886721	1	1	DESAI, BHAVIM MD	6/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162368	08	Family Practice	0	In state provider	None	1665 DOMINICAN WAY	STE 222A	SANTA CRUZ	CA	95065	1515	44	06087	36.99032886	-121.9811968	Santa Cruz County
133476	Fee-for-Service	1912939109	1912939109	1	1	DUDLEY, LEWIS T MD	8/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94986	30	Radiology	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
133504	Fee-for-Service	1609053701	1609053701	1	1	DAI, HUI-WEN A DO	5/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10278	08	Family Practice	0	In state provider	None	521 EAST ELDER STREET	STE 103	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
133516	Fee-for-Service	1730393398	1730393398	1	1	DU, ELIZABETH MD	8/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142813	18	Ophthalmology	0	In state provider	None	14501 MAGNOLIA ST	STE 103	WESTMINSTER	CA	92683	1307	30	06059	33.75188963	-117.9723601	Orange County
133548	Fee-for-Service	1326494071	1326494071	1	1	DUONG, LOC MD	6/27/2019	207R00000X	NA	Other	026	PHYSICIANS	153879	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
133552	Fee-for-Service	1598278467	1598278467	1	2	DANIEL RANSON, LICENSED CLIN	3/21/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	D CONSULTING, INC.	549 OLD MAMMOTH RD.	SUITE 204	MAMMOTH LAKES	CA	93546	3813	26	06051	37.63801502	-118.9665687	Mono County
133561	Fee-for-Service	1831266022	1831266022	1	1	DIAMOND, WAYNE	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
133626	Fee-for-Service	1316146665	1316146665	1	1	DHALIWAL, RAMANDEEP S MD	4/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111795	08	Family Practice	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
133640	Fee-for-Service	1619025509	1619025509	1	1	DAYTON, DIANE P CRNA	4/18/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
133676	Fee-for-Service	1982667135	1982667135	1	1	DAVID A SPIEGEL MD INC	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48521	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3909 WARING RD	STE A	OCEANSIDE	CA	92056	4455	37	06073	33.18780506	-117.2917896	San Diego County
133696	Fee-for-Service	1255345567	1255345567	1	1	DEGUZMAN, LESTER M MD	3/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108885	01	General Practice	0	In state provider	None	1010 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	5929	19	06037	33.886314	-118.395912	Los Angeles County
133728	Fee-for-Service	1700803418	1700803418	1	54	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
133737	Fee-for-Service	1659455129	1659455129	1	1	DOLAN,EUGEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 10TH AVE N	None	BILLINGS	MT	59101	0703	00	None	45.789696	-108.5132835	Yellowstone County
133744	Fee-for-Service	1780134981	1780134981	1	1	DIVINITY HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2130 CHESTER AVE	STE 102	BAKERSFIELD	CA	93301	4472	15	06029	35.37890524	-119.018714	Kern County
133758	Fee-for-Service	1194857615	1194857615	1	1	DOSANJH, AMARJIT S MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86528	24	Plastic Surgery	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
133762	Fee-for-Service	1912939109	1912939109	1	1	DUDLEY, LEWIS T MD	8/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94986	40	Pediatrics	0	In state provider	None	5151 F ST	None	SACRAMENTO	CA	95819	3223	34	06067	38.571156	-121.4391555	Sacramento County
133768	Fee-for-Service	1790946143	1790946143	1	1	DEREE, JESSICA A MD	8/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87084	89	Surgery-Traumatic	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
133772	Fee-for-Service	1700909355	1700909355	1	1	DE LA ROSA, DANIEL	12/2/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 SOUTH FIRST STREET	SUITE 1800	BURBANK	CA	91502	1959	19	06037	34.17942444	-118.3096895	Los Angeles County
133789	Fee-for-Service	1700803418	1700803418	1	53	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 341	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
133811	Fee-for-Service	1487602819	1487602819	1	1	DHILLON, MANJIT S MD	4/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89879	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
133825	Fee-for-Service	1760722342	1760722342	1	1	DURAN, REBECCA NP	2/6/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
133862	Fee-for-Service	1275604167	1275604167	1	1	DEUTSCH, NICHOLAS MD	12/4/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	65292	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
133985	Fee-for-Service	1447755640	1447755640	1	1	DASARI, KARTHEEK S MD	11/10/2021	208M00000X	NA	Other	026	PHYSICIANS	17876	None	None	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
134017	Fee-for-Service	1700803418	1700803418	1	54	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134024	Fee-for-Service	1780134981	1780134981	1	1	DIVINITY HOSPICE	7/10/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2130 CHESTER AVE	STE 102	BAKERSFIELD	CA	93301	4472	15	06029	35.37890524	-119.018714	Kern County
134077	Fee-for-Service	1427291350	1427291350	1	1	DILCHER, KANANI K MD	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2801 DAGGETT AVENUE	None	KLAMATH FALLS	OR	97601	1106	00	None	42.25271647	-121.787181	Klamath County
134079	Fee-for-Service	1700803418	1700803418	1	53	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	6555 COYLE AVENUE	SUITE 341	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134086	Fee-for-Service	1700803418	1700803418	1	67	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 3	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
134103	Fee-for-Service	1114542578	1114542578	1	1	DEL BUONO, BENEDICT	7/2/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
134143	Fee-for-Service	1467421602	1467421602	1	1	DAVIS, BEN D MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
134178	Fee-for-Service	1174553697	1174553697	1	1	DROMSKY, DAVID M MD	5/28/2024	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	138598	20	Orthopedic Surgery	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
134205	Fee-for-Service	1942662473	1942662473	1	1	DOBOS, KATHARINE MD	7/26/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	150917	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
134206	Fee-for-Service	1770549875	1770549875	1	1	DURAND, DAVID JOSEPH MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	43370	79	Neurology-Child	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
134209	Fee-for-Service	1023019718	1023019718	1	1	DOUGLAS COUNTY HLTH CTR	8/16/2008	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4102 WOOLWORTH AVE	None	OMAHA	NE	68105	1899	00	None	41.24521046	-95.9742315	Douglas County
134214	Fee-for-Service	1295469724	1295469724	1	1	DR LEE PAIN MD INC	11/17/2022	207LP2900X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	13768 ROSWELL AVE STE 22	None	CHINO	CA	91710	1408	36	06071	34.0038	-117.7218555	San Bernardino County
134231	Fee-for-Service	1720677180	1720677180	1	1	DUNBAR, TERI	5/7/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
134305	Fee-for-Service	1700803418	1700803418	1	54	DIGNITY HEALTH MEDICAL FOUND	4/14/2016	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134324	Fee-for-Service	1255892857	1255892857	1	1	DHADWAL, NEHA DO	9/30/2024	2081P0301X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	20589	25	Physical Medicine and Rehabilitation	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
134358	Fee-for-Service	1578116778	1578116778	1	1	DYER, ANDREA R LMFT	5/8/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
134365	Fee-for-Service	1700803418	1700803418	1	53	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 341	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134371	Fee-for-Service	1396800462	1396800462	1	1	DOBROV, THOMAS L NP	4/15/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	17	06033	39.03772106	-122.9223338	Lake County
134376	Fee-for-Service	1700803418	1700803418	1	67	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	7115 GREENBACK LN	FL 3	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
134394	Fee-for-Service	1992232151	1992232151	1	1	D'EON, MAYA S PHD	10/2/2017	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
134424	Fee-for-Service	1336198878	1336198878	1	1	DE, AJANTA MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55862	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
134441	Fee-for-Service	1063643542	1063643542	1	1	DZHASHI, VLADIMIR MD	8/23/2020	207R00000X	NA	Other	026	PHYSICIANS	137450	None	None	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
134473	Fee-for-Service	1124056056	1124056056	1	1	DAYTON, JEFFREY P MD	9/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89485	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
134496	Fee-for-Service	1023019718	1023019718	1	1	DOUGLAS COUNTY HLTH CTR	8/16/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	4102 WOOLWORTH AVE	None	OMAHA	NE	68105	1899	00	None	41.24521046	-95.9742315	Douglas County
134503	Fee-for-Service	1255674982	1255674982	1	1	DOAN, LOUIS A DO	1/29/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
134516	Fee-for-Service	1962057349	1962057349	1	1	DALAR EXPRESS	5/28/2021	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2110 N GLENOAKS	None	BURBANK	CA	91504	2827	19	06037	34.1978711	-118.3263031	Los Angeles County
134527	Fee-for-Service	1174071708	1174071708	1	1	DIAZ, CONNIE	9/13/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	31930 VIA DEL SENOR	None	HOMELAND	CA	92548	9302	33	06065	33.78235363	-117.105514	Riverside County
134550	Fee-for-Service	1285889998	1285889998	1	2	DUNNE, QUENTIN L LMFT	9/1/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23822 VALENCIA BLVD	207	VALENCIA	CA	91355	5302	19	06037	34.41372708	-118.5513626	Los Angeles County
134576	Fee-for-Service	1083394605	1083394605	1	1	DEMUTH, LINDSEY NP	1/21/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
134583	Fee-for-Service	1326485293	1326485293	1	1	DIALYSIS CENTER OF	12/17/2013	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	PORTERVILLE LLC	841 WEST HENDERSON AVE	None	PORTERVILLE	CA	93257	1742	54	06107	36.078156	-119.03715	Tulare County
134585	Fee-for-Service	1396410684	1396410684	1	1	DESTEFANO, DANIELLE M NP	9/28/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
134592	Fee-for-Service	1700803418	1700803418	1	54	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134600	Fee-for-Service	1447362017	1447362017	1	1	DUSEJA, REENA MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109344	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM 1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
134612	Fee-for-Service	1497396527	1497396527	1	1	DE ANDA, EDWARD	8/23/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3928 COLEMAN AVE	None	SAN DIEGO	CA	92154	2515	37	06073	32.582945	-117.0496652	San Diego County
134650	Fee-for-Service	1356310882	1356310882	1	1	DAVIS,STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DAVIS RADIOLOGY	1221 SOUTH GEAR AVE	None	W BURLINTON	IA	52655	0000	00	None	40.809483	-91.1743785	Des Moines County
134656	Fee-for-Service	1700803418	1700803418	1	53	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	6555 COYLE AVENUE	SUITE 341	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134662	Fee-for-Service	1700803418	1700803418	1	67	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 3	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
134667	Fee-for-Service	1851428031	1851428031	1	1	DENNING, DEAN K DC	12/31/1984	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	160 S J ST	None	TULARE	CA	93274	4025	54	06107	36.20669193	-119.3470962	Tulare County
134678	Fee-for-Service	1093800229	1093800229	1	3	DINER, MARAT	12/19/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2299 POST ST	SUITE LL-8	SAN FRANCISCO	CA	94115	3443	38	06075	37.78434298	-122.4392033	San Francisco County
134681	Fee-for-Service	1063122893	1063122893	1	1	DR TUNG NGO, INC	5/2/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	14571 MAGNOLIA ST	201	WESTMINSTER	CA	92683	5575	30	06059	33.75097286	-117.9723502	Orange County
134710	Fee-for-Service	1902888514	1902888514	1	1	DAMUTH, HAROLD D JR MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	40072	30	Radiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
134713	Fee-for-Service	1336198878	1336198878	1	1	DE, AJANTA MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55862	01	General Practice	0	In state provider	None	1174 CASTRO ST	STE 201	MOUNTAIN VIEW	CA	94040	2569	43	06085	37.3822628	-122.0861276	Santa Clara County
134764	Fee-for-Service	1437622164	1437622164	1	1	DENOLA, MAYA LCSW	1/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
134768	Fee-for-Service	1568572618	1568572618	1	1	DARVISH, MAURICE MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42393	41	Internal Medicine	0	In state provider	None	11611 SAN VICENTE BLVD	None	LOS ANGELES	CA	90049	5106	19	06037	34.05400331	-118.4627584	Los Angeles County
134816	Fee-for-Service	1174071708	1174071708	1	1	DIAZ, CONNIE	9/13/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	31930 VIA DEL SENOR	None	HOMELAND	CA	92548	9302	33	06065	33.78235363	-117.105514	Riverside County
134855	Fee-for-Service	1770092843	1770092843	1	1	DOWNEY, MICHELE L LMFT	10/16/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7171 ALVARADO RD	STE 100A	LA MESA	CA	91942	8996	37	06073	32.77267798	-117.0445155	San Diego County
134880	Fee-for-Service	1700803418	1700803418	1	54	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 380	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134933	Fee-for-Service	1780750752	1780750752	1	1	DIJAMCO, ETHEL S MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	48307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6511 VAN NUYS BLVD	None	VAN NUYS	CA	91401	1425	19	06037	34.18912197	-118.4487608	Los Angeles County
134936	Fee-for-Service	1962426833	1962426833	1	1	DOMB, GEORGE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31077	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	SHASTA ENT SPECIALISTS A	2125 COURT ST	None	REDDING	CA	96001	2531	45	06089	40.57744821	-122.3932735	Shasta County
134946	Fee-for-Service	1700803418	1700803418	1	53	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	6555 COYLE AVENUE	SUITE 341	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
134949	Fee-for-Service	1700803418	1700803418	1	67	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	7115 GREENBACK LN	FL 3	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
134989	Fee-for-Service	1376710434	1376710434	1	1	DAYYANI, FARSHID MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125971	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	SAN FRANCISCO	CA	92868	3201	38	06075	33.78674051	-117.8888713	Orange County
134996	Fee-for-Service	1659686772	1659686772	1	1	DEIRMENDJIAN, TINA	5/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
135008	Fee-for-Service	1730230459	1730230459	1	1	DEVIREN, VEDAT MD	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86860	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135024	Fee-for-Service	1639255144	1639255144	1	1	DAO, ROSE B MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74040	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
135188	Fee-for-Service	1962605642	1962605642	1	1	DAI, YUN MING AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10 SCHUBERT CT	None	IRVINE	CA	92617	4036	30	06059	33.64070875	-117.8380958	Orange County
135218	Fee-for-Service	1780750752	1780750752	1	1	DIJAMCO, ETHEL S MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	48307	13	Neurology (M.D. only)	0	In state provider	None	6511 VAN NUYS BLVD	None	VAN NUYS	CA	91401	1425	19	06037	34.18912197	-118.4487608	Los Angeles County
135225	Fee-for-Service	1275600199	1275600199	1	1	DAMIANO, MICHAEL L MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82958	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
135226	Fee-for-Service	1962426833	1962426833	1	1	DOMB, GEORGE H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31077	04	Otology, Laryngology, Rhinology	0	In state provider	SHASTA ENT SPECIALISTS A	2125 COURT ST	None	REDDING	CA	96001	2531	45	06089	40.57744821	-122.3932735	Shasta County
135284	Fee-for-Service	1376710434	1376710434	1	1	DAYYANI, FARSHID MD	3/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125971	78	Neoplastic Diseases/Oncology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	SAN FRANCISCO	CA	92868	3201	38	06075	33.78674051	-117.8888713	Orange County
135303	Fee-for-Service	1467025809	1467025809	1	1	DANIEL, LORA L LCSW	9/17/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
135313	Fee-for-Service	1083681134	1083681134	1	1	DEVENDRA, GANESH L MD	3/31/1988	174400000X	NA	Other	026	PHYSICIANS	44521	None	None	0	In state provider	None	10515 BALBOA BLVD	STE 225	GRANADA HILLS	CA	91344	6359	19	06037	34.261497	-118.502318	Los Angeles County
135321	Fee-for-Service	1952748501	1952748501	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 VAN NUYS BLVD	STE 120	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
135366	Fee-for-Service	1215919402	1215919402	1	1	DR. STUART SENKFOR	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
135374	Fee-for-Service	1770043929	1770043929	1	1	DAL PORTO-KUJANPAA, STEPHANI	11/8/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	E E DPM	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
135377	Fee-for-Service	1053547968	1053547968	1	1	DHINGANI, DARSHAN R MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144626	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3000 Q STREET	FL 2	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
135452	Fee-for-Service	1912430265	1912430265	1	1	DHILLON, RANVIR MD	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	157722	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
135514	Fee-for-Service	1568693588	1568693588	1	1	DOWNEY, JOHN R MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113314	30	Radiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
135536	Fee-for-Service	1952845265	1952845265	1	1	DYER, HOLLY M CCC-SLP	4/15/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
135589	Fee-for-Service	1588060271	1588060271	1	1	DEBOLE, MATTHEW J	8/24/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
135594	Fee-for-Service	1801990247	1801990247	1	1	DESAI, RASHMI MD	1/31/1992	207R00000X	NA	Other	026	PHYSICIANS	33268	01	General Practice	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
135610	Fee-for-Service	1952748501	1952748501	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	7100 VAN NUYS BLVD	STE 120	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
135668	Fee-for-Service	1427069236	1427069236	1	1	DULONG, LINDA E NP	3/20/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135673	Fee-for-Service	1598109043	1598109043	1	1	DAYEL, HALEY M	2/11/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
135674	Fee-for-Service	1144861493	1144861493	1	1	DHILLON, JASPREET K NP	8/23/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
135675	Fee-for-Service	1427122035	1427122035	1	1	DEBONIS, JOSEPH A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
135686	Fee-for-Service	1306435557	1306435557	1	1	DUNCAN, REBECCA R DOULA	1/9/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
135706	Fee-for-Service	1861567307	1861567307	1	1	DHILLON, GURTEJ S MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50100	None	None	0	In state provider	None	1912 SOUTH COURT STREET	#A	VISALIA	CA	93277	5426	54	06107	36.313614	-119.291247	Tulare County
135764	Fee-for-Service	1124081245	1124081245	1	1	DUBOSE, ELIZABETH MD	4/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	74545	30	Radiology	0	In state provider	None	2365 QUIMBY ROAD	STE 100	SAN JOSE	CA	95122	1337	43	06085	37.325106	-121.8094335	Santa Clara County
135790	Fee-for-Service	1376570960	1376570960	1	1	DOVICHI, ERIC A MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64235	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135806	Fee-for-Service	1801273735	1801273735	1	1	DANG, BRIAN MD	9/11/2019	390200000X	NA	Other	026	PHYSICIANS	146568	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
135827	Fee-for-Service	1366469298	1366469298	1	1	DANDU, MADHAVI MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77321	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
135907	Fee-for-Service	1982947388	1982947388	1	1	DOTY, MEGHANA Y MD	6/14/2019	207L00000X	NA	Other	026	PHYSICIANS	132409	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
135956	Fee-for-Service	1841215480	1841215480	2	1	DEAN, KEVIN L MD	3/20/2022	207P00000X	NA	Other	026	PHYSICIANS	91503	None	None	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
136014	Fee-for-Service	1609989946	1609989946	1	1	DAVID B STANTON MD	12/31/1992	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	49428	10	Gastroenterology (M.D. only)	0	In state provider	None	1140 W LA VETA AVE	STE 550	ORANGE	CA	92868	4214	30	06059	33.7802984	-117.8651669	Orange County
136073	Fee-for-Service	1245506872	1245506872	1	1	DUONG, THERESA N MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129630	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
136079	Fee-for-Service	1780047191	1780047191	1	1	DIAZ, JOSEPH D MD	8/5/2019	207R00000X	NA	Other	026	PHYSICIANS	154571	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
136118	Fee-for-Service	1386722023	1386722023	1	1	DRABKIN MARK EMIL MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83860	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
136132	Fee-for-Service	1689809071	1689809071	1	1	DAWSON, JESSICA LMFT	10/13/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9700 EL CAMINO REAL	301	ATASCADERO	CA	93422	5581	40	06079	35.46523281	-120.647999	San Luis Obispo County
136149	Fee-for-Service	1023346970	1023346970	1	1	DOLL, LAURA LEE REID	10/30/2009	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	140 W SAN JOSE AVE	UNIT A	CLAREMONT	CA	91711	5204	19	06037	34.08314253	-117.7159185	Los Angeles County
136168	Fee-for-Service	1649474438	1649474438	1	1	DOYLE, BRIAN J MD	5/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120600	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
136188	Fee-for-Service	1699176982	1699176982	1	1	DOYLE, COLIN M CRNA	9/26/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	500 SW RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
136210	Fee-for-Service	1912064130	1912064130	1	1	DUVALL, BRUCE G OD	1/31/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1095 E ARROW HWY	None	UPLAND	CA	91786	5465	36	06071	34.09981452	-117.63702	San Bernardino County
136242	Fee-for-Service	1013203306	1013203306	1	1	DICKEY, JOHN P MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128214	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
136284	Fee-for-Service	1639827850	1639827850	1	1	DOEBEREINER, EMILY CCC-SLP	2/6/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
136293	Fee-for-Service	1669409934	1669409934	1	1	DIASOUND SERVICES INC	7/10/2009	247100000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	SUITE 216	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
136314	Fee-for-Service	1619105608	1619105608	1	1	DIANTS, LIANA MD	2/22/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	106644	08	Family Practice	0	In state provider	None	2 WEST FERN AVE	None	REDLANDS	CA	92373	0722	36	06071	34.05016907	-117.1793443	San Bernardino County
136328	Fee-for-Service	1588362701	1588362701	1	1	DELGADO, KAYLEEN	6/13/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	55	06109	0	0	None
136369	Fee-for-Service	1649556465	1649556465	1	1	DUMADAG, PAOLA D LMFT	7/25/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
136403	Fee-for-Service	1700803418	1700803418	1	61	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
136413	Fee-for-Service	1104878727	1104878727	1	1	DELGADO, JAIME H MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	24411	30	Radiology	0	In state provider	None	1281 W LAMBERT RD	None	LA HABRA	CA	90631	6614	30	06059	33.9247203	-117.9601046	Orange County
136444	Fee-for-Service	1528012374	1528012374	1	1	DAS, BIBI MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85212	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
136516	Fee-for-Service	1730387853	1730387853	1	1	DOAGA, ANDREEA MD	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99064	08	Family Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
136527	Fee-for-Service	1508925116	1508925116	1	1	DANESH, MITCHELL M MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56705	13	Neurology (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
136530	Fee-for-Service	1548745094	1548745094	1	1	DEAN, DEANNE M LPCC	1/7/2022	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	122	TEMECULA	CA	92590	4857	33	06065	33.52030169	-117.1659061	Riverside County
136586	Fee-for-Service	1265610273	1265610273	1	1	DOUGLAS, PAULETTE LMFT	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49399	-	NOT APPLICABLE	0	In state provider	None	710 E 111TH PLACE	None	LOS ANGELES	CA	90059	1578	19	06037	33.93454026	-118.2626368	Los Angeles County
136598	Fee-for-Service	1649951856	1649951856	1	1	DAVIS, KELTY RUE	11/8/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3710 9 1/2 AVE	None	HANFORD	CA	93230	9711	16	06031	36.42022211	-119.6278697	Kings County
136629	Fee-for-Service	1265099089	1265099089	1	1	DESERT MEDICAL TRANSPORT INC	3/31/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	.	44105 JACKSON STEET	107	INDIO	CA	92201	3280	33	06065	33.728877	-116.216336	Riverside County
136690	Fee-for-Service	1700803418	1700803418	1	61	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
136705	Fee-for-Service	1639130347	1639130347	1	1	DIAMOND DRUGS, INC.	10/1/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	645 KOLTER DR	None	INDIANA	PA	15701	3570	00	None	40.60791	-79.17309896	Indiana County
136716	Fee-for-Service	1043502677	1043502677	1	2	DAWSON, MELISSA L DO	9/20/2018	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	16459	None	None	0	In state provider	None	1425 MAGNOLIA AVE	None	CHICO	CA	95926	3226	04	06007	39.74063551	-121.8499048	Butte County
136741	Fee-for-Service	1982127015	1982127015	1	1	DOI, RUSSELL N OD	1/1/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4939 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3114	19	06037	34.0215836	-118.1627028	Los Angeles County
136742	Fee-for-Service	1104393362	1104393362	1	1	DANG, BINH T MD INC	12/28/2018	193200000X	NA	Other	026	PHYSICIANS	107616	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2209 COFFEE ROAD	STE I	MODESTO	CA	95355	2360	50	06099	37.674603	-120.975788	Stanislaus County
136754	Fee-for-Service	1841397304	1841397304	1	1	DAUGHARTY, BARBARA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COEUR D'ALENE	ID	83814	0000	00	None	47.69465937	-116.7917936	Kootenai County
136776	Fee-for-Service	1285632729	1285632729	1	1	DAVIS, JEFFREY M MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	24794	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
136871	Fee-for-Service	1922558162	1922558162	1	1	DODGEN, JUDY LMFT	10/19/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10419 BOGARDUS AVE	100	WHITTIER	CA	90603	2665	19	06037	33.941871	-117.9842755	Los Angeles County
136883	Fee-for-Service	1649951856	1649951856	1	1	DAVIS, KELTY RUE	11/8/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3710 9 1/2 AVE	None	HANFORD	CA	93230	9711	16	06031	36.42022211	-119.6278697	Kings County
136897	Fee-for-Service	1275284432	1275284432	1	1	DOHENY, MEGAN LMFT	3/26/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
136976	Fee-for-Service	1700803418	1700803418	1	61	DIGNITY HEALTH MEDICAL FOUND	5/17/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
137025	Fee-for-Service	1326571795	1326571795	1	1	DEVOE, LOUIS MD	8/4/2021	207L00000X	NA	Other	026	PHYSICIANS	158184	None	None	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
137029	Fee-for-Service	1104393362	1104393362	1	1	DANG, BINH T MD INC	12/28/2018	193200000X	NA	Other	026	PHYSICIANS	107616	01	General Practice	0	In state provider	None	2209 COFFEE ROAD	STE I	MODESTO	CA	95355	2360	50	06099	37.674603	-120.975788	Stanislaus County
137070	Fee-for-Service	1124292594	1124292594	1	1	DEVINE, CHRISTINA T MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110630	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
137131	Fee-for-Service	1902421027	1902421027	1	1	DIAMOND, BROOKE	11/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
137141	Fee-for-Service	1023285889	1023285889	1	1	DENMAN, CHARLES E MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108094	41	Internal Medicine	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
137164	Fee-for-Service	1861594848	1861594848	1	1	DIVID C HUGHES	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD STE 800	None	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
137179	Fee-for-Service	1831320316	1831320316	1	1	DIN, SAIRA LCSW	11/17/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
137204	Fee-for-Service	1366935678	1366935678	1	1	DUONG, CHERYL C OD	1/17/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	521 E ELDER ST	STE 102	FALLBROOK	CA	92028	3082	37	06073	33.38015149	-117.246267	San Diego County
137256	Fee-for-Service	1730270620	1730270620	1	1	DINELLO, CHRISTOPHER MD	12/27/1996	207L00000X	NA	Other	026	PHYSICIANS	69682	05	Anesthesiology	0	In state provider	MARIN GENERAL HOSPITAL	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
137257	Fee-for-Service	1700803418	1700803418	1	62	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1561 CREEKSIDE DR	STE 150	FOLSOM	CA	95630	3495	34	06067	38.668032	-121.150188	Sacramento County
137266	Fee-for-Service	1144326612	1144326612	1	1	DAUR, LANCE R LMFT	12/6/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	38709	-	NOT APPLICABLE	0	In state provider	None	2035 E BALL RD	STE 100A, 100P	ANAHEIM	CA	92806	5158	30	06059	33.81812448	-117.8880075	Orange County
137275	Fee-for-Service	1639112386	1639112386	1	1	DUNTON, MARIA J DO	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7414	08	Family Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
137314	Fee-for-Service	1396087672	1396087672	1	1	DOCTORS MEDICAL CENTER OF	8/1/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MODESTO INC	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
137318	Fee-for-Service	1194942672	1194942672	1	1	DANIELS, ERIC J MD	5/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78892	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
137337	Fee-for-Service	1811076235	1811076235	1	1	DESANCTIS, DINA L LMFT	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1910 HUNTINGTON DR	None	SOUTH PASADENA	CA	91030	4812	19	06037	34.10428151	-118.143801	Los Angeles County
137340	Fee-for-Service	1720168651	1720168651	1	1	DENNIS, ERIC S MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	4880 S WYNN RD	None	LAS VEGAS	NV	89103	5406	00	None	36.10169134	-115.1953733	Clark County
137358	Fee-for-Service	1912102823	1912102823	1	1	DARRICK WESLEY WOODS MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	STE 142	PHOENIX	AZ	85013	3449	00	None	33.49179	-112.07844	Maricopa County
137360	Fee-for-Service	1487855599	1487855599	1	1	DHALIWAL, JASMINE K MD	12/10/2009	207R00000X	NA	Other	026	PHYSICIANS	105382	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
137371	Fee-for-Service	1720481526	1720481526	1	1	DENWORTH, CORRINE L NP	8/17/2019	363LP0222X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
137426	Fee-for-Service	1316127145	1316127145	1	1	DERUSO, WILLIAM MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101578	30	Radiology	0	In state provider	None	2320 BATH ST	STE 208	SANTA BARBARA	CA	93105	3805	42	06083	34.43082689	-119.7223032	Santa Barbara County
137446	Fee-for-Service	1093900649	1093900649	1	1	DONALDSON, MELISSA PSYD	11/27/2023	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
137463	Fee-for-Service	1790890408	1790890408	1	1	DELILLY, JULIE A MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	67084	01	General Practice	0	In state provider	None	510 N PROSPECT AVE	STE 208	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
137467	Fee-for-Service	1144287855	1144287855	1	1	DURST, ROBERT A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2929 5TH ST	STE 100	RAPID CITY	SD	57701	7355	00	None	44.05598594	-103.2274757	Pennington County
137475	Fee-for-Service	1972752368	1972752368	1	1	DE NOVO HEALTH CARE INC	4/1/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	803 ROSECRANS AVE	None	E RANCHO DOMINGUE	CA	90221	2145	19	06037	33.9035073	-118.2153406	Los Angeles County
137484	Fee-for-Service	1396935458	1396935458	1	1	DERGUN, MARINA MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93428	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
137524	Fee-for-Service	1700803418	1700803418	1	52	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 290	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
137544	Fee-for-Service	1700803418	1700803418	1	62	DIGNITY HEALTH MEDICAL FOUND	10/24/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1561 CREEKSIDE DR	STE 150	FOLSOM	CA	95630	3495	34	06067	38.668032	-121.150188	Sacramento County
137602	Fee-for-Service	1396087672	1396087672	1	1	DOCTORS MEDICAL CENTER OF	8/1/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MODESTO INC	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
137658	Fee-for-Service	1063785004	1063785004	1	1	DAVE, SHIVANGI B	11/14/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3280	41	06081	37.65894608	-122.440161	San Mateo County
137686	Fee-for-Service	1285196832	1285196832	1	1	DRUTMAN, BRITTANY M DO	10/24/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20076	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
137711	Fee-for-Service	1598940223	1598940223	1	1	DHALIWAL, GURBIR S MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120598	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	440 PLUMAS BOULEVARD	None	YUBA CITY	CA	95991	5071	51	06101	39.13140416	-121.6141951	Sutter County
137712	Fee-for-Service	1740868686	1740868686	1	1	DO, DENNIS DO	9/13/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
137749	Fee-for-Service	1790890408	1790890408	1	1	DELILLY, JULIE A MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	67084	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	510 N PROSPECT AVE	STE 208	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
137757	Fee-for-Service	1801916630	1801916630	1	1	DAVID A TERRY DO	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6120 W BELL RD	STE 100	GLENDALE	AZ	85308	3780	00	None	33.639102	-112.1913405	Maricopa County
137765	Fee-for-Service	1972752368	1972752368	1	1	DE NOVO HEALTH CARE INC	4/1/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	803 ROSECRANS AVE	None	E RANCHO DOMINGUE	CA	90221	2145	19	06037	33.9035073	-118.2153406	Los Angeles County
137784	Fee-for-Service	1033394531	1033394531	1	1	DHAND, SADHNA MD	1/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	37505	08	Family Practice	0	In state provider	None	1433 W MERCED AVE	STE 311	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
137791	Fee-for-Service	1609017532	1609017532	1	1	DALAL, PRITHA B MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132097	25	Physical Medicine and Rehabilitation	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
137803	Fee-for-Service	1114079910	1114079910	1	1	DUBOIS, JEFFREY J MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	52737	40	Pediatrics	0	In state provider	None	5275 F ST	STE 3	SACRAMENTO	CA	95819	3225	34	06067	38.57042952	-121.4377223	Sacramento County
137811	Fee-for-Service	1700803418	1700803418	1	72	DIGNITY HEALTH MEDICAL FOUND	1/5/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3980 DOUGLAS BLVD	STE 110	ROSEVILLE	CA	95661	4263	31	06061	38.74382331	-121.2286168	Placer County
137820	Fee-for-Service	1497016182	1497016182	1	1	DESAI, VIRENDRA R MD	7/1/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
137821	Fee-for-Service	1487926689	1487926689	1	1	DONOHOE, TERESA R NP	11/8/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
137836	Fee-for-Service	1700803418	1700803418	1	62	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1561 CREEKSIDE DR	STE 150	FOLSOM	CA	95630	3495	34	06067	38.668032	-121.150188	Sacramento County
137842	Fee-for-Service	1407876659	1407876659	1	1	DO, CHRISTOPHER N MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	62877	41	Internal Medicine	0	In state provider	None	1692 TULLY RD	STE 8	SAN JOSE	CA	95122	2550	43	06085	37.3212391	-121.8273245	Santa Clara County
137853	Fee-for-Service	1942828496	1942828496	1	1	DEVOTED HEALTH HOSPICE	7/6/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	STE 204D	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
137885	Fee-for-Service	1013956655	1013956655	1	1	DAVULURI, PRAVEEN K MD	5/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53080	05	Anesthesiology	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95340	6211	24	06047	37.29248035	-120.4730619	Merced County
137895	Fee-for-Service	1750644837	1750644837	1	1	DAVIS, MIRIAM T MD	6/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128097	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
137910	Fee-for-Service	1932158771	1932158771	1	1	DALE, KENNETH M DO	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	7060	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
137966	Fee-for-Service	1548557077	1548557077	1	1	DHALIWAL, ANDREA G MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133138	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	SUITE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
137998	Fee-for-Service	1386096048	1386096048	1	1	DARIA BORAH	4/19/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	5317	00	None	40.700349	-73.9416015	Kings County
138037	Fee-for-Service	1063875524	1063875524	1	1	DICESARE, JASMINE A MD	6/1/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	156738	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138039	Fee-for-Service	1790890408	1790890408	1	1	DELILLY, JULIE A MD	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	67084	41	Internal Medicine	0	In state provider	None	510 N PROSPECT AVE	STE 208	REDONDO BEACH	CA	90277	3030	19	06037	33.85259344	-118.379739	Los Angeles County
138045	Fee-for-Service	1508989831	1508989831	1	1	DEL PRADO, DANIEL MD	8/8/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55849	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
138079	Fee-for-Service	1609017532	1609017532	1	1	DALAL, PRITHA B MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132097	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
138087	Fee-for-Service	1043374440	1043374440	1	1	DUBOW, ELIZABETH B MD	10/2/2020	2084N0402X	NA	Neurology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
138100	Fee-for-Service	1700803418	1700803418	1	52	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	6555 COYLE AVENUE	SUITE 290	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
138102	Fee-for-Service	1750365375	1750365375	2	1	DEANCO HEALTHCARE LLC	7/12/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
138118	Fee-for-Service	1346644226	1346644226	1	1	DUARTE, CLARABELLE T NP	8/7/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
138123	Fee-for-Service	1558407825	1558407825	1	1	DURAND, DANIEL J MD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130791	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
138142	Fee-for-Service	1942828496	1942828496	1	1	DEVOTED HEALTH HOSPICE	7/6/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	STE 204D	NORTH HILLS	CA	91343	4354	19	06037	34.232355	-118.467768	Los Angeles County
138144	Fee-for-Service	1215016472	1215016472	1	1	DAS, KINGSHUK MD	11/9/2010	207ZP0105X	NA	Other	026	PHYSICIANS	100259	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	STE B 186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
138149	Fee-for-Service	1174646335	1174646335	1	1	DIXON FAMILY PRACTICE	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	131 W A ST	None	DIXON	CA	95620	3437	48	06095	38.4455395	-121.823283	Solano County
138172	Fee-for-Service	1124040084	1124040084	1	1	DE MOTT, DEBORAH LYNN MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76639	01	General Practice	0	In state provider	None	2999 REGENT ST	STE 525	BERKELEY	CA	94705	2120	01	06001	37.85592021	-122.2566436	Alameda County
138187	Fee-for-Service	1760473664	1760473664	1	1	DOBRY, MARY M MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67293	07	Dermatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138189	Fee-for-Service	1134146871	1134146871	1	1	DUSHENKO, TERRANCE W PHD	7/9/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1045 ATLANTIC AVE	STE 806	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
138253	Fee-for-Service	1548557077	1548557077	1	1	DHALIWAL, ANDREA G MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133138	01	General Practice	0	In state provider	None	3687 MT DIABLO BLVD	SUITE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
138265	Fee-for-Service	1093207656	1093207656	1	1	DELBRUCK, LINA MD	2/18/2020	390200000X	NA	Other	026	PHYSICIANS	17610	08	Family Practice	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
138267	Fee-for-Service	1679077721	1679077721	1	1	DEEDAS, CRYSTAL T MD	9/8/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164704	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
138270	Fee-for-Service	1609980911	1609980911	1	1	DAVID J. PEACE MD	3/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1740 W TAYLOR ST	None	CHICAGO	IL	60612	7232	00	None	41.8692353	-87.67061005	Cook County
138276	Fee-for-Service	1386823318	1386823318	1	1	DIRKS, DIANE K CNM	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2620 LAS POSAS RD	None	CAMARILLO	CA	99301	3400	56	06111	34.23720123	-119.035911	Ventura County
138325	Fee-for-Service	1497765614	1497765614	1	1	DU QUETTE, MARY W MD	10/31/1992	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	70844	08	Family Practice	0	In state provider	None	200 4TH AVE	None	SAN DIEGO	CA	92101	6959	37	06073	32.71422314	-117.1611308	San Diego County
138371	Fee-for-Service	1710919345	1710919345	1	1	DIAZ, MARCO A MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67180	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
138377	Fee-for-Service	1639360613	1639360613	1	1	DOMINGUEZ, AARON J MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	91370	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2790 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.700533	-119.7908665	Fresno County
138384	Fee-for-Service	1184037202	1184037202	1	1	DANG, NANCY T OD	10/12/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	30	06059	33.77387145	-117.9966555	Orange County
138388	Fee-for-Service	1700803418	1700803418	1	52	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 290	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
138391	Fee-for-Service	1750365375	1750365375	2	1	DEANCO HEALTHCARE LLC	7/12/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
138420	Fee-for-Service	1093769259	1093769259	1	1	DIRE, ANTHONY J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
138474	Fee-for-Service	1760473664	1760473664	1	1	DOBRY, MARY M MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67293	01	General Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
138487	Fee-for-Service	1437326428	1437326428	1	1	DONAHOE, JAVIER A	7/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 N MOUNTAIN AVE.	SUITE 219	UPLAND	CA	90003	1311	36	06071	34.10424442	-117.6701797	San Bernardino County
138509	Fee-for-Service	1578095113	1578095113	1	1	DESAI, ANYA MD	5/29/2020	390200000X	NA	Other	026	PHYSICIANS	160200	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
138565	Fee-for-Service	1891807509	1891807509	1	1	DELGADO, STACY E PHD	3/31/2023	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	25208 JACLYN AVE	None	MORENO VALLEY	CA	92557	5740	33	06065	33.95715728	-117.2231297	Riverside County
138613	Fee-for-Service	1497765614	1497765614	1	1	DU QUETTE, MARY W MD	10/31/1992	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	70844	36	Psychiatry	0	In state provider	None	200 4TH AVE	None	SAN DIEGO	CA	92101	6959	37	06073	32.71422314	-117.1611308	San Diego County
138628	Fee-for-Service	1407869233	1407869233	1	1	DENG, CHARLES MD	9/30/1993	207P00000X	NA	Other	026	PHYSICIANS	73364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
138629	Fee-for-Service	1699124537	1699124537	1	1	DAVID T DANG MD INC	4/30/2019	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	50 BELLEFONTAINE ST	STE 308	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
138631	Fee-for-Service	1568003820	1568003820	1	1	DOYLE, TERI L PSYD	10/23/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
138649	Fee-for-Service	1821212879	1821212879	1	1	DONOVAN, SCOTT E LMFT	9/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18888 OUTER HWY 18	205	APPLE VALLEY	CA	92307	2315	36	06071	34.53773582	-117.2522355	San Bernardino County
138651	Fee-for-Service	1487768586	1487768586	1	1	DUTTA, SUKALPA J MD	5/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	87325	None	None	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
138662	Fee-for-Service	1962725119	1962725119	1	1	DOWDY, ANDREA M	3/15/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
138663	Fee-for-Service	1376575639	1376575639	1	1	DANG-VU, BAY	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45226	None	None	0	In state provider	None	401 E 18TH ST	None	OAKLAND	CA	94606	1850	01	06001	37.7990177	-122.2509059	Alameda County
138784	Fee-for-Service	1215317441	1215317441	1	1	DIAZ, ROSEMARIE B MD	10/15/2021	207P00000X	NA	Other	026	PHYSICIANS	171845	None	None	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
138814	Fee-for-Service	1972920098	1972920098	1	1	DIVINE MEDICAL WELLNESS CENT	12/19/2024	111N00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	5150 N 6TH ST	STE 100	FRESNO	CA	93710	7505	10	06019	36.81127498	-119.7632093	Fresno County
139016	Fee-for-Service	1265404222	1265404222	1	1	DANIELS, DENNIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1906A GREENWOOD DR	None	POPLAR BLUFF	MO	63901	2430	00	None	36.78079288	-90.4207778	Butler County
139024	Fee-for-Service	1699780049	1699780049	1	1	DOLBY, JENNIFER H MD	12/1/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71269	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
139045	Fee-for-Service	1477029940	1477029940	1	1	DURANT, JACOB LMFT	7/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1370 RIDGEWOOD DRIVE	9	CHICO	CA	95973	7803	04	06007	39.77435386	-121.8407227	Butte County
139061	Fee-for-Service	1215353792	1215353792	1	1	DIEFENBACHER, NADINE LMFT	7/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5050 SUNRISE BLVD	STE C5	FAIR OAKS	CA	95628	4942	34	06067	38.658429	-121.271904	Sacramento County
139070	Fee-for-Service	1730265257	1730265257	1	1	DAOUDI, ZINEB B MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69289	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
139075	Fee-for-Service	1861508780	1861508780	1	1	DIMITRIADES, CONSTANTINE	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142989	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
139111	Fee-for-Service	1457333684	1457333684	1	1	DANIEL J. RONCONE	8/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	929 JASONWAY AVE	None	COLUMBUS	OH	43214	2330	00	None	40.06233915	-83.04369682	Franklin County
139114	Fee-for-Service	1588815534	1588815534	1	1	DAVIS, MARY N CNM	11/16/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
139137	Fee-for-Service	1508195223	1508195223	1	1	DAMON, HEATHER LCSW	11/8/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7444 SPICEWOOD DR	None	SACRAMENTO	CA	95831	4927	34	06067	38.486673	-121.537413	Sacramento County
139139	Fee-for-Service	1992934525	1992934525	1	1	DOUEK, SAHAR MD	5/13/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	115953	-	NOT APPLICABLE	0	In state provider	None	6736 LAUREL CANYON BLVD	SUITE 200	NORTH HOLLYWOOD	CA	91606	1576	19	06037	34.193493	-118.3964925	Los Angeles County
139278	Fee-for-Service	1538344189	1538344189	1	1	DEVEREAUX, ROBERT A MD INC	1/1/2012	261QP2300X	NA	Other	026	PHYSICIANS	31475	08	Family Practice	0	In state provider	None	11100 WARNER AVE	STE 100	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
139354	Fee-for-Service	1154897841	1154897841	1	1	DEMPSEY, TOSHIE CNP	4/16/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1720 S BASCOM AVE	None	CAMPBELL	CA	95008	0608	43	06085	37.292472	-121.9315815	Santa Clara County
139377	Fee-for-Service	1093732992	1093732992	1	1	DAOUD, RONALD N MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51211	41	Internal Medicine	0	In state provider	None	7630 E CHAPMAN AVE	STE B	ORANGE	CA	92869	8536	30	06059	33.79509767	-117.7717717	Orange County
139382	Fee-for-Service	1881249563	1881249563	1	2	DAPHCO	3/3/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1601 N GOWER ST	107	LOS ANGELES	CA	90028	7596	19	06037	34.099965	-118.3223675	Los Angeles County
139406	Fee-for-Service	1174072078	1174072078	1	1	DUGGAN, MEGHAN E CRNA	11/24/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
139429	Fee-for-Service	1255829669	1255829669	1	1	DELUCA, CHRISTIE CCC-SP	9/6/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
139481	Fee-for-Service	1194883520	1194883520	1	1	DENKABE, JACQUELINE MD	11/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93117	None	None	0	In state provider	None	3555 CESAR CHAVEZ ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
139498	Fee-for-Service	1255718375	1255718375	1	1	DYER, KATHERINE M LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
139500	Fee-for-Service	1962401943	1962401943	1	1	DULIK, JEFFREY S DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2037 WALES RD NE	None	MASSILLON	OH	44646	4185	00	None	40.82192702	-81.50309093	Stark County
139535	Fee-for-Service	1518277656	1518277656	1	1	DE LEON FUENTES, CYNTHIA LM	8/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	13200 CROSSROADS PKWY	STE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
139570	Fee-for-Service	1730316944	1730316944	1	1	DANIEL E NEUMEYER, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 NAVARRE AVE	None	OREGON	OH	43616	3207	00	None	41.63666551	-83.485098	Lucas County
139577	Fee-for-Service	1205413978	1205413978	1	1	DAEDLER, ANDREW MD	9/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
139586	Fee-for-Service	1295148658	1295148658	1	1	DABROWSKI, THOMAS	9/9/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	130486	01	General Practice	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
139649	Fee-for-Service	1629121975	1629121975	1	1	DANIELS, DAVID V MD	1/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
139659	Fee-for-Service	1710448196	1710448196	1	1	DABREO, EVAN R MD	6/19/2023	207L00000X	NA	Other	026	PHYSICIANS	186247	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
139670	Fee-for-Service	1679638019	1679638019	1	1	DELANO UNION SCHOOL DISTRICT	1/31/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1405 12TH AVE	None	DELANO	CA	93215	2468	15	06029	35.77288645	-119.2394745	Kern County
139694	Fee-for-Service	1528197613	1528197613	1	1	DOO, MICHAEL MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95520	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
139700	Fee-for-Service	1396073052	1396073052	1	1	DOW, LISA P PHD	10/21/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
139760	Fee-for-Service	1780643270	1780643270	1	1	DECASTRO, MARLON C MD	11/12/2010	207R00000X	NA	Other	026	PHYSICIANS	53594	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
139780	Fee-for-Service	1508328972	1508328972	1	2	DURST-WEISMAN, LEESA LCSW	3/18/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
139795	Fee-for-Service	1992433627	1992433627	1	1	D BEST TRANSPORTATION LLC	3/6/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	68805 PEREZ RD	UNIT G-66-67	CATHEDRAL CITY	CA	92234	7227	33	06065	33.78386508	-116.4617244	Riverside County
139796	Fee-for-Service	1679920227	1679920227	1	1	DORONILA-GADDI, KRISTINA D	5/26/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1308 EAST CAMBRIDGE CT	None	LANCASTER	CA	93535	2984	19	06037	34.6682127	-118.105174	Los Angeles County
139815	Fee-for-Service	1700184280	1700184280	1	1	DEREK NGUYEN MD INC	11/6/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4435 BROCKTON AVE	STE B	RIVERSIDE	CA	92501	4004	33	06065	33.97779042	-117.3837878	Riverside County
139821	Fee-for-Service	1982757290	1982757290	1	1	DONG, Y'LANG T PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
139880	Fee-for-Service	1932563707	1932563707	1	1	DANG, PHUONG K MD	7/19/2019	208M00000X	NA	Other	026	PHYSICIANS	157960	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
139900	Fee-for-Service	1366588725	1366588725	1	1	DICK, WENDI J MD	2/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103784	41	Internal Medicine	0	In state provider	None	1601 E HAZELTON AVE	None	STOCKTON	CA	95202	6229	39	06077	37.9501034	-121.2684501	San Joaquin County
139908	Fee-for-Service	1780211813	1780211813	1	1	DANG, JEANNIE B	8/17/2023	2085B0100X	NA	MRI Provider	026	PHYSICIANS	184927	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
139953	Fee-for-Service	1962964502	1962964502	1	1	DIRECT CARE HOME HEALTH INC	7/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	232 N LAKE AVE	SUITE 212	PASADENA	CA	91101	4152	19	06037	34.150005	-118.1323505	Los Angeles County
139958	Fee-for-Service	1376842997	1376842997	1	1	DOSHI, MAANSI V DO	10/21/2020	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	16239	None	None	0	In state provider	None	2121 COLORADO AVE	SUITE C	TURLOCK	CA	95382	2012	50	06099	37.5117454	-120.8353096	Stanislaus County
139976	Fee-for-Service	1699138917	1699138917	1	1	DRISCOLL, DENISE MD	12/9/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
139980	Fee-for-Service	1134115884	1134115884	1	1	DAVID BARRANCO MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	4434	00	None	33.4805218	-112.0782792	Maricopa County
139983	Fee-for-Service	1528197613	1528197613	1	1	DOO, MICHAEL MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95520	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
139997	Fee-for-Service	1619055118	1619055118	1	1	DEPRY, DWAYNE R MD	8/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	4903	36	Psychiatry	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
140047	Fee-for-Service	1578810842	1578810842	1	1	DHP OF VALLEY MEDICAL GROUP	8/10/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1000 TRANCAS STREET	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
140085	Fee-for-Service	1679920227	1679920227	1	1	DORONILA-GADDI, KRISTINA D	5/26/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1308 EAST CAMBRIDGE CT	None	LANCASTER	CA	93535	2984	19	06037	34.6682127	-118.105174	Los Angeles County
140093	Fee-for-Service	1487099826	1487099826	1	1	DAHER, MOHAMMED H MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119997	36	Psychiatry	0	In state provider	None	1320 STANDIFORD AVE	SUITE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
140134	Fee-for-Service	1811901762	1811901762	1	1	DE LA PENA, ALBERT MD	10/30/1991	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 N GRAND AVE	None	SANTA ANA	CA	92701	2627	30	06059	33.758541	-117.8519485	Orange County
140159	Fee-for-Service	1679780480	1679780480	1	1	DAVID, JUDITHANN H PHD	11/27/2017	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	919 THE ALAMEDA	None	BERKELEY	CA	94707	2301	01	06001	37.89099063	-122.2769728	Alameda County
140165	Fee-for-Service	1700803418	1700803418	1	49	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 210	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
140172	Fee-for-Service	1790006179	1790006179	1	1	DE GIACOMO, ANTHONY F MD	6/24/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	143263	20	Orthopedic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
140174	Fee-for-Service	1780609180	1780609180	1	1	DAVID W MERCER M.D.	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
140203	Fee-for-Service	1942428461	1942428461	1	1	DAVIES, DANTAE D MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	28898	02	General Surgery	0	In state provider	None	1189 SWALLOW LN	STE 201	SIMI VALLEY	CA	93065	1204	56	06111	34.26051348	-118.7944618	Ventura County
140228	Fee-for-Service	1669665063	1669665063	1	1	DHAND, SARA MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100873	36	Psychiatry	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
140287	Fee-for-Service	1356375653	1356375653	1	1	DERN, MICHELLE S MD	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53765	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
140321	Fee-for-Service	1083736037	1083736037	1	1	DANA DAVIS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNM MEDICAL GROUP INC	2211 LOMAS	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
140324	Fee-for-Service	1659424604	1659424604	1	1	DANZ, WILLIAM A	1/1/1979	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	490 POST ST	STE 1609	SAN FRANCISCO	CA	94102	1313	38	06075	37.78812774	-122.4096884	San Francisco County
140344	Fee-for-Service	1134108038	1134108038	1	1	DAMAJ, NOUHAD B MD	5/27/2008	193400000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6850 N DURANGO DR	None	LAS VEGAS	NV	89149	4597	00	None	36.285876	-115.285266	Clark County
140358	Fee-for-Service	1972526960	1972526960	1	1	DACOSTA, JASON G MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91285	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
140400	Fee-for-Service	1700803418	1700803418	1	22	DIGNITY HEALTH MEDICAL FOUND	4/1/2024	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
140401	Fee-for-Service	1154347235	1154347235	1	1	DIAMOND, ANDREW S MD	5/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88519	41	Internal Medicine	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
140405	Fee-for-Service	1326312067	1326312067	1	8	DCHS MEDICAL FOUNDATION	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2675 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.9892055	-118.2228885	Los Angeles County
140420	Fee-for-Service	1811901762	1811901762	1	1	DE LA PENA, ALBERT MD	1/31/1990	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1520 N GRAND AVE	None	SANTA ANA	CA	92701	2627	30	06059	33.758541	-117.8519485	Orange County
140447	Fee-for-Service	1619967809	1619967809	1	1	DI ZINNO, LIBRO E MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	30996	18	Ophthalmology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
140454	Fee-for-Service	1700803418	1700803418	1	49	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 210	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
140480	Fee-for-Service	1487728184	1487728184	1	1	DAYLIGHT-HOLLYWOOD ADULT	10/8/2009	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	DAY HEALTH CARE CENTER	5300 SANTA MONICA BLVD	SUITE 317	LOS ANGELES	CA	90029	1256	19	06037	34.09075271	-118.305509	Los Angeles County
140516	Fee-for-Service	1609933274	1609933274	1	1	DONCHEVA, DIANA MD	10/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55408	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
140586	Fee-for-Service	1972529295	1972529295	1	1	DOUGLAS COPLEN MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS PL	None	SAINT LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
140601	Fee-for-Service	1427412808	1427412808	1	1	DYBALL, JANE MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	152452	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
140603	Fee-for-Service	1710737630	1710737630	1	1	DELA CRUZ, KRISTA ARIEL C OT	8/7/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
140625	Fee-for-Service	1669550422	1669550422	1	1	DYBBRO, PAUL E MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	47684	30	Radiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
140631	Fee-for-Service	1922447937	1922447937	1	1	DAYAL, RITI S MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138766	40	Pediatrics	0	In state provider	None	307 PLACENTIA AVE	STE 107	NEWPORT BEACH	CA	92663	3307	30	06059	33.62631386	-117.9310576	Orange County
140638	Fee-for-Service	1447647326	1447647326	1	1	DORNAN, ANDREW M MD	3/1/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143742	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
140645	Fee-for-Service	1396843827	1396843827	1	1	DAO, HOANGTU T	3/3/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12881 KNOTT ST	STE 103	GARDEN GROVE	CA	92841	3939	30	06059	33.77542911	-118.0080111	Orange County
140669	Fee-for-Service	1659463966	1659463966	1	1	DRURY, JAMES K MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39080	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8635 W 3RD ST	STE 1050W	LOS ANGELES	CA	90048	6105	19	06037	34.07361928	-118.3803143	Los Angeles County
140687	Fee-for-Service	1629094099	1629094099	1	1	DESTINY HOME HEALTH SERVICES	6/16/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	410-412 E FLORENCE AVE	None	INGLEWOOD	CA	90302	2405	19	06037	33.96770159	-118.3502187	Los Angeles County
140689	Fee-for-Service	1700803418	1700803418	1	22	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
140695	Fee-for-Service	1326312067	1326312067	1	8	DCHS MEDICAL FOUNDATION	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	2675 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.9892055	-118.2228885	Los Angeles County
140700	Fee-for-Service	1134614498	1134614498	1	1	DILLON-CHI, ANNEMARIE C LCSW	9/19/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
140702	Fee-for-Service	1841230935	1841230935	1	1	DOCHERTY, MICHAEL J MD	6/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74870	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
140716	Fee-for-Service	1154335735	1154335735	1	1	DANG, ANDY H MD	10/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66898	41	Internal Medicine	0	In state provider	None	23838 VALENCIA BLVD	STE 200	VALENCIA	CA	91355	5319	19	06037	34.41337791	-118.5520369	Los Angeles County
140739	Fee-for-Service	1700803418	1700803418	1	49	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	6555 COYLE AVENUE	SUITE 210	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
140791	Fee-for-Service	1568620672	1568620672	1	1	DE PAZ, CESAR MD	11/19/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
140810	Fee-for-Service	1750432456	1750432456	1	1	DISCOUNT OPTICAL	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CENTER	18353 VANOWEN ST	STE K	RESEDA	CA	91335	5498	19	06037	34.19387294	-118.5332417	Los Angeles County
140816	Fee-for-Service	1881250918	1881250918	1	1	DAVID D BROWN DO INC	8/1/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	12062 VALLEY VIEW ST	107	GARDEN GROVE	CA	92845	1738	30	06059	33.78720885	-118.028413	Orange County
140837	Fee-for-Service	1952527186	1952527186	1	1	DAVEREDE, MARIA E LMFT	9/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	412 AVIATION BLVD	K	SANTA ROSA	CA	95403	1089	49	06097	38.512233	-122.7855735	Sonoma County
140874	Fee-for-Service	1508072752	1508072752	1	1	DIFEDERICO, ELAINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4701 MONTGOMERY BLVD NE	None	ALBUQUERQUE	NM	87109	1219	00	None	35.13107363	-106.5908411	Bernalillo County
140884	Fee-for-Service	1174565741	1174565741	1	1	DZANKIC, SAMIR MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82244	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
140914	Fee-for-Service	1831168368	1831168368	1	1	DALAL, KIMBERLY M MD	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98482	78	Neoplastic Diseases/Oncology	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
140948	Fee-for-Service	1033149711	1033149711	1	1	DEFOTO, JOSEPH T MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63218	01	General Practice	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
140953	Fee-for-Service	1366806630	1366806630	1	1	DEESING, MICHOLE A MD	11/10/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	162150	36	Psychiatry	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
140978	Fee-for-Service	1700803418	1700803418	1	22	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
141005	Fee-for-Service	1154335735	1154335735	1	1	DANG, ANDY H MD	10/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	66898	67	Endocrinology	0	In state provider	None	23838 VALENCIA BLVD	STE 200	VALENCIA	CA	91355	5319	19	06037	34.41337791	-118.5520369	Los Angeles County
141020	Fee-for-Service	1376596981	1376596981	1	1	DICIRO, DOMINIC T MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85160	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
141027	Fee-for-Service	1700803418	1700803418	1	49	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	6555 COYLE AVENUE	SUITE 210	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
141041	Fee-for-Service	1801899570	1801899570	1	1	DISMOND, SAMUEL R MD	10/18/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	62220	01	General Practice	0	In state provider	None	515 MICHIGAN BLVD	None	WEST SACRAMENTO	CA	95691	2705	57	06113	38.58298316	-121.5265736	Yolo County
141072	Fee-for-Service	1427085927	1427085927	1	1	DOBYNS, JEFFREY L	10/22/1997	174400000X	NA	Other	026	PHYSICIANS	50776	20	Orthopedic Surgery	0	In state provider	None	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
141089	Fee-for-Service	1457390346	1457390346	1	1	DEUTSCH, JAMES MD	8/1/1995	207P00000X	NA	Other	026	PHYSICIANS	26008	66	Emergency Medicine (Urgent Care)	0	In state provider	None	22805 AVALON BLVD	None	CARSON	CA	90745	5015	19	06037	33.81910704	-118.2638134	Los Angeles County
141097	Fee-for-Service	1649356205	1649356205	1	1	DRUG THERAPY SYSTEM CO.	7/8/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC.	195 COHASSET RD	None	CHICO	CA	95926	2201	04	06007	39.75175734	-121.8533226	Butte County
141211	Fee-for-Service	1770710006	1770710006	1	1	DANG, VU H MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146944	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
141216	Fee-for-Service	1790898823	1790898823	2	1	DOHERTY, JANNA L MD	6/15/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	64380	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
141219	Fee-for-Service	1356535256	1356535256	1	1	DAVIDSON, STEPHANIE L PHD	4/12/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
141235	Fee-for-Service	1033149711	1033149711	1	1	DEFOTO, JOSEPH T MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63218	08	Family Practice	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
141265	Fee-for-Service	1700803418	1700803418	1	22	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
141302	Fee-for-Service	1467709758	1467709758	1	1	DORSEY, ANN L MD	12/13/2022	207R00000X	NA	Other	026	PHYSICIANS	122368	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
141322	Fee-for-Service	1205876992	1205876992	1	1	DANIEL M FRUECHTE M.D.	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2419 MULLAN RD	None	MISSOULA	MT	59808	1856	00	None	46.881918	-114.0287355	Missoula County
141326	Fee-for-Service	1396803698	1396803698	1	1	DOYLE PARK FAMILY MED.	8/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
141327	Fee-for-Service	1700803418	1700803418	1	40	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
141345	Fee-for-Service	1174546568	1174546568	1	1	DANESHMAND, SIAMAK MD	12/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	63444	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
141351	Fee-for-Service	1912983792	1912983792	1	1	DR. GILBERTO AGUSTIN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SOUTHEASR TEXAS NEUROLOG	3780 MEMORIAL BLVD	None	PORT ARTHUR	TX	77640	0209	00	None	29.91303546	-93.9479166	Jefferson County
141364	Fee-for-Service	1235336181	1235336181	1	1	DEO, EKNATH A MD & ONC	10/27/1995	174400000X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	ASSOCIATES MED GRP INC	701 E 28TH STREET	STE 418	LONG BEACH	CA	90806	2661	19	06037	33.80803441	-118.1847137	Los Angeles County
141405	Fee-for-Service	1982667564	1982667564	1	1	DELA CRUZ, TEDDY V MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50232	40	Pediatrics	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
141426	Fee-for-Service	1699940494	1699940494	1	1	DANESHVAR, SAMUEL A MD	2/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98722	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
141445	Fee-for-Service	1023373297	1023373297	1	1	DO, PATRICK H MD	6/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127106	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
141472	Fee-for-Service	1669517868	1669517868	1	1	DHEW IND HTLH SV HLTH SV	11/6/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	COLORADO RIVER IHS PHMCY	12033 AGENCY RD	None	PARKER	AZ	85344	7718	00	None	34.14638102	-114.3057195	La Paz County
141476	Fee-for-Service	1720545122	1720545122	1	1	DOCTORS PREFERRED HOME	1/27/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	4415 COWELL RD	STE 141	CONCORD	CA	94518	1997	07	06013	37.95019584	-121.9966053	Contra Costa County
141477	Fee-for-Service	1386016764	1386016764	1	1	DIAZ-RODRIGUEZ, LILIANA LMF	12/8/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
141513	Fee-for-Service	1851456479	1851456479	1	1	DANIELS, KAY I MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	54099	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
141518	Fee-for-Service	1316050743	1316050743	1	1	DIMUNDO, REBECCA L MD	10/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81638	40	Pediatrics	0	In state provider	None	8787 HALL RD	None	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
141527	Fee-for-Service	1518705904	1518705904	1	1	DR MARVI V RIJHWANI	8/7/2024	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	13328 SAN PABLO AVE	None	SAN PABLO	CA	94806	3902	07	06013	37.95432429	-122.3341025	Contra Costa County
141528	Fee-for-Service	1033149711	1033149711	1	1	DEFOTO, JOSEPH T MD	10/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63218	41	Internal Medicine	0	In state provider	None	9201 W SUNSET BLVD	SUITE 812	WEST HOLLYWOOD	CA	90069	3709	19	06037	34.09054375	-118.392295	Los Angeles County
141535	Fee-for-Service	1184406381	1184406381	1	1	DEMIT, MEGAN	11/15/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
141553	Fee-for-Service	1700803418	1700803418	1	22	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
141583	Fee-for-Service	1336298280	1336298280	1	1	DEVELOPMENTAL CLIENT	6/10/2003	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INDUSTRIES INC	11751 DAVIS ST	None	MORENO VALLEY	CA	92557	6316	33	06065	33.95046828	-117.2396104	Riverside County
141611	Fee-for-Service	1700803418	1700803418	1	50	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	STE 215	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
141632	Fee-for-Service	1578630307	1578630307	1	1	DANG, THAO-TRANG MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67625	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
141650	Fee-for-Service	1235336181	1235336181	1	1	DEO, EKNATH A MD & ONC	10/27/1995	174400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	ASSOCIATES MED GRP INC	701 E 28TH STREET	STE 418	LONG BEACH	CA	90806	2661	19	06037	33.80803441	-118.1847137	Los Angeles County
141694	Fee-for-Service	1982667564	1982667564	1	1	DELA CRUZ, TEDDY V MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50232	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
141699	Fee-for-Service	1467983296	1467983296	1	1	DOLLBAUM, RYAN MD	11/16/2023	207P00000X	NA	Other	026	PHYSICIANS	158163	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
141711	Fee-for-Service	1881914646	1881914646	1	1	DURAIRAJ, K KAY AMC	3/18/2013	261QH0100X	NA	Other	026	PHYSICIANS	56015	None	None	0	In state provider	None	800 FAIRMOUNT AVE	STE 210	PASADENA	CA	91105	3152	19	06037	34.13193177	-118.1517805	Los Angeles County
141808	Fee-for-Service	1326196155	1326196155	1	1	DANDADE, DIPIKA P MD	1/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75353	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
141818	Fee-for-Service	1982762472	1982762472	1	1	DAVID, QUEENIE C NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1550 W MANCHESTER AVE	None	LOS ANGELES	CA	90047	5424	19	06037	33.95996247	-118.3043925	Los Angeles County
141821	Fee-for-Service	1063435493	1063435493	1	1	DOUDIKIAN-SCAFF, NAYIRI	8/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67181	24	Plastic Surgery	0	In state provider	MD INC	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
141841	Fee-for-Service	1700803418	1700803418	1	22	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
141887	Fee-for-Service	1568521219	1568521219	1	1	DEITER, PAUL D MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	10618	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
141900	Fee-for-Service	1700803418	1700803418	1	50	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	FOUNDATION	6555 COYLE AVENUE	STE 215	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
141906	Fee-for-Service	1134661218	1134661218	1	1	DUMALIGAN, PHILIP PT	2/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
141911	Fee-for-Service	1003451691	1003451691	1	1	DULCE HOGAR ADULT DAY HEALTH	9/14/2023	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	18040 SHERMAN WAY	SUITE 150	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
141914	Fee-for-Service	1770151003	1770151003	1	1	DOYLE, JACKSON S CSW	7/12/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
142035	Fee-for-Service	1316914294	1316914294	1	1	DO, KHA T OD	8/28/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2414 S FAIRVIEW ST	STE 103	SANTA ANA	CA	92704	5318	30	06059	33.71437705	-117.9079237	Orange County
142078	Fee-for-Service	1700803418	1700803418	1	20	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6660 COYLE AVE	STE 200	CARMICHAEL	CA	95608	6335	34	06067	38.667447	-121.3091505	Sacramento County
142090	Fee-for-Service	1740655935	1740655935	1	1	DR RONALD B MOSS INC	11/23/2015	261QH0100X	NA	Other	026	PHYSICIANS	79340	03	Allergy	0	In state provider	None	345 SAXONY RD	STE 105	ENCINITAS	CA	92024	2787	37	06073	33.05403165	-117.285548	San Diego County
142107	Fee-for-Service	1386221661	1386221661	1	1	DANIELS, JULIUS	8/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
142109	Fee-for-Service	1205068392	1205068392	1	1	DAYAN, JONATHAN G MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121321	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142112	Fee-for-Service	1063435493	1063435493	1	1	DOUDIKIAN-SCAFF, NAYIRI	8/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67181	66	Emergency Medicine (Urgent Care)	0	In state provider	MD INC	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
142127	Fee-for-Service	1770733446	1770733446	1	1	DE SOUZA, AIESKA MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137775	07	Dermatology	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
142170	Fee-for-Service	1073584413	1073584413	1	1	DAVIS, BOLIVIA MD	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89411	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
142188	Fee-for-Service	1093133340	1093133340	1	1	DAVENPORT, JILLIAN R MD	1/31/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140588	None	None	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
142191	Fee-for-Service	1700803418	1700803418	1	40	DIGNITY HEALTH MEDICAL FOUND	5/11/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
142216	Fee-for-Service	1669535134	1669535134	1	1	DEMERS, CARSON D	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
142307	Fee-for-Service	1134502131	1134502131	1	1	DESTINY JUDKINS	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
142308	Fee-for-Service	1497079735	1497079735	1	1	DANG, TIFFENY U OT	3/31/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
142328	Fee-for-Service	1497729958	1497729958	1	1	DAREN HAROLD HERSH, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8811 VILLAGE DR	None	SAN ANTONIO	TX	78217	5415	00	None	29.52050008	-98.42777396	Bexar County
142339	Fee-for-Service	1649203639	1649203639	1	1	DOUGHERTY, PAUL J MD INC	3/1/2024	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1821 DAILY DR	None	CAMARILLO	CA	93010	6201	56	06111	34.21782879	-119.0452962	Ventura County
142356	Fee-for-Service	1740679927	1740679927	1	1	DHANI, RUBINA LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
142367	Fee-for-Service	1700803418	1700803418	1	20	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6660 COYLE AVE	STE 200	CARMICHAEL	CA	95608	6335	34	06067	38.667447	-121.3091505	Sacramento County
142369	Fee-for-Service	1235400557	1235400557	1	1	DE LA CRUZ, MARIA LCSW	11/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
142388	Fee-for-Service	1811926223	1811926223	1	1	DEIDMAN, GRAIG S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 HILYARD ST	STE 450	EUGENE	OR	97401	8164	00	None	44.04616862	-123.082151	Lane County
142393	Fee-for-Service	1194112516	1194112516	1	1	DAUB, AARON C	8/12/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	173636	None	None	0	In state provider	None	1401 SPANOS CT	STE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
142399	Fee-for-Service	1205068392	1205068392	1	1	DAYAN, JONATHAN G MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121321	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
142406	Fee-for-Service	1871121418	1871121418	1	1	DACARETT GALEANO, DENNIS J M	6/6/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	187378	36	Psychiatry	0	In state provider	D	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
142440	Fee-for-Service	1841243755	1841243755	1	1	DIAB, MOHAMMAD MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86439	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
142478	Fee-for-Service	1700803418	1700803418	1	40	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
142527	Fee-for-Service	1407072382	1407072382	1	1	DOUDS, GREGORY L MD	3/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	14	Neurological Surgery	1	Border provider	None	3061 S MARYLAND PKWY	STE 200	LAS VEGAS	NV	89109	6227	00	None	36.134172	-115.1369265	Clark County
142533	Fee-for-Service	1336312172	1336312172	1	1	DESERT AIDS PROJECT	7/1/1990	251E00000X	NA	Other	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
142538	Fee-for-Service	1447270053	1447270053	1	1	DANIEL I CHOO, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
142614	Fee-for-Service	1316905839	1316905839	1	1	DEBACKER, CHRISTOPHER MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85368	18	Ophthalmology	0	In state provider	None	1237 B ST	None	HAYWARD	CA	94541	2915	01	06001	37.67566503	-122.0786821	Alameda County
142629	Fee-for-Service	1649203639	1649203639	1	1	DOUGHERTY, PAUL J MD INC	4/4/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1821 DAILY DR	None	CAMARILLO	CA	93010	6201	56	06111	34.21782879	-119.0452962	Ventura County
142639	Fee-for-Service	1922259423	1922259423	1	1	DANG, JARED DO	11/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16237	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
142653	Fee-for-Service	1700803418	1700803418	1	20	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6660 COYLE AVE	STE 200	CARMICHAEL	CA	95608	6335	34	06067	38.667447	-121.3091505	Sacramento County
142695	Fee-for-Service	1457649436	1457649436	1	1	DRIFTWOOD SANTA CRUZ	9/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OPERATING COMPANY LP	675 24TH AVENUE	None	SANTA CRUZ	CA	95062	4205	44	06087	36.96479042	-121.979556	Santa Cruz County
142711	Fee-for-Service	1477631224	1477631224	1	1	DU, LEE T MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73859	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
142730	Fee-for-Service	1104152628	1104152628	1	1	DAVIDSON, TOM B MD	11/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95340	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
142738	Fee-for-Service	1730700709	1730700709	1	1	DAVIS, SANDRA	6/4/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	976 PALMER CIR.	None	FOLSOM	CA	95630	9548	34	06067	38.658042	-121.1518395	Sacramento County
142742	Fee-for-Service	1790877173	1790877173	1	1	DEVANEY, ERIC J MD	4/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78188	33	Thoracic Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
142766	Fee-for-Service	1700803418	1700803418	1	50	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	STE 215	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
142814	Fee-for-Service	1437513751	1437513751	1	1	DOMINGUEZ, AARON J MD INC	9/6/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	91370	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	550 W CYPRESS AVE	None	REEDLEY	CA	93654	2096	10	06019	36.60787518	-119.4523704	Fresno County
142821	Fee-for-Service	1609308089	1609308089	1	1	DIAZ, MARIA M MD	6/16/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	161658	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
142842	Fee-for-Service	1295175099	1295175099	1	1	DIXON, TASHA M	1/16/2020	390200000X	NA	Other	086	MEDICAL DIRECTORS	133443	-	NOT APPLICABLE	0	In state provider	None	1670 E 120TH ST	STE 1003, 1E04, 2E07, 21	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
142856	Fee-for-Service	1942571211	1942571211	1	1	DR MARIA M KING INC	9/14/2011	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	8649	40	Pediatrics	0	In state provider	None	437 OLD MAMMOTH RD	STE B3	MAMMOTH LAKES	CA	93546	9407	26	06051	37.63987829	-118.9665964	Mono County
142860	Fee-for-Service	1437339637	1437339637	1	1	DESAI, ANGELA RN	4/18/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6120 VINELAND AVE	None	NORTH HOLLYWOOD	CA	91606	4914	19	06037	34.1819583	-118.3702737	Los Angeles County
142889	Fee-for-Service	1376699041	1376699041	1	1	DENES, ALEXANDER E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	96146	20	Orthopedic Surgery	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.64575895	-118.9638914	Mono County
142895	Fee-for-Service	1467487926	1467487926	1	1	DAVIDSON, JOSEPH K MD	1/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86649	18	Ophthalmology	0	In state provider	None	301 N LAKE AVE	STE 110	PASADENA	CA	91101	5125	19	06037	34.15083203	-118.1324046	Los Angeles County
142914	Fee-for-Service	1841433547	1841433547	1	1	DINI, ARASH A MD	1/29/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	127823	20	Orthopedic Surgery	0	In state provider	None	4415 W PICO BLVD	None	LOS ANGELES	CA	90019	4242	19	06037	34.04825454	-118.3312406	Los Angeles County
142926	Fee-for-Service	1396703617	1396703617	1	1	DICKER, ROCHELLE A MD	10/24/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76850	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
142930	Fee-for-Service	1558143438	1558143438	1	1	DURAN, AMANDA B LMFT	10/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE	130	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
142939	Fee-for-Service	1790385219	1790385219	1	1	DUARTE-CHAIREZ, CLAUDIA I LC	3/3/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
142997	Fee-for-Service	1417175787	1417175787	1	1	DACARE, INC	10/1/1998	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	DAYOUT ADHC	757 MAIN ST	None	EL CENTRO	CA	92243	0000	13	06025	32.79280448	-115.560297	Imperial County
143003	Fee-for-Service	1164649992	1164649992	1	1	DUCLOS-ROBINSON, ALISA	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PHD	614 FIFTH AVE	STE A	SAN DIEGO	CA	92101	6964	37	06073	32.71204632	-117.1601718	San Diego County
143018	Fee-for-Service	1710432802	1710432802	1	1	DINH, HOAITRAM N NP	10/23/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
143027	Fee-for-Service	1427497833	1427497833	1	1	DO, LAN H MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138460	01	General Practice	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
143028	Fee-for-Service	1730700709	1730700709	1	1	DAVIS, SANDRA	6/4/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	976 PALMER CIR.	None	FOLSOM	CA	95630	9548	34	06067	38.658042	-121.1518395	Sacramento County
143030	Fee-for-Service	1790877173	1790877173	1	1	DEVANEY, ERIC J MD	4/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78188	02	General Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
143050	Fee-for-Service	1588893770	1588893770	1	1	DORSAY, ADAM A PHD	2/21/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
143054	Fee-for-Service	1700803418	1700803418	1	50	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	6555 COYLE AVENUE	STE 215	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
143064	Fee-for-Service	1013519685	1013519685	1	1	DAUGHERTY, ALISON MD	9/9/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2305 CAMINO RAMON	STE 100	SAN RAMON	CA	94583	1316	07	06013	37.77544224	-121.9657563	Contra Costa County
143066	Fee-for-Service	1477656049	1477656049	1	1	DWABE, KEFAH T MD	3/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94193	01	General Practice	0	In state provider	UNIVERSAL CARE MEDICAL C	4863 EL CAJON BLVD	UNIT A	SAN DIEGO	CA	92115	4636	37	06073	32.75637025	-117.0897188	San Diego County
143079	Fee-for-Service	1912064619	1912064619	1	1	DOMINGUEZ, GLORIA NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
143087	Fee-for-Service	1912376823	1912376823	1	1	DROZD, AMANDA J LCSW	5/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
143090	Fee-for-Service	1437215597	1437215597	1	1	DECKER, LAWRENCE C MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152158	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
143138	Fee-for-Service	1790216406	1790216406	1	1	DOWNS, IAN A MD	5/16/2023	207R00000X	NA	Other	026	PHYSICIANS	171659	None	None	0	In state provider	None	2020 SANTA MONICA BLVD	550	SANTA MONICA	CA	90404	2000	19	06037	34.02901811	-118.4795396	Los Angeles County
143188	Fee-for-Service	1356386510	1356386510	1	1	DUGGAL, POONAM MD	9/22/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54342	08	Family Practice	0	In state provider	None	2522 GRAND CANAL BLVD	STE 8	STOCKTON	CA	95207	9521	39	06077	37.98353982	-121.3388944	San Joaquin County
143209	Fee-for-Service	1649616483	1649616483	1	1	DABABNEH, LUMA M MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142992	01	General Practice	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
143211	Fee-for-Service	1346457009	1346457009	1	1	DE LA TORRE, DENA M CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3401 SOUTH HARBOR BLVD	None	SANTA ANA	CA	92704	7933	30	06059	33.701166	-117.9194305	Orange County
143213	Fee-for-Service	1396703617	1396703617	1	1	DICKER, ROCHELLE A MD	10/24/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76850	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143223	Fee-for-Service	1457409401	1457409401	1	1	DEFRAWY, MOSEN M MD	9/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	60701	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
143270	Fee-for-Service	1548332380	1548332380	1	1	DUNN, ALISHA O MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40268	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
143297	Fee-for-Service	1700803418	1700803418	1	44	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
143298	Fee-for-Service	1235576653	1235576653	1	1	DANG, PHAT T MD	6/4/2020	207L00000X	NA	Other	026	PHYSICIANS	155339	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
143344	Fee-for-Service	1043693401	1043693401	1	1	DATSYUK, TETYANA	6/2/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9113 IRISH GOLD WAY	None	SACRAMENTO	CA	95826	5073	34	06067	38.539134	-121.3621695	Sacramento County
143351	Fee-for-Service	1467409664	1467409664	1	2	DE LA RIVA, JUAN C MD	10/11/2016	207L00000X	NA	Other	026	PHYSICIANS	58822	05	Anesthesiology	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
143357	Fee-for-Service	1790748549	1790748549	1	1	DEVRIES, DONALD F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1011 E MAIN AVE	STE 302	PUYALLUP	WA	98372	6775	00	None	47.1919083	-122.2808243	Pierce County
143406	Fee-for-Service	1437912607	1437912607	1	1	DE LA CRUZ, MACKENZIE L CD	4/26/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
143409	Fee-for-Service	1154533255	1154533255	1	1	DUONG, JAMES H. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
143459	Fee-for-Service	1912288432	1912288432	1	1	DIGNITY HEALTH MEDICAL FOUND	8/7/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2528 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14932543	-122.2191932	Tehama County
143476	Fee-for-Service	1356386510	1356386510	1	1	DUGGAL, POONAM MD	9/22/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2522 GRAND CANAL BLVD	STE 8	STOCKTON	CA	95207	9521	39	06077	37.98353982	-121.3388944	San Joaquin County
143504	Fee-for-Service	1174667158	1174667158	1	3	DIGNITY HEALTH	1/17/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2235 HAYES ST	5TH FLOOR	SAN FRANCISCO	CA	94117	1012	38	06075	37.77302045	-122.4529717	San Francisco County
143512	Fee-for-Service	1013931179	1013931179	1	3	DELGADO, JOSE D MD	3/10/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	43559	-	NOT APPLICABLE	0	In state provider	None	5723 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4222	19	06037	34.01838548	-118.1475832	Los Angeles County
143546	Fee-for-Service	1013927425	1013927425	1	1	DANQUE, FLORA I MD	2/28/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62874	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
143559	Fee-for-Service	1548332380	1548332380	1	1	DUNN, ALISHA O MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40268	36	Psychiatry	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
143566	Fee-for-Service	1003853722	1003853722	1	1	DIMAFELIX, CRISANTO MD	10/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
143587	Fee-for-Service	1700803418	1700803418	1	24	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
143595	Fee-for-Service	1366917361	1366917361	1	2	DAVID TAFTIAN DO, INC	10/5/2023	208100000X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	18040 SHERMAN WAY	SUITE 304	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
143617	Fee-for-Service	1013085810	1013085810	2	1	DENNISH, ANDREW MD	11/9/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	99253	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	295 POSADA LN	STE A	TEMPLETON	CA	93465	4055	40	06079	35.55315971	-120.7214435	San Luis Obispo County
143631	Fee-for-Service	1043693401	1043693401	1	1	DATSYUK, TETYANA	6/2/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9113 IRISH GOLD WAY	None	SACRAMENTO	CA	95826	5073	34	06067	38.539134	-121.3621695	Sacramento County
143640	Fee-for-Service	1316993231	1316993231	1	1	DEBOER, LARESA G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 S MAPLE ST	None	WACONIA	MN	55387	1752	00	None	44.843139	-93.79078701	Carver County
143735	Fee-for-Service	1639425655	1639425655	1	1	DU, YEN K LMFT	5/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
143754	Fee-for-Service	1821181470	1821181470	1	1	DRURY, ELLEN CNM	2/8/2015	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3800 JANES ROAD	SUITE 101	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
143759	Fee-for-Service	1740677756	1740677756	1	1	DEL CID, MARGARETH V PHD	2/4/2021	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 7M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
143763	Fee-for-Service	1699721472	1699721472	1	1	DAVIDSON, JEFFREY A MD	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
143793	Fee-for-Service	1811192164	1811192164	1	1	DR. SAMMY RAZIK	11/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3623 LATROBE DR	STE 216	CHARLOTTE	NC	28211	2117	00	None	35.196597	-80.7973065	Mecklenburg County
143794	Fee-for-Service	1740352699	1740352699	1	1	DEWAN, ASHEESH K MD	9/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74356	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
143799	Fee-for-Service	1417287509	1417287509	1	1	DEWAN, KARUNA MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135541	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	200 MEDICAL PLAZA	STE 550	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
143801	Fee-for-Service	1356331730	1356331730	1	2	DUNCHOK, RONNIE MD	1/4/2018	207R00000X	NA	Other	026	PHYSICIANS	42469	41	Internal Medicine	0	In state provider	None	1334 WEST COVINA BLVD	SUITE 204	SAN DIMAS	CA	91773	3211	19	06037	34.097067	-117.833751	Los Angeles County
143803	Fee-for-Service	1932630860	1932630860	1	1	DANG, THAO T MD	10/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147163	40	Pediatrics	0	In state provider	None	589 LOS COCHES	None	MILPITAS	CA	95035	5423	43	06085	37.43176807	-121.8935163	Santa Clara County
143809	Fee-for-Service	1023267499	1023267499	1	1	DRIVON, MELISSA E LMFT	4/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	193 BLUE RAVINE RD	SUITE #220	FOLSOM	CA	95630	4756	34	06067	38.653461	-121.17996	Sacramento County
143821	Fee-for-Service	1821020017	1821020017	1	1	DEMARCO, ROLAND D MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	56076	30	Radiology	0	In state provider	None	2110 PROFESSIONAL DR	STE 100	ROSEVILLE	CA	95661	3752	31	06061	38.74234873	-121.2521259	Placer County
143874	Fee-for-Service	1700803418	1700803418	1	24	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
143888	Fee-for-Service	1891869491	1891869491	1	1	DASILVA, THOMAS B DPM	9/30/1990	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
143892	Fee-for-Service	1518428598	1518428598	1	1	DIMAANO, KATRINA	9/6/2022	208600000X	NA	General Surgery	026	PHYSICIANS	177478	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
143988	Fee-for-Service	1629069935	1629069935	1	1	DEWRI, RAYMOND A MD	4/1/1999	207P00000X	NA	Other	026	PHYSICIANS	68716	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
143992	Fee-for-Service	1174667158	1174667158	1	4	DIGNITY HEALTH	1/17/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1 SHRADER ST	STE 450	SAN FRANCISCO	CA	94117	1022	38	06075	37.77467326	-122.4529451	San Francisco County
144039	Fee-for-Service	1861889065	1861889065	1	1	DIXON, WILLIAM W MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
144083	Fee-for-Service	1740352699	1740352699	1	1	DEWAN, ASHEESH K MD	9/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74356	67	Endocrinology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
144092	Fee-for-Service	1225059223	1225059223	1	1	DOMZALSKI, FRANCIS MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85909	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
144116	Fee-for-Service	1033312202	1033312202	1	1	DAO, HAI N MD	6/20/2008	207R00000X	NA	Other	026	PHYSICIANS	97539	41	Internal Medicine	0	In state provider	None	1700 NORTH WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5105	36	06071	34.130214	-117.2788065	San Bernardino County
144125	Fee-for-Service	1780907329	1780907329	1	1	DUA, MONICA M MD	7/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97541	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
144140	Fee-for-Service	1508640335	1508640335	1	1	DANA YOUNG THERAPY INC	4/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	520 PLAZA DR	130	FOLSOM	CA	95630	4791	34	06067	38.65707	-121.1733585	Sacramento County
144141	Fee-for-Service	1609290212	1609290212	1	1	DUNGAN, KATHRYN J	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
144160	Fee-for-Service	1700803418	1700803418	1	44	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
144168	Fee-for-Service	1518117795	1518117795	1	1	DAOUD, NASIM S MD	10/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115840	41	Internal Medicine	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
144182	Fee-for-Service	1518705904	1518705904	1	2	DR MARVI V RIJHWANI	8/7/2024	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1628 B ST	None	HAYWARD	CA	94541	3020	01	06001	37.6795481	-122.0717846	Alameda County
144229	Fee-for-Service	1255927034	1255927034	1	1	DSOUZA, DANIELLE REGINA	1/14/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	40171 PASADENA DRIVE	None	TEMECULA	CA	92591	7501	33	06065	33.53791438	-117.1594092	Riverside County
144242	Fee-for-Service	1043262074	1043262074	1	1	DE JUAN, EUGENE JR MD	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86176	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
144264	Fee-for-Service	1477610640	1477610640	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
144359	Fee-for-Service	1235690330	1235690330	1	1	DONG, SIWEI DO	10/14/2024	390200000X	NA	Other	026	PHYSICIANS	22413	02	General Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
144388	Fee-for-Service	1093246076	1093246076	1	1	DERMARKARIAN, CHRISTOPHER R	5/17/2021	390200000X	NA	Other	026	PHYSICIANS	171440	None	None	0	In state provider	MD	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
144391	Fee-for-Service	1861406225	1861406225	1	1	DAO, VIET T MD	12/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96409	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
144417	Fee-for-Service	1750735908	1750735908	1	1	DIETRICH, CATHERINE A MD	6/18/2021	207LP3000X	NA	Other	026	PHYSICIANS	167391	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
144445	Fee-for-Service	1700803418	1700803418	1	68	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
144448	Fee-for-Service	1700803418	1700803418	1	24	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
144516	Fee-for-Service	1255927034	1255927034	1	1	DSOUZA, DANIELLE REGINA	1/14/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	40171 PASADENA DRIVE	None	TEMECULA	CA	92591	7501	33	06065	33.53791438	-117.1594092	Riverside County
144551	Fee-for-Service	1477610640	1477610640	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
144557	Fee-for-Service	1093712119	1093712119	1	1	DAO, HUU-NINH MD	1/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85089	30	Radiology	0	In state provider	None	2801 K ST	STE 115	SACRAMENTO	CA	95816	5118	34	06067	38.572947	-121.46904	Sacramento County
144578	Fee-for-Service	1396703328	1396703328	1	1	DHARMAVARAM, SREENIVASA R MD	8/27/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
144587	Fee-for-Service	1063737195	1063737195	1	1	DISQUE, ANDREW A MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120097	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
144660	Fee-for-Service	1891212270	1891212270	1	1	DOVER HOME HEALTH CARE INC	11/3/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	167 N 3RD AVE	SUITE C	UPLAND	CA	91786	6052	36	06071	34.095618	-117.647108	San Bernardino County
144690	Fee-for-Service	1588807606	1588807606	1	1	DEHOFF, GEORGE W MD	11/12/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
144696	Fee-for-Service	1700803418	1700803418	1	1	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
144700	Fee-for-Service	1548555394	1548555394	1	1	DOSHI, RACHIT R MD	6/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122750	01	General Practice	0	In state provider	None	722 BAKER STREET	None	COSTA MESA	CA	92626	4320	30	06059	33.68016047	-117.886563	Orange County
144703	Fee-for-Service	1801233804	1801233804	1	1	DARMAN, MOHAMMAD	4/9/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	570 BLOSSOM HILL RD	None	SAN JOSE	CA	95123	3212	43	06085	37.25054647	-121.840839	Santa Clara County
144715	Fee-for-Service	1891092086	1891092086	1	1	DEWAN, CHANCHAL MD FAAP INC	12/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	40120	40	Pediatrics	0	In state provider	None	2250 W WHITTIER BLVD	STE 100	LA HABRA	CA	90631	3470	30	06059	33.93979053	-117.971073	Orange County
144732	Fee-for-Service	1700803418	1700803418	1	68	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
144736	Fee-for-Service	1669456075	1669456075	1	1	DISKIN, FAYE L	11/24/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1610 ARDEN WAY	SUITE 195	SACRAMENTO	CA	95815	4035	34	06067	38.598597	-121.42863	Sacramento County
144740	Fee-for-Service	1700803418	1700803418	1	24	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
144820	Fee-for-Service	1922263466	1922263466	1	1	DAWOOD, FARAH Z MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143088	01	General Practice	0	In state provider	None	9834 GENESEE AVENUE	SUITE 101	LA JOLLA	CA	92037	1214	37	06073	32.884074	-117.225855	San Diego County
144825	Fee-for-Service	1770638124	1770638124	1	1	DEAN E ROLLER	12/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
144839	Fee-for-Service	1477610640	1477610640	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
144853	Fee-for-Service	1568780948	1568780948	1	1	DING, ANTHONY S MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119761	20	Orthopedic Surgery	0	In state provider	None	1600 ESPLANADE	STE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
144873	Fee-for-Service	1598748923	1598748923	1	1	DRUMMOND LEWIS, JACQUELI	8/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96586	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
144900	Fee-for-Service	1922176858	1922176858	1	1	DE GUZMAN-FOX, MARILOU A	1/30/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
144909	Fee-for-Service	1134513187	1134513187	1	1	DATTA, TATINI MD	8/30/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	144990	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
144914	Fee-for-Service	1487029435	1487029435	1	1	DE JESUS, ANA M LCSW	5/25/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3478 BUSKIRK AVE	SUITE 1000	PLEASANT HILL	CA	94523	4344	07	06013	37.93963113	-122.0591644	Contra Costa County
144939	Fee-for-Service	1306058987	1306058987	1	1	DAUDERMAN, CRAIG LMFT	9/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
144983	Fee-for-Service	1700803418	1700803418	1	1	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	FOUNDATION	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
144989	Fee-for-Service	1851962062	1851962062	1	1	DELAPAZ, ARLENE M NP	7/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	80495 US HIGHWAY 111	None	INDIO	CA	92201	6534	33	06065	33.70724448	-116.260686	Riverside County
145022	Fee-for-Service	1700803418	1700803418	1	68	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
145024	Fee-for-Service	1700803418	1700803418	1	44	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
145052	Fee-for-Service	1922116482	1922116482	1	1	DAVILA, JOSE MD	4/30/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41066	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
145072	Fee-for-Service	1922205202	1922205202	1	1	DASTGHEIB, KOROSH A MD INC	8/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	85637	18	Ophthalmology	0	In state provider	None	26671 ALISO CREEK RD	STE 205	ALISO VIEJO	CA	92656	4810	30	06059	33.576831	-117.7255935	Orange County
145075	Fee-for-Service	1174086144	1174086144	1	1	DIGESTIVE AND HEALTH CENTER	4/26/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	OF ORANGE COUNTY INC.	10900 WARNER AVE	STE 201	FOUNTAIN VALLEY	CA	92708	3846	30	06059	33.71628153	-117.9388215	Orange County
145110	Fee-for-Service	1326126491	1326126491	1	1	DENG, CALVIN H MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83695	41	Internal Medicine	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
145118	Fee-for-Service	1902465404	1902465404	1	1	DIMBIL, SADIA J MD	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	180849	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
145144	Fee-for-Service	1801113535	1801113535	1	1	DEROIAN, LIANA Y LMFT	5/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	104 W 4TH ST	None	SAN BERNARDINO	CA	92415	0035	36	06071	34.1064933	-117.285246	San Bernardino County
145162	Fee-for-Service	1326106501	1326106501	1	2	DON M ENDRESS, MD	8/1/1998	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	53357	01	General Practice	0	In state provider	None	3191 EL PRADO RD	# D	LA GRANGE	CA	95329	9761	55	06109	37.682568	-120.326651	Tuolumne County
145222	Fee-for-Service	1700803418	1700803418	1	11	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
145237	Fee-for-Service	1841264678	1841264678	1	1	DR. ERIC MILLMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 PENN AVE	None	PITTSBURGH	PA	15224	1334	00	None	40.46605162	-79.9530831	Allegheny County
145265	Fee-for-Service	1356421499	1356421499	1	1	DRAKE, MICHAEL V MD	6/1/1980	207W00000X	NA	Ophthalmology	026	PHYSICIANS	33224	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	# A733	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
145271	Fee-for-Service	1700803418	1700803418	1	1	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	FOUNDATION	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
145272	Fee-for-Service	1255312294	1255312294	1	1	DWYER, TIMOTHY W MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53442	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
145274	Fee-for-Service	1104271659	1104271659	1	1	DHILLON, MANDEEP OD	2/12/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
145275	Fee-for-Service	1225430937	1225430937	1	1	DAS, ANKUR K MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148194	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
145286	Fee-for-Service	1558360479	1558360479	3	1	DEVLIN, PATRICK G MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	56533	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK DR	SUITE G05	SANTA ROSA	CA	95405	4555	49	06097	38.44332	-122.6985255	Sonoma County
145308	Fee-for-Service	1700803418	1700803418	1	68	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
145312	Fee-for-Service	1700803418	1700803418	1	24	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	550 W RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
145343	Fee-for-Service	1447506142	1447506142	1	1	DIABETES AND ENDOCRINOLOGY	10/29/2013	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	67	Endocrinology	0	In state provider	SPECIALISTS INC	2182 EAST STREET	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
145351	Fee-for-Service	1508922006	1508922006	1	1	DEL POZO, JESSICA M PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2120 PROFESSIONAL DRIVE	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
145358	Fee-for-Service	1104896083	1104896083	1	1	DOSADO, JOSE MARIUS D MD	9/6/2017	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	150862	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITE 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
145377	Fee-for-Service	1912270216	1912270216	1	1	DUKHOVNY, DIANA L NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
145418	Fee-for-Service	1588660849	1588660849	1	1	DERKUM, SCOTT A MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54344	41	Internal Medicine	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
145441	Fee-for-Service	1053463232	1053463232	1	1	DINH, MICHAEL Q MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80594	05	Anesthesiology	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
145465	Fee-for-Service	1760048300	1760048300	1	1	DANIELLE THOMAS MD INC	12/18/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2936 DE LA VINA ST	None	SANTA BARBARA	CA	93105	3354	42	06083	34.4383104	-119.7278207	Santa Barbara County
145512	Fee-for-Service	1700803418	1700803418	1	11	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
145521	Fee-for-Service	1144296393	1144296393	1	1	DANIEL,RONALD	6/15/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	4922	00	None	40.700349	-73.9416015	Kings County
145558	Fee-for-Service	1700803418	1700803418	1	1	DIGNITY HEALTH MEDICAL FOUND	3/2/2018	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
145573	Fee-for-Service	1558360479	1558360479	3	1	DEVLIN, PATRICK G MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	56533	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 DOYLE PARK DR	SUITE G05	SANTA ROSA	CA	95405	4555	49	06097	38.44332	-122.6985255	Sonoma County
145599	Fee-for-Service	1700803418	1700803418	1	68	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
145602	Fee-for-Service	1700803418	1700803418	1	44	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
145626	Fee-for-Service	1093130981	1093130981	1	1	DAN Q VU MD INC	10/1/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	2315 E ANAHEIM ST	None	LONG BEACH	CA	90804	3501	19	06037	33.78263692	-118.1640686	Los Angeles County
145631	Fee-for-Service	1447506142	1447506142	1	1	DIABETES AND ENDOCRINOLOGY	10/29/2013	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	SPECIALISTS INC	2182 EAST STREET	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
145649	Fee-for-Service	1083971881	1083971881	1	6	DIGNITY HEALTH MEDICAL FOUND	2/17/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3838 SAN DIMAS STREET	STE A200	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
145651	Fee-for-Service	1316300510	1316300510	1	1	DELISSER, RENIK MD	8/17/2021	207L00000X	NA	Other	026	PHYSICIANS	169950	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
145784	Fee-for-Service	1184638058	1184638058	1	1	DANDAMUDI, NAGAMANI MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50946	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
145798	Fee-for-Service	1700803418	1700803418	1	11	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
145807	Fee-for-Service	1114098878	1114098878	1	1	DANSKY, TANYA MD	12/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61481	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 213	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
145823	Fee-for-Service	1588601207	1588601207	1	1	DRAOUA,JAY	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH STREET	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
145830	Fee-for-Service	1487065215	1487065215	1	1	DUTT, SHELLY MD	6/14/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	142460	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
145860	Fee-for-Service	1700803418	1700803418	1	1	DIGNITY HEALTH MEDICAL FOUND	3/1/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
145886	Fee-for-Service	1700803418	1700803418	1	68	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 1	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
145887	Fee-for-Service	1700803418	1700803418	1	44	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
145898	Fee-for-Service	1104074483	1104074483	1	1	DANIEL WILLIAMS MD	12/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 BURDICK EXPY W	None	MINOT	ND	58701	4406	00	None	48.2325845	-101.2938165	Ward County
145927	Fee-for-Service	1730307851	1730307851	1	1	DIHN, HOWARD H MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84322	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
145973	Fee-for-Service	1891819090	1891819090	1	1	DE LEON, BALDOMERO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	35749	41	Internal Medicine	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
146003	Fee-for-Service	1487763009	1487763009	1	1	DABO, TARAM M MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78607	08	Family Practice	0	In state provider	None	1919 GRAND AVE	STE 1E	SAN DIEGO	CA	92109	4578	37	06073	32.79914761	-117.2340878	San Diego County
146012	Fee-for-Service	1851939979	1851939979	1	1	DIMPUDUS, DELISA A CNP	7/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1325 E. COOLEY DR	SUITE 101	COLTON	CA	92324	3947	36	06071	34.05468148	-117.306261	San Bernardino County
146017	Fee-for-Service	1861712739	1861712739	1	1	DEITCHMAN, JASON K, MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118590	08	Family Practice	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146019	Fee-for-Service	1245541291	1245541291	1	1	DR BRAR INC	9/29/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	67489	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	481 PLUMAS BLVD	STE 201	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
146043	Fee-for-Service	1427181007	1427181007	1	4	DIGNITY HEALTH	9/18/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	111 MADRONE ST	None	SANTA CRUZ	CA	95060	2714	44	06087	36.98278208	-122.0304092	Santa Cruz County
146044	Fee-for-Service	1255382065	1255382065	1	1	DORFMAN, LESLIE J MD	1/1/1982	2084N0400X	NA	Neurology	026	PHYSICIANS	18144	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
146058	Fee-for-Service	1780239996	1780239996	1	1	DCCV INC	2/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9448 KIWI CIRCLE	None	FOUNTAIN VALLEY	CA	92708	5748	30	06059	33.69494013	-117.963804	Orange County
146088	Fee-for-Service	1700803418	1700803418	1	11	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
146104	Fee-for-Service	1720419757	1720419757	1	1	DESIGN FOR CHANGE	8/22/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1066 E AVENUE J	None	LANCASTER	CA	93535	3870	19	06037	34.68927415	-118.1100041	Los Angeles County
146136	Fee-for-Service	1700803418	1700803418	1	1	DIGNITY HEALTH MEDICAL FOUND	11/14/1991	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146189	Fee-for-Service	1992980106	1992980106	1	1	DONNELLY, THERESE M NP	2/17/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8001 VENTURA CANYON AVE	None	PANORAMA CITY	CA	91402	6312	19	06037	34.21619623	-118.4287605	Los Angeles County
146192	Fee-for-Service	1821190356	1821190356	1	1	DOWNS, DENNIS R MD	12/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36905	01	General Practice	0	In state provider	None	200 N HARBOR BLVD	STE 100	ANAHEIM	CA	92805	2511	30	06059	33.83572835	-117.9199135	Orange County
146204	Fee-for-Service	1841378601	1841378601	1	1	DHILLON, INDER MD	12/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44190	07	Dermatology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
146214	Fee-for-Service	1730307851	1730307851	1	1	DIHN, HOWARD H MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84322	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
146259	Fee-for-Service	1306166681	1306166681	1	1	DIVANJI, DIANA S MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136471	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
146269	Fee-for-Service	1174647507	1174647507	1	1	DAVIS, KARA L DO	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10098	68	Hematology	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
146279	Fee-for-Service	1376721316	1376721316	1	1	DR.WILLIAM GALLIMORE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NAZ HOSPITAL	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	0000	00	None	34.558992	-112.481901	Yavapai County
146312	Fee-for-Service	1548463250	1548463250	1	1	DELLAMAGGIORA, RYAN MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100387	20	Orthopedic Surgery	0	In state provider	None	8536 W 3RD STREET	None	LOS ANGELES	CA	90048	6101	19	06037	34.07350062	-118.3780926	Los Angeles County
146376	Fee-for-Service	1700803418	1700803418	1	11	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4400 DUCKHORN DR	STE 100	SACRAMENTO	CA	95834	2589	34	06067	38.65086	-121.531833	Sacramento County
146381	Fee-for-Service	1174777643	1174777643	1	1	DOLEZAL, MILANA V MD	11/20/2008	174400000X	NA	Other	026	PHYSICIANS	74043	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MIC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
146392	Fee-for-Service	1083764856	1083764856	1	1	DRUCKER, BRYAN J MD	5/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77403	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
146468	Fee-for-Service	1235213208	1235213208	1	1	DANS, MICHAEL J MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89288	07	Dermatology	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
146520	Fee-for-Service	1700099223	1700099223	1	1	DENG, JOSEPH Y MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94888	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92359	2808	36	06071	34.049547	-117.264078	San Bernardino County
146531	Fee-for-Service	1396372090	1396372090	1	1	DING, YANG MD	1/31/2024	207P00000X	NA	Other	026	PHYSICIANS	188591	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
146556	Fee-for-Service	1174647507	1174647507	1	1	DAVIS, KARA L DO	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10098	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
146563	Fee-for-Service	1427125434	1427125434	1	1	DIEGO, ANNIE M T MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	79702	05	Anesthesiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
146597	Fee-for-Service	1285624502	1285624502	1	1	DALEY, PATRICK D MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	34597	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
146611	Fee-for-Service	1578799193	1578799193	1	2	DELDAR, SALAR MD	1/28/2020	2081P2900X	NA	Physical Medicine and Rehabilitation	086	MEDICAL DIRECTORS	113516	-	NOT APPLICABLE	0	In state provider	None	637 BROADWAY ST	None	KING CITY	CA	93930	3231	27	06053	36.20997663	-121.1314821	Monterey County
146617	Fee-for-Service	1568799500	1568799500	1	1	DIGNITY HEALTH	7/13/2010	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	912 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31783091	-122.3215427	Siskiyou County
146640	Fee-for-Service	1649816174	1649816174	1	1	DELANO MEDICAL GROUP, INC.	10/1/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1230 JEFFERSON ST	None	DELANO	CA	93215	2204	15	06029	35.77274103	-119.2450573	Kern County
146664	Fee-for-Service	1700803418	1700803418	1	46	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146672	Fee-for-Service	1295783751	1295783751	1	1	DR YOLANDA BOGAERT	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6440	00	None	39.72047057	-104.8985959	Denver County
146722	Fee-for-Service	1508049388	1508049388	1	1	DAS, SAMRAT MD	7/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
146742	Fee-for-Service	1669638193	1669638193	1	1	DE LEON, MARRIANNE L NP	8/18/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	121 S GLENOAKS BLVD	SUITE 3	BURBANK	CA	91502	1315	19	06037	34.18291031	-118.3058877	Los Angeles County
146790	Fee-for-Service	1932298957	1932298957	1	1	DOREEN L TEOH, MD	2/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORTH WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
146804	Fee-for-Service	1912205816	1912205816	1	1	DR SHAMEEM KHAN OPTOMETRIST	2/7/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	13768 ROSWELL AVE	STE 208	CHINO	CA	91710	1414	36	06071	34.0038	-117.7218555	San Bernardino County
146823	Fee-for-Service	1952867277	1952867277	1	1	DIGNITY ADULT DAY HEALTH	8/12/2019	251S00000X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	4110 HOLT BLVD	None	MONTCLAIR	CA	91763	4515	36	06071	34.06329646	-117.715428	San Bernardino County
146848	Fee-for-Service	1013737378	1013737378	1	1	DOULAS OF AMERICA INTERNATIO	3/24/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
146871	Fee-for-Service	1386884237	1386884237	1	1	DALMIA, LOPA DPM	5/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7551 MADISON AVENUE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
146873	Fee-for-Service	1477610640	1477610640	2	2	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	222 W EULALIA ST	STE 211	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
146888	Fee-for-Service	1255708251	1255708251	1	1	DOSS, RENEE	9/1/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 E SECOND ST	STE 2	POMONA	CA	91766	2020	19	06037	34.05845654	-117.7423951	Los Angeles County
146902	Fee-for-Service	1215015508	1215015508	1	1	DENNIS, TSHEKEDI G MD	8/17/2010	2084P0800X	NA	Psychiatry	026	PHYSICIANS	96369	None	None	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
146907	Fee-for-Service	1568799500	1568799500	1	1	DIGNITY HEALTH	1/28/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	912 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31783091	-122.3215427	Siskiyou County
146921	Fee-for-Service	1427048016	1427048016	1	1	D'ATTELLIS, NICOLA P MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51674	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
146956	Fee-for-Service	1710199112	1710199112	1	1	DI LORENZO, ROSA PHD	2/21/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
146957	Fee-for-Service	1700803418	1700803418	1	46	DIGNITY HEALTH MEDICAL FOUND	11/14/1991	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
146985	Fee-for-Service	1154577328	1154577328	1	1	DALY, SHAUN C MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141954	02	General Surgery	0	In state provider	None	101 THE CITY DRIVE SOUTH	STE B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
146994	Fee-for-Service	1174707335	1174707335	1	1	DELACRUZ, BRENDA LCSW	11/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
147022	Fee-for-Service	1124292891	1124292891	1	1	DENNIS, DEBBIE A MD	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	69461	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1201 JEFFERSON ST	None	DELANO	CA	93215	2203	15	06029	35.77204969	-119.2449995	Kern County
147047	Fee-for-Service	1902561491	1902561491	1	1	DE LA ROSA FAMILY VISION, PC	7/18/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	TER	105 1/2 S VERMONT AVE	None	LOS ANGELES	CA	90004	5904	19	06037	34.0723767	-118.2917492	Los Angeles County
147079	Fee-for-Service	1952748501	1952748501	1	1	DE LA PENA EYE CLINIC, A MED	8/12/2013	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 VAN NUYS BLVD	STE 120	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
147112	Fee-for-Service	1669675781	1669675781	1	1	DESILVA, FALAYA LMFT	10/19/2021	225XM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	410 FLORENCE	None	INGLEWOOD	CA	90301	1300	19	06037	33.96553848	-118.3622585	Los Angeles County
147143	Fee-for-Service	1609843564	1609843564	1	1	DIMEN, LUIS L MD	3/31/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	76052	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10 CONGRESS STREET	SUITE 208	PASADENA	CA	91105	3207	19	06037	34.13396893	-118.1528162	Los Angeles County
147185	Fee-for-Service	1558463943	1558463943	1	1	DEL ROSARIO, SALVADOR MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74867	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
147188	Fee-for-Service	1053643171	1053643171	1	2	DR MONA SHAH PROFESSIONAL CO	3/15/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1600 S GAFFEY ST	None	SAN PEDRO	CA	90731	4628	19	06037	33.729498	-118.292351	Los Angeles County
147194	Fee-for-Service	1568799500	1568799500	1	1	DIGNITY HEALTH	1/28/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	912 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31783091	-122.3215427	Siskiyou County
147236	Fee-for-Service	1992236699	1992236699	1	1	DEUTSCH, AMANDA J MD	6/17/2021	207P00000X	NA	Other	026	PHYSICIANS	172169	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147242	Fee-for-Service	1700803418	1700803418	1	46	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	FOUNDATION	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
147250	Fee-for-Service	1649303728	1649303728	1	1	DOWLING, JOHN J LMFT	4/3/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	119 FIGUEROA ST	SUITE# 2	VENTURA	CA	93001	2756	56	06111	34.27916165	-119.2977526	Ventura County
147311	Fee-for-Service	1124587464	1124587464	1	1	DIXON, CRAWFORD M DO	3/6/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22358	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
147333	Fee-for-Service	1821134040	1821134040	1	1	DIGNITY HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	124 S COLLEGE DRIVE	SUITE B	SANTA MARIA	CA	93454	5325	42	06083	34.951968	-120.4247835	Santa Barbara County
147341	Fee-for-Service	1245264910	1245264910	1	1	DERMATOLOGY ASSOCIATES OF	3/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86029	07	Dermatology	0	In state provider	SOUTHERN CALIFORNIA INC	917 PINE AVE	None	LONG BEACH	CA	90813	4325	19	06037	33.77819879	-118.1923826	Los Angeles County
147353	Fee-for-Service	1891054995	1891054995	1	1	DAMANI, MAUSAM R MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123787	18	Ophthalmology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
147368	Fee-for-Service	1952748501	1952748501	1	1	DE LA PENA EYE CLINIC, A MED	8/12/2013	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	7100 VAN NUYS BLVD	STE 120	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
147395	Fee-for-Service	1558479543	1558479543	1	1	DESERT VALLEY MEDICAL	2/11/2005	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION INC	14828 SEVENTH ST	None	VICTORVILLE	CA	92395	4024	36	06071	34.52026434	-117.3090574	San Bernardino County
147432	Fee-for-Service	1609843564	1609843564	1	1	DIMEN, LUIS L MD	3/31/1993	207RP1001X	NA	Pulmonology	026	PHYSICIANS	76052	41	Internal Medicine	0	In state provider	None	10 CONGRESS STREET	SUITE 208	PASADENA	CA	91105	3207	19	06037	34.13396893	-118.1528162	Los Angeles County
147457	Fee-for-Service	1508992769	1508992769	1	1	DOSIOU, CHRYSOULA MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67866	67	Endocrinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
147472	Fee-for-Service	1699886846	1699886846	1	1	DHAR, USHA MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	42012	01	General Practice	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 614	ORANGE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange
147476	Fee-for-Service	1053643171	1053643171	1	2	DR MONA SHAH PROFESSIONAL CO	6/15/2023	207R00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 S GAFFEY ST	None	SAN PEDRO	CA	90731	4628	19	06037	33.729498	-118.292351	Los Angeles County
147478	Fee-for-Service	1568799500	1568799500	1	1	DIGNITY HEALTH	1/28/2010	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	912 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31783091	-122.3215427	Siskiyou County
147509	Fee-for-Service	1457327157	1457327157	1	1	DEMONTE, ROBERT W JR MD	8/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	54446	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
147527	Fee-for-Service	1700803418	1700803418	1	46	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	FOUNDATION	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
147533	Fee-for-Service	1700803418	1700803418	1	2	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3301 C ST	STE 550	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
147591	Fee-for-Service	1366442584	1366442584	1	1	DESANTIS, STEPHEN A MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40996	02	General Surgery	0	In state provider	None	27852 PUERTA REAL #310	None	MISSION VIEJO	CA	92691	0000	30	06059	33.56849493	-117.6696298	Orange County
147619	Fee-for-Service	1821134040	1821134040	1	1	DIGNITY HEALTH	1/1/2002	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	124 S COLLEGE DRIVE	SUITE B	SANTA MARIA	CA	93454	5325	42	06083	34.951968	-120.4247835	Santa Barbara County
147625	Fee-for-Service	1144457995	1144457995	1	1	DESAI, SHIREENA S MD	9/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114928	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
147634	Fee-for-Service	1245009828	1245009828	1	1	DUAN, XUMIN	12/3/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	17671 IRVINE BLVD	STE 116	TUSTIN	CA	92780	3128	30	06059	33.74842552	-117.824076	Orange County
147680	Fee-for-Service	1861703555	1861703555	1	1	DEEPAK KUMAR SINGH M.D	12/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
147733	Fee-for-Service	1629613393	1629613393	1	2	DRNAT CORP	7/22/2022	207RC0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
147742	Fee-for-Service	1508992769	1508992769	1	1	DOSIOU, CHRYSOULA MD	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67866	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
147769	Fee-for-Service	1467420679	1467420679	1	1	DUFLOT, JOSEPH MD	4/28/1999	207RN0300X	NA	Nephrology	026	PHYSICIANS	44916	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
147774	Fee-for-Service	1700803418	1700803418	1	59	DIGNITY HEALTH MEDICAL FOUND	2/7/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2110 PROFESSIONAL DR	STE 190	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
147815	Fee-for-Service	1700803418	1700803418	1	46	DIGNITY HEALTH MEDICAL FOUND	4/14/2016	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
147821	Fee-for-Service	1083885677	1083885677	1	1	DOWNS, MARIA OLIVITA M LMFT	5/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	PY	501 1ST AVENUE	SUITE 1A	SAN MATEO	CA	94401	3213	41	06081	37.56829343	-122.32232	San Mateo County
147822	Fee-for-Service	1700803418	1700803418	1	2	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	3301 C ST	STE 550	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
147826	Fee-for-Service	1215937933	1215937933	1	1	DAVIES, ROBERT W MD	12/31/1988	207RN0300X	NA	Nephrology	026	PHYSICIANS	42189	01	General Practice	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 101	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
147831	Fee-for-Service	1467670455	1467670455	1	1	DORESTIN, JUNISE	4/23/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
147842	Fee-for-Service	1144546151	1144546151	1	1	DOBLADO, MANUEL A MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131490	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
147904	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	231H00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
147905	Fee-for-Service	1598170714	1598170714	1	1	DHALIWAL, PUNEET K MD	4/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145194	08	Family Practice	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
147915	Fee-for-Service	1629539754	1629539754	1	1	DIONISIO, ROBERT G MD	8/9/2022	390200000X	NA	Other	026	PHYSICIANS	176855	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
147952	Fee-for-Service	1144272717	1144272717	1	1	DESERT VALLEY MEDICAL	8/1/2001	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP INC	14214 MAIN ST	None	HESPERIA	CA	92345	4632	36	06071	34.4267645	-117.352836	San Bernardino County
147964	Fee-for-Service	1346602935	1346602935	1	1	DONTI, NIKITA DO	11/14/2021	207R00000X	NA	Other	026	PHYSICIANS	18926	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
148010	Fee-for-Service	1962722587	1962722587	1	1	DME PROFESSIONAL, INC	12/14/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	18271 MCDURMOTT W	A-1	IRVINE	CA	92614	6754	30	06059	33.68845084	-117.8669142	Orange County
148039	Fee-for-Service	1104960780	1104960780	1	1	DO, ROSE Q MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116729	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
148041	Fee-for-Service	1467913194	1467913194	1	1	DUPRE, AMANDA R DO	10/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19725	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
148062	Fee-for-Service	1700803418	1700803418	1	29	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
148084	Fee-for-Service	1710498613	1710498613	1	1	DRAN, JENNA A NP	12/15/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148093	Fee-for-Service	1881656106	1881656106	1	1	DAVID OKUBO M.D.	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1995 W 9000 S	None	WEST JORDAN	UT	84088	9345	00	None	40.58773299	-111.9442314	Salt Lake County
148105	Fee-for-Service	1700803418	1700803418	1	46	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
148110	Fee-for-Service	1700803418	1700803418	1	2	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3301 C ST	STE 550	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
148114	Fee-for-Service	1083728430	1083728430	1	1	DR. ROBERT SCOGGINS	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 W IRONWOOD DR	STE 378	COEUR D ALENE	ID	83814	4401	00	None	47.69438484	-116.7931559	Kootenai County
148135	Fee-for-Service	1437686318	1437686318	1	1	DULAY, RASNIK K MD	10/20/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	173292	None	None	0	In state provider	None	23803 MCBEAN PKWY	SUITE 101, 201, 202	VALENCIA	CA	91355	2001	19	06037	34.39750589	-118.552072	Los Angeles County
148189	Fee-for-Service	1831536481	1831536481	1	1	DE LA PENA EYE CLINIC, A MED	8/15/2013	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL GROUP INC	1520 N GRAND AVENUE	None	SANTA ANA	CA	92701	2627	30	06059	33.758541	-117.8519485	Orange County
148192	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
148200	Fee-for-Service	1588693204	1588693204	1	1	DASS, SHERMEIL MD	5/1/2002	2084P0800X	NA	Psychiatry	026	PHYSICIANS	78214	36	Psychiatry	0	In state provider	SANTA CRUZ HEALTH CENTER	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
148205	Fee-for-Service	1548408735	1548408735	1	1	DUBLIN PHYSICAL THERAPY, INC	4/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY	6759 SIERRA CT	SUITE A	DUBLIN	CA	94568	2670	01	06001	37.70825702	-121.9144925	Alameda County
148251	Fee-for-Service	1508880121	1508880121	1	1	DIGESTIVE DISEASE CNSLT.	3/24/1993	193400000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	A MEDICAL CORP.	1187 E HERNDON AVE	STE 101	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
148279	Fee-for-Service	1881612729	1881612729	1	1	DECK, JOSEPH J	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	81249	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
148307	Fee-for-Service	1710960026	1710960026	1	1	DILLON,JOSEPH S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
148323	Fee-for-Service	1114244100	1114244100	1	1	DENHAM, LAURA J MD	8/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117628	None	None	0	In state provider	None	11370 ANDERSON STREET	SUITE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
148338	Fee-for-Service	1508857442	1508857442	1	1	DEAN M HAVLIK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2021 N 12TH ST	None	GRAND JCT	CO	81501	2980	00	None	39.085983	-108.552377	Mesa County
148351	Fee-for-Service	1700803418	1700803418	1	29	DIGNITY HEALTH MEDICAL FOUND	3/24/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
148377	Fee-for-Service	1134329717	1134329717	1	1	DE VERA PILI, ANNA A	1/18/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
148378	Fee-for-Service	1871578146	1871578146	1	1	DE LOS SANTOS, DAVID MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	236 W 6TH STREET	STE 200	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
148479	Fee-for-Service	1831536481	1831536481	1	1	DE LA PENA EYE CLINIC, A MED	8/15/2013	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	A MEDICAL GROUP INC	1520 N GRAND AVENUE	None	SANTA ANA	CA	92701	2627	30	06059	33.758541	-117.8519485	Orange County
148482	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	231H00000X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
148493	Fee-for-Service	1548408735	1548408735	1	1	DUBLIN PHYSICAL THERAPY, INC	11/12/2020	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERAPY	6759 SIERRA CT	SUITE A	DUBLIN	CA	94568	2670	01	06001	37.70825702	-121.9144925	Alameda County
148513	Fee-for-Service	1396796850	1396796850	1	1	DR. ROBERT B LINK MD	11/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1978 INDUSTRIAL BLVD	None	HOUMA	LA	70363	7055	00	None	29.56952911	-90.6883119	Terrebonne Parish
148537	Fee-for-Service	1063878296	1063878296	1	1	DE MEYERE, LISA M NP	10/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
148563	Fee-for-Service	1497813133	1497813133	1	1	DAILLAK, STEPHEN J PT	10/26/2021	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1191 CRESTON RD	STE 115	PASO ROBLES	CA	93446	3033	40	06079	35.6227971	-120.6606503	San Luis Obispo County
148625	Fee-for-Service	1467657353	1467657353	1	1	DABBERT, JACK M	5/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DRIVE	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
148636	Fee-for-Service	1982320271	1982320271	1	1	DOLBERRY, ERRIS-SHERON LCSW	12/6/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
148637	Fee-for-Service	1700803418	1700803418	1	29	DIGNITY HEALTH MEDICAL FOUND	3/24/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
148658	Fee-for-Service	1083904536	1083904536	1	1	DUONG, JONATHAN A MD	7/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130765	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148665	Fee-for-Service	1871578146	1871578146	1	1	DE LOS SANTOS, DAVID MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	236 W 6TH STREET	STE 200	RENO	NV	89503	4550	00	None	39.53151304	-119.8186228	Washoe County
148707	Fee-for-Service	1992806277	1992806277	1	1	DOLATABADI, SOHA MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93675	41	Internal Medicine	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
148717	Fee-for-Service	1841731924	1841731924	1	1	DAVIS, MARK T MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137731	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
148736	Fee-for-Service	1841391752	1841391752	1	1	DERRICO, ROCCO J JR LCSW	6/13/1999	104100000X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8300 FAIR OAKS BLVD	STE 402	CARMICHAEL	CA	95608	1969	34	06067	38.636037	-121.3088895	Sacramento County
148761	Fee-for-Service	1184654923	1184654923	1	1	DOCTORS MEDICAL CENTER OF	6/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
148768	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
148800	Fee-for-Service	1497737639	1497737639	1	1	DALSASO, TIMOTHY J MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101314	30	Radiology	0	In state provider	None	2127 HARRISON STREET	STE 3	EUREKA	CA	95501	3213	12	06023	40.78801009	-124.1396022	Humboldt County
148819	Fee-for-Service	1134351000	1134351000	1	1	DEWESTER, KRISTIN G MFT	10/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94584	-	NOT APPLICABLE	0	In state provider	None	1885 LUNDY AVENUE	#223	SAN JOSE	CA	95131	1888	43	06085	37.39329538	-121.8907367	Santa Clara County
148829	Fee-for-Service	1245304567	1245304567	1	1	DAMIAN, RAYMUND M MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	54874	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
148836	Fee-for-Service	1720432560	1720432560	1	1	DAVIDSON, EVAN N MD	6/20/2021	207L00000X	NA	Other	026	PHYSICIANS	167278	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
148839	Fee-for-Service	1154422368	1154422368	2	1	DIRECT LINE TRANSPORT	6/30/2008	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4949 DILLON CROSS WAY	None	ANTELOPE	CA	95843	5617	34	06067	38.718108	-121.348422	Sacramento County
148853	Fee-for-Service	1427275676	1427275676	1	1	DEMERS, CHRISTOPHER P MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116313	14	Neurological Surgery	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
148865	Fee-for-Service	1497012777	1497012777	1	1	DRBAL, NICHOLAS V DPM	7/31/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
148920	Fee-for-Service	1639523665	1639523665	1	1	DOUGLAS, MICHAEL S MD	7/1/2021	207L00000X	NA	Other	026	PHYSICIANS	151081	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
148926	Fee-for-Service	1700803418	1700803418	1	59	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2110 PROFESSIONAL DR	STE 190	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
148927	Fee-for-Service	1437473147	1437473147	1	1	DUNN, CHERYL O LMFT	6/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3508 KEYSTONE AVE	APT 8	LOS ANGELES	CA	90034	5530	19	06037	34.02504018	-118.4104969	Los Angeles County
148965	Fee-for-Service	1962484725	1962484725	1	1	DAVIS, JOHN A MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150412	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148978	Fee-for-Service	1952805491	1952805491	1	1	DHILLON, JASPREET K MD	6/17/2021	208M00000X	NA	Other	026	PHYSICIANS	164464	None	None	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
149049	Fee-for-Service	1184654923	1184654923	1	1	DOCTORS MEDICAL CENTER OF	6/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
149056	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	3/2/2018	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
149074	Fee-for-Service	1265405096	1265405096	1	1	DATTEL, BONNIE J MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	43784	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	316 W JUNIPERO STREET	None	SANTA BARBARA	CA	93105	4305	42	06083	34.43088296	-119.723844	Santa Barbara County
149085	Fee-for-Service	1275735193	1275735193	1	1	DEANE, SEAN G MD	10/14/2008	207RA0201X	NA	Other	026	PHYSICIANS	95614	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
149135	Fee-for-Service	1285694349	1285694349	1	1	DU, PINGFENG MD	6/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95673	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	320 SANTA FE DR	STE 204	ENCINITAS	CA	92024	5179	37	06073	33.038847	-117.285579	San Diego County
149168	Fee-for-Service	1619067501	1619067501	1	1	DENA BROWNSTEIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
149174	Fee-for-Service	1093393670	1093393670	1	1	DAMARIS NJERI KINUTHIA KITEN	4/20/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9279 THILOW DRIVE	None	SACRAMENTO	CA	95826	4116	34	06067	38.555928	-121.35501	Sacramento County
149186	Fee-for-Service	1528484086	1528484086	1	1	DIOP, NDIAWAR	3/14/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	27753 LAFAYETTE WAY	None	MORENO VALLEY	CA	92555	5714	33	06065	33.90952926	-117.1784535	Riverside County
149200	Fee-for-Service	1124118468	1124118468	1	1	DONALD D DAMSCHEN, MD	11/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BROADWAY ST	None	MISSOULA	MT	59802	4008	00	None	46.87419951	-114.0007525	Missoula County
149215	Fee-for-Service	1700803418	1700803418	1	29	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6511 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669886	-121.3127505	Sacramento County
149222	Fee-for-Service	1891999033	1891999033	1	1	DELGADILLO, LISA M LCSW	5/24/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
149238	Fee-for-Service	1790748234	1790748234	1	1	DLUGOS, SCOTT EDWARD MD	4/22/2010	207P00000X	NA	Other	026	PHYSICIANS	77449	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
149261	Fee-for-Service	1104944255	1104944255	1	1	DIGNITY HEALTH	9/30/2001	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	MERCY HOME CARE	1544 MARKET ST	None	REDDING	CA	96001	1023	45	06089	40.58365696	-122.3906878	Shasta County
149291	Fee-for-Service	1669857488	1669857488	1	1	DAVIS, CHRISTINE E DO	9/11/2024	207R00000X	NA	Other	026	PHYSICIANS	23287	41	Internal Medicine	0	In state provider	None	502 EUCLID AVE	STE 304	NATIONAL CITY	CA	91950	2931	37	06073	32.68505421	-117.0832793	San Diego County
149308	Fee-for-Service	1104856095	1104856095	1	2	DESERT REGIONAL MEDICAL	6/6/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 N INDIAN CANYON DR	SUITE 120	PALM SPRINGS	CA	92262	4872	33	06065	33.838542	-116.5455735	Riverside County
149332	Fee-for-Service	1598945016	1598945016	1	1	DURMUS-PENNOCK, GULBIN LMFT	9/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149344	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
149347	Fee-for-Service	1700992443	1700992443	1	1	DIETZ, ANDREW C MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117303	68	Hematology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149464	Fee-for-Service	1093393670	1093393670	1	1	DAMARIS NJERI KINUTHIA KITEN	4/20/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9279 THILOW DRIVE	None	SACRAMENTO	CA	95826	4116	34	06067	38.555928	-121.35501	Sacramento County
149473	Fee-for-Service	1528484086	1528484086	1	1	DIOP, NDIAWAR	3/14/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	27753 LAFAYETTE WAY	None	MORENO VALLEY	CA	92555	5714	33	06065	33.90952926	-117.1784535	Riverside County
149475	Fee-for-Service	1093731622	1093731622	1	1	DAMON, CHRISTOPHER R MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	62346	20	Orthopedic Surgery	0	In state provider	None	800 3RD ST	None	MARYSVILLE	CA	95901	5831	58	06115	39.13757487	-121.5949642	Yuba County
149489	Fee-for-Service	1306059357	1306059357	1	1	DANG, TUAN M DO	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9331	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
149503	Fee-for-Service	1700803418	1700803418	1	59	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2110 PROFESSIONAL DR	STE 190	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
149507	Fee-for-Service	1649256561	1649256561	1	1	DENNIS,MARK A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10101 RIDGEGATE PKWY	None	LONE TREE	CO	80124	0000	00	None	39.529305	-104.870799	Douglas County
149539	Fee-for-Service	1598336166	1598336166	1	1	DANTANAVATANAWONG-BARNES, JE	2/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NNIFER CCC-SLP	1440 WASHINGTON BLVD	A5	CONCORD	CA	94521	4098	07	06013	37.94935969	-121.9564591	Contra Costa County
149582	Fee-for-Service	1144240896	1144240896	1	1	DANG, MINH N OD	2/24/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149596	Fee-for-Service	1699881839	1699881839	1	1	DESAI, BINDU T MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	43344	13	Neurology (M.D. only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
149614	Fee-for-Service	1730820473	1730820473	1	1	DREIBUS, KANANI V NP	5/3/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149624	Fee-for-Service	1851832315	1851832315	1	1	DEDICATED HOSPITALIST	6/29/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	SERVICES INC	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
149632	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	231H00000X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
149635	Fee-for-Service	1700992443	1700992443	1	1	DIETZ, ANDREW C MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117303	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149647	Fee-for-Service	1700803418	1700803418	1	71	DIGNITY HEALTH MEDICAL FOUND	1/25/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1050 IRON POINT RD	None	FOLSOM	CA	95630	8013	34	06067	38.643309	-121.1787405	Sacramento County
149648	Fee-for-Service	1134206097	1134206097	1	1	DAO, QUANG MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61096	40	Pediatrics	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
149757	Fee-for-Service	1225073000	1225073000	1	1	DEEN, ANDREW L MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82366	41	Internal Medicine	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
149769	Fee-for-Service	1659454510	1659454510	1	1	DAVIS, HOWARD	9/1/1997	1744P3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1660 SAN PABLO AVE	STE 200	PINOLE	CA	94564	2072	07	06013	38.0043007	-122.2979847	Contra Costa County
149774	Fee-for-Service	1700822681	1700822681	1	1	DEMPSEY, DAVID H MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	29679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	600 MARINE BLVD	None	MOSS BEACH	CA	94038	9641	41	06081	37.52703039	-122.5075216	San Mateo County
149786	Fee-for-Service	1023253101	1023253101	1	1	DAVID B BYBEE M D INC	2/24/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
149793	Fee-for-Service	1881742831	1881742831	1	1	DOERNER, THOMAS C MD	2/28/1988	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30583	41	Internal Medicine	0	In state provider	None	1141 W REDONDO BEACH BLV	STE 206	GARDENA	CA	90247	3584	19	06037	33.89247036	-118.2941482	Los Angeles County
149810	Fee-for-Service	1689628323	1689628323	1	1	DEREK R MULLINIX M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2986 KATE BOUND RD	None	MEMPHIS	TN	38133	0000	00	None	35.20710098	-89.80232323	Shelby County
149835	Fee-for-Service	1437488715	1437488715	1	2	DIGNITY COMMUNITY CARE	8/25/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7601 HOSPITAL DR	SUITE 103	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
149845	Fee-for-Service	1669630513	1669630513	1	1	DEOL, SANDEEP K MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116492	08	Family Practice	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
149859	Fee-for-Service	1689648206	1689648206	1	1	DVA RENAL HEALTHCARE INC	1/1/2001	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ATWATER DIALYSIS	1201 COMMERCE AVE	None	ATWATER	CA	95301	5224	24	06047	37.34302489	-120.6125961	Merced County
149898	Fee-for-Service	1124216288	1124216288	1	1	DELMAN, ERIC B DO INC	12/16/2005	193400000X	NA	Other	026	PHYSICIANS	8917	02	General Surgery	0	In state provider	None	1168 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3407	51	06101	39.14561745	-121.6208176	Sutter County
149909	Fee-for-Service	1710183165	1710183165	1	1	DAGHER, OUSSAMA I MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100106	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 COLORADO AVE	STE 210	TURLOCK	CA	95382	2707	50	06099	37.50941613	-120.8353105	Stanislaus County
149920	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
149924	Fee-for-Service	1700992443	1700992443	1	1	DIETZ, ANDREW C MD	8/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117303	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
149928	Fee-for-Service	1245340538	1245340538	1	1	DAVID LEE HOTCHKIN MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
149933	Fee-for-Service	1235285222	1235285222	1	1	DEISING, ADAM C DO	4/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	9780	10	Gastroenterology (M.D. only)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
149945	Fee-for-Service	1114566940	1114566940	1	1	DOSHI, GRINAL PT	1/29/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
149967	Fee-for-Service	1699777508	1699777508	1	1	DASHIELL, LINDA	5/4/2006	163W00000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	230 HOSPITAL DR	SUITE A	UKIAH	CA	95482	4563	23	06045	39.15171639	-123.2035457	Mendocino County
149996	Fee-for-Service	1326312067	1326312067	1	11	DCHS MEDICAL FOUNDATION	11/3/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	18550 DE PAUL DR	SUITE 208	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
150006	Fee-for-Service	1801154307	1801154307	1	1	DORCAS PINTO MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	43 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.653133	-73.7752995	Albany County
150011	Fee-for-Service	1053461822	1053461822	1	1	DWORSKY, PHYLLIS E	8/10/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3333 SKYPARK DR	SUITE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
150015	Fee-for-Service	1154470839	1154470839	1	1	DAVE, SANGEETA MD	11/22/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56412	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
150024	Fee-for-Service	1154431419	1154431419	1	1	DE LA ROCHA, CHANTEL M	10/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81708	40	Pediatrics	0	In state provider	MD	3116 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	2217	19	06037	34.02382271	-118.137273	Los Angeles County
150047	Fee-for-Service	1215313150	1215313150	1	1	DURAL, FANNYJANE B	12/11/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2295 S VINEYARD	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
150074	Fee-for-Service	1801165477	1801165477	1	1	DE LA CRUZ, ZELDA SARMIENTO	9/22/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	88683	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD INC	1 BAYWOOD AVE	STE 7	SAN MATEO	CA	94402	1537	41	06081	37.56513159	-122.3284067	San Mateo County
150078	Fee-for-Service	1942311451	1942311451	1	1	DILEO, STEPHANIE K DPM	7/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
150096	Fee-for-Service	1306905922	1306905922	1	1	DEVITA, STEPHEN MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71103	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
150139	Fee-for-Service	1164571055	1164571055	1	1	DUNKELMAN, DANIEL S MD	1/23/1993	174400000X	NA	Other	026	PHYSICIANS	33660	02	General Surgery	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
150209	Fee-for-Service	1700803418	1700803418	1	48	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	231H00000X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 180	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
150212	Fee-for-Service	1629602230	1629602230	1	1	DARBIDIAN, ANDRE B PT	3/3/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 N CENTRAL AVE.	SUITE 110	GLENDALE	CA	91202	2957	19	06037	34.15992057	-118.2572221	Los Angeles County
150226	Fee-for-Service	1184654923	1184654923	1	4	DOCTORS MEDICAL CENTER OF	3/11/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4016 DALE ROAD	None	MODESTO	CA	95356	9268	50	06099	37.69723812	-121.049967	Stanislaus County
150230	Fee-for-Service	1700381399	1700381399	1	1	DALEY, TARA D LMFT	2/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
150247	Fee-for-Service	1922478361	1922478361	1	1	DUNN, REBECCA K PSYD	5/3/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
150276	Fee-for-Service	1770661688	1770661688	1	1	DOMINGUEZ, FELIPE DE JES	4/29/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	57510	40	Pediatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
150284	Fee-for-Service	1326312067	1326312067	1	11	DCHS MEDICAL FOUNDATION	11/3/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18550 DE PAUL DR	SUITE 208	MORGAN HILL	CA	95037	2911	43	06085	37.15297169	-121.6473528	Santa Clara County
150320	Fee-for-Service	1720231681	1720231681	1	1	DAVIS, HILARY S LMFT	4/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	318 WESTLAKE CTR	STE. 204	DALY CITY	CA	94015	1437	41	06081	37.70104849	-122.4832932	San Mateo County
150323	Fee-for-Service	1063432557	1063432557	1	1	DEMING, DOUGLAS D MD	7/3/1997	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	34057	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	# 1200	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
150339	Fee-for-Service	1447291992	1447291992	1	1	DAY, JOHN W MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52734	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150367	Fee-for-Service	1073680971	1073680971	1	1	DULLET, NAVNEET K MD	7/1/1998	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	40016	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
150372	Fee-for-Service	1689800013	1689800013	1	1	DHHS IHS PHOENIX AREA NEVADA	9/25/2013	3245S0500X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	1	Border provider	SKIES YOUTH WELLNESS CTR	104 BIG BEND RANCH RD	None	WADSWORTH	NV	89442	0208	00	None	39.63129365	-119.2959314	Washoe County
150416	Fee-for-Service	1023538105	1023538105	1	1	DHALIWAL, HARMANDEEP S MD	4/20/2020	207R00000X	NA	Other	026	PHYSICIANS	162512	41	Internal Medicine	0	In state provider	None	5810 JAMESON CT	STE 1	CARMICHAEL	CA	95608	0881	34	06067	38.650878	-121.329036	Sacramento County
150418	Fee-for-Service	1700803418	1700803418	1	31	DIGNITY HEALTH MEDICAL FOUND	8/11/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	3939 J STREET	SUITE 250	SACRAMENTO	CA	95819	3637	34	06067	38.570211	-121.45374	Sacramento County
150424	Fee-for-Service	1164571055	1164571055	1	1	DUNKELMAN, DANIEL S MD	1/23/1993	174400000X	NA	Other	026	PHYSICIANS	33660	01	General Practice	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
150442	Fee-for-Service	1780968214	1780968214	1	1	DIAZ, MELISSA A OT	6/28/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4300 GREEN RIVER ROAD	114	CORONA	CA	92878	2306	33	06065	33.87886214	-117.6493182	Riverside County
150476	Fee-for-Service	1700803418	1700803418	1	56	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	6555 COYLE AVENUE	SUITE 390	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
150477	Fee-for-Service	1184932535	1184932535	1	1	DU, ANNIE T PHD	4/14/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1761 BROADWAY	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
150493	Fee-for-Service	1568049922	1568049922	1	1	DUFFENS, ALI MD	8/22/2023	207R00000X	NA	Other	026	PHYSICIANS	184449	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
150494	Fee-for-Service	1255963948	1255963948	1	1	DAVIDSON, CAROL L LMFT	3/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
150495	Fee-for-Service	1275513970	1275513970	1	1	DUQUETTE, RUSSELL C MC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE,	STE 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
150538	Fee-for-Service	1306921887	1306921887	1	1	DELTA REGIONAL MEDICAL	1/18/2009	282NR1301X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1400 E UNION STREET	None	GREENVILLE	MS	38703	3246	00	None	33.40994451	-91.0352205	Washington County
150548	Fee-for-Service	1700803418	1700803418	1	25	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
150572	Fee-for-Service	1043284433	1043284433	1	1	DUBERG, ARTHUR C MD	1/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	56129	30	Radiology	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
150579	Fee-for-Service	1245298769	1245298769	1	1	DELGADILLO, ALEXANDER MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89399	41	Internal Medicine	0	In state provider	None	591 E ELDER ST	STE C	FALLBROOK	CA	92028	5001	37	06073	33.3801147	-117.2454154	San Diego County
150589	Fee-for-Service	1104856095	1104856095	1	5	DESERT REGIONAL MEDICAL	11/25/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	INC	1180 N INDIAN CANYON DR	SUITE 400	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
150607	Fee-for-Service	1407374614	1407374614	1	1	DOMINGUEZ, ANGELICA	6/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
150635	Fee-for-Service	1326660119	1326660119	1	1	DESAI, SONIA A MD	11/1/2024	207P00000X	NA	Other	026	PHYSICIANS	186839	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
150658	Fee-for-Service	1689800013	1689800013	1	1	DHHS IHS PHOENIX AREA NEVADA	9/25/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	1	Border provider	SKIES YOUTH WELLNESS CTR	104 BIG BEND RANCH RD	None	WADSWORTH	NV	89442	0208	00	None	39.63129365	-119.2959314	Washoe County
150660	Fee-for-Service	1174538979	1174538979	1	1	DUNN, MONTY M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78778	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
150692	Fee-for-Service	1093019077	1093019077	1	1	DYER, KAROLY M NP	7/8/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150704	Fee-for-Service	1700803418	1700803418	1	31	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3939 J STREET	SUITE 250	SACRAMENTO	CA	95819	3637	34	06067	38.570211	-121.45374	Sacramento County
150729	Fee-for-Service	1083971881	1083971881	1	10	DIGNITY HEALTH MEDICAL FOUND	4/17/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-BAKERSFIELD	3838 SAN DIMAS ST	STE B 111	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
150759	Fee-for-Service	1508662404	1508662404	1	1	DORADO, JENNIFER H NP	3/17/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4922 WHITTIER BLVD	None	LOS ANGELES	CA	90022	1111	19	06037	34.02163273	-118.1631725	Los Angeles County
150764	Fee-for-Service	1700803418	1700803418	1	56	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	6555 COYLE AVENUE	SUITE 390	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
150772	Fee-for-Service	1437532058	1437532058	1	1	DAVID, KASEY LCSW	9/9/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
150774	Fee-for-Service	1346765955	1346765955	1	1	DO, CHRISTOPHER P CNP	4/20/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7999 GATEWAY BLVD	SUITE 200	NEWARK	CA	94560	1188	01	06001	37.53814232	-122.0629661	Alameda County
150822	Fee-for-Service	1609920727	1609920727	1	1	DAH, NAJU M MD	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31448	08	Family Practice	0	In state provider	None	2800 N CALIFORNIA ST	STE 17	STOCKTON	CA	95204	3759	39	06077	37.97782434	-121.2919633	San Joaquin County
150828	Fee-for-Service	1306921887	1306921887	1	1	DELTA REGIONAL MEDICAL	1/18/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1400 E UNION STREET	None	GREENVILLE	MS	38703	3246	00	None	33.40994451	-91.0352205	Washington County
150834	Fee-for-Service	1700803418	1700803418	1	25	DIGNITY HEALTH MEDICAL FOUND	9/11/2017	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
150847	Fee-for-Service	1700803418	1700803418	1	27	DIGNITY HEALTH MEDICAL FOUND	1/13/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	1561 CREEKSIDE DR	STE 170	FOLSOM	CA	95630	3495	34	06067	38.668032	-121.150188	Sacramento County
150879	Fee-for-Service	1700803418	1700803418	1	39	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1580 CREEKSIDE DR	STE 250	FOLSOM	CA	95630	3889	34	06067	38.668914	-121.148028	Sacramento County
150927	Fee-for-Service	1508076365	1508076365	1	1	DUNDEE, SARAH QUANRUD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 S MAPLE ST	None	WACONIA	MN	55387	1752	00	None	44.843139	-93.79078701	Carver County
150949	Fee-for-Service	1174538979	1174538979	1	1	DUNN, MONTY M MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78778	05	Anesthesiology	0	In state provider	None	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
150992	Fee-for-Service	1700803418	1700803418	1	31	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3939 J STREET	SUITE 250	SACRAMENTO	CA	95819	3637	34	06067	38.570211	-121.45374	Sacramento County
151026	Fee-for-Service	1154707875	1154707875	1	1	DISLA CUEVAS, ABIEZER N MD	10/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	154728	01	General Practice	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
151052	Fee-for-Service	1356450977	1356450977	1	1	DOWNEY ACUTE CARE MED	6/1/1998	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	GROUP	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
151053	Fee-for-Service	1700803418	1700803418	1	56	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 390	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
151096	Fee-for-Service	1700803418	1700803418	1	5	DIGNITY HEALTH MEDICAL FOUND	10/23/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
151098	Fee-for-Service	1114958865	1114958865	1	1	DEXTER, JAMES R MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30995	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
151121	Fee-for-Service	1265522155	1265522155	1	1	DOUGLAS S HAWKINS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CHILDRENS UNIV MD GRP	4500 SAND POINT WAY	None	SEATTLE	WA	98105	0000	00	None	47.66165594	-122.2864502	King County
151127	Fee-for-Service	1932243003	1932243003	1	1	DIGNITY HEALTH	1/1/2002	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
151132	Fee-for-Service	1700803418	1700803418	1	27	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1561 CREEKSIDE DR	STE 170	FOLSOM	CA	95630	3495	34	06067	38.668032	-121.150188	Sacramento County
151142	Fee-for-Service	1700803418	1700803418	1	25	DIGNITY HEALTH MEDICAL FOUND	11/14/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
151163	Fee-for-Service	1700803418	1700803418	1	39	DIGNITY HEALTH MEDICAL FOUND	9/21/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1580 CREEKSIDE DR	STE 250	FOLSOM	CA	95630	3889	34	06067	38.668914	-121.148028	Sacramento County
151164	Fee-for-Service	1629044235	1629044235	1	1	DITCHEY, ROY V MD	9/26/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37783	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2638 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57129583	-122.3975042	Shasta County
151170	Fee-for-Service	1801100540	1801100540	1	1	DABIESINGH, DEVINDRA S MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14002	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
151208	Fee-for-Service	1699932467	1699932467	1	1	DIGIACOMO, LILLIAN MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106405	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
151237	Fee-for-Service	1669933941	1669933941	1	1	DEMIGILLO, JOSEMARIA M MD	10/18/2022	207R00000X	NA	Other	026	PHYSICIANS	181072	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
151256	Fee-for-Service	1831783315	1831783315	1	1	DOCKSTADER, ERIKA K CNP	1/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
151258	Fee-for-Service	1952981409	1952981409	1	1	DUONG, HANH MD	11/18/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
151305	Fee-for-Service	1588050025	1588050025	1	1	DOMPOR, JAMES P DO	8/7/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	15200	13	Neurology (M.D. only)	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
151325	Fee-for-Service	1427280510	1427280510	1	1	DEREK, ELIKA MD	11/4/2014	208600000X	NA	General Surgery	026	PHYSICIANS	117936	02	General Surgery	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
151340	Fee-for-Service	1700803418	1700803418	1	56	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 390	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
151369	Fee-for-Service	1093893828	1093893828	2	1	DARWISH, CAROL J MD	4/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	80131	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	204 E. BEACH ST	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
151385	Fee-for-Service	1700803418	1700803418	1	5	DIGNITY HEALTH MEDICAL FOUND	10/23/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
151387	Fee-for-Service	1114958865	1114958865	1	1	DEXTER, JAMES R MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30995	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
151398	Fee-for-Service	1568437978	1568437978	1	1	DVA RENAL HEALTHCARE INC	5/29/2002	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	292 EUCLID AVE	STE 100	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
151414	Fee-for-Service	1700803418	1700803418	1	25	DIGNITY HEALTH MEDICAL FOUND	11/14/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	FOUNDATION	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
151421	Fee-for-Service	1700803418	1700803418	1	27	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1561 CREEKSIDE DR	STE 170	FOLSOM	CA	95630	3495	34	06067	38.668032	-121.150188	Sacramento County
151444	Fee-for-Service	1417961186	1417961186	1	1	DITLOVE, JACK MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25418	45	Nephrology (Renal-Kidney)	0	In state provider	A MEDICAL CORP	435 N ROXBURY DR	STE 102	BEVERLY HILLS	CA	90210	5054	19	06037	34.06777102	-118.4067032	Los Angeles County
151451	Fee-for-Service	1700803418	1700803418	1	39	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1580 CREEKSIDE DR	STE 250	FOLSOM	CA	95630	3889	34	06067	38.668914	-121.148028	Sacramento County
151452	Fee-for-Service	1629044235	1629044235	1	1	DITCHEY, ROY V MD	9/26/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37783	41	Internal Medicine	0	In state provider	None	2638 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57129583	-122.3975042	Shasta County
151472	Fee-for-Service	1083971881	1083971881	1	7	DIGNITY HEALTH MEDICAL FOUND	8/8/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	707 W VALLEY BLVD	None	TEHACHAPI	CA	93561	2119	15	06029	35.12433846	-118.4591228	Kern County
151480	Fee-for-Service	1477592806	1477592806	1	1	DENHAM, JEFFREY H MD	8/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67746	41	Internal Medicine	0	In state provider	None	50 BELLEFONTAINE ST	STE 203	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
151494	Fee-for-Service	1336216209	1336216209	1	1	DAVID, MARGARET J MD	3/31/1995	207R00000X	NA	Other	026	PHYSICIANS	77297	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
151548	Fee-for-Service	1083684229	1083684229	1	1	DRUCKER, RICHARD B MD	5/12/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	21784	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2501 SHOREVIEW	None	SANTA CRUZ	CA	95062	0000	44	06087	36.95844474	-121.9820485	Santa Cruz County
151553	Fee-for-Service	1669745121	1669745121	1	1	DIAZ, GILBERTO LCSW	1/1/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
151578	Fee-for-Service	1366774259	1366774259	1	1	DRIVER, MARIA T LCSW	9/11/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	770 MAGNOLIA AVE	STE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
151616	Fee-for-Service	1467530105	1467530105	1	1	DONG, RACHEL K MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85799	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
151657	Fee-for-Service	1821416686	1821416686	1	1	DANI, AVACE MD	3/31/2022	207L00000X	NA	Other	026	PHYSICIANS	163232	None	None	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
151674	Fee-for-Service	1700803418	1700803418	1	5	DIGNITY HEALTH MEDICAL FOUND	10/23/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
151679	Fee-for-Service	1346572831	1346572831	1	1	DARCY, NICOLE F MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110829	30	Radiology	0	In state provider	None	4733 W. SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
151683	Fee-for-Service	1043217359	1043217359	1	1	DANG, ALAN MD	6/4/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	82876	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2621 S BRISTOL ST	STE 300	SANTA ANA	CA	92704	5766	30	06059	33.711876	-117.885371	Orange County
151685	Fee-for-Service	1457437253	1457437253	1	2	DE PINTO, MARIO G MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55902	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
151691	Fee-for-Service	1417446683	1417446683	1	1	DSOUZA, STEPHANIE	7/23/2021	207L00000X	NA	Other	026	PHYSICIANS	151909	None	None	0	In state provider	None	14445 OLIVE VIEW	None	SYLMAR	CA	91342	1437	19	06037	34.32450186	-118.4456317	Los Angeles County
151694	Fee-for-Service	1700803418	1700803418	1	25	DIGNITY HEALTH MEDICAL FOUND	11/14/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
151714	Fee-for-Service	1487026910	1487026910	1	1	DIAZ, GABRIELA PSYD	2/23/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
151715	Fee-for-Service	1427152446	1427152446	1	1	DELANOY, DANIEL L LMFT	3/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
151753	Fee-for-Service	1508898099	1508898099	1	1	DEOL, AJIT SINGH MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73499	89	Surgery-Traumatic	0	In state provider	None	2800 L STREET	SUITE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
151758	Fee-for-Service	1619423407	1619423407	1	1	DWELLEY, HALEY LMFT	8/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
151769	Fee-for-Service	1477592806	1477592806	1	1	DENHAM, JEFFREY H MD	8/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67746	66	Emergency Medicine (Urgent Care)	0	In state provider	None	50 BELLEFONTAINE ST	STE 203	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
151791	Fee-for-Service	1063670966	1063670966	1	1	DAO, LOAN T P MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101522	08	Family Practice	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
151836	Fee-for-Service	1477507697	1477507697	1	1	DEGUZMAN, JOSE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
151838	Fee-for-Service	1083684229	1083684229	1	1	DRUCKER, RICHARD B MD	5/12/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	21784	01	General Practice	0	In state provider	None	2501 SHOREVIEW	None	SANTA CRUZ	CA	95062	0000	44	06087	36.95844474	-121.9820485	Santa Cruz County
151898	Fee-for-Service	1326312067	1326312067	1	6	DCHS MEDICAL FOUNDATION	6/16/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	455 O'CONNOR DR	STE 150	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
151920	Fee-for-Service	1639382708	1639382708	1	1	DANG, KULMEET S DO	12/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10600	None	None	0	In state provider	None	1301 ROSE DRIVE	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
151945	Fee-for-Service	1942271143	1942271143	1	1	DERIENZO, DAMIAN P MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51186	22	Pathology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
151961	Fee-for-Service	1700803418	1700803418	1	5	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
151988	Fee-for-Service	1700803418	1700803418	1	25	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1730 PRAIRIE CITY ROAD	SUITE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
151990	Fee-for-Service	1265499826	1265499826	1	1	DAVID W CAMACHO MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1190 WAIANUENUE AVE	None	HILO	HI	96720	2089	00	None	19.71752563	-155.1129745	Hawaii County
152036	Fee-for-Service	1912534090	1912534090	1	1	DERRY, LAURA T MD	9/22/2023	207R00000X	NA	Other	026	PHYSICIANS	189109	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
152039	Fee-for-Service	1508898099	1508898099	1	1	DEOL, AJIT SINGH MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73499	02	General Surgery	0	In state provider	None	2800 L STREET	SUITE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
152048	Fee-for-Service	1144240631	1144240631	1	1	DIEP, BRIAN MD	1/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147173	08	Family Practice	0	In state provider	None	10538 MISSION GORGE RD	SUITE 100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
152056	Fee-for-Service	1093913998	1093913998	1	1	DINANI, ALEEM S	6/15/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
152078	Fee-for-Service	1649237819	1649237819	1	1	DECASTRO, JENNIFER L	1/4/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	14911 NATIONAL AVE	SUITE 2	LOS GATOS	CA	95032	2632	43	06085	37.25172742	-121.951483	Santa Clara County
152105	Fee-for-Service	1760893879	1760893879	1	1	DUGAR, BRANDON DO	10/17/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	14356	None	None	0	In state provider	None	19111 TOWN CENTER DR	None	APPLE VALLEY	CA	92308	8989	36	06071	34.46573149	-117.2467156	San Bernardino County
152151	Fee-for-Service	1659472611	1659472611	1	1	DESAI, SNEHAL MD	1/4/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	None	36.19740597	-115.1207123	Clark County
152177	Fee-for-Service	1376596098	1376596098	1	1	DONALD AVIANO, M.D.	8/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
152184	Fee-for-Service	1710518808	1710518808	1	1	DATE-CHONG, LAUREN N NP	7/15/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
152185	Fee-for-Service	1326312067	1326312067	1	6	DCHS MEDICAL FOUNDATION	6/16/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	455 O'CONNOR DR	STE 150	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
152228	Fee-for-Service	1992135081	1992135081	1	1	DECULING, JOSELYN A NP	3/18/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	321 TURNER	None	LODI	CA	95240	0517	39	06077	38.14571389	-121.2776835	San Joaquin County
152235	Fee-for-Service	1538780127	1538780127	1	1	DESAI, SAGAR MD	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
152250	Fee-for-Service	1700803418	1700803418	1	5	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
152259	Fee-for-Service	1295753234	1295753234	1	1	DEMIROZU, MEHMET MD	1/24/2018	207R00000X	NA	Other	026	PHYSICIANS	52940	41	Internal Medicine	0	In state provider	None	4477 W 118TH ST	SUITE 303	HAWTHORNE	CA	90250	2255	19	06037	33.92734752	-118.354221	Los Angeles County
152281	Fee-for-Service	1285832501	1285832501	1	1	DUONG, NGHI	6/20/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
152293	Fee-for-Service	1154746782	1154746782	1	1	DR. KESHA CRICHLOW MD	4/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	71 PROSPECT AVE	None	HUDSON	NY	12534	2927	00	None	42.246324	-73.7778015	Columbia County
152294	Fee-for-Service	1225322290	1225322290	1	1	DELAURIER, GEOFFREY P MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129397	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3700 EAST SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
152379	Fee-for-Service	1487947404	1487947404	1	1	DARRAH, JUSTIN M MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135802	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	LOS ANGELES	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles
152399	Fee-for-Service	1558852665	1558852665	1	1	DITANGCO, ROSELLER MARTIN C	8/23/2021	207R00000X	NA	Other	026	PHYSICIANS	173531	None	None	0	In state provider	MD	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
152400	Fee-for-Service	1851785547	1851785547	1	1	DAVID, HENRY MD	7/20/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	135061	79	Neurology-Child	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
152434	Fee-for-Service	1609926526	1609926526	1	1	DRAPER, JENNIFER E MD	6/11/2008	207R00000X	NA	Other	026	PHYSICIANS	96807	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
152443	Fee-for-Service	1598843211	1598843211	1	1	DIRKX, CYNTHIA MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60344	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
152501	Fee-for-Service	1033993449	1033993449	1	1	DR KRIYA INCORPORATED	2/29/2024	2086S0122X	NA	General Surgery	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	150 S RODEO DR	SUITE 200	BEVERLY HILLS	CA	90212	2440	19	06037	34.06526821	-118.4012376	Los Angeles County
152536	Fee-for-Service	1700803418	1700803418	1	5	DIGNITY HEALTH MEDICAL FOUND	10/23/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
152557	Fee-for-Service	1730442914	1730442914	1	1	DESMOND, MATTHEW K MD	12/16/2019	207L00000X	NA	Other	026	PHYSICIANS	134812	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
152592	Fee-for-Service	1487731337	1487731337	1	1	DHAR, ANJALI MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54191	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
152626	Fee-for-Service	1588640312	1588640312	1	1	DODGE II, WILLIAM R MD	12/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70260	None	None	0	In state provider	None	4077 FIFTH AVENUE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
152644	Fee-for-Service	1861488249	1861488249	1	1	DAWES, MELANIE F MD	9/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	51910	41	Internal Medicine	0	In state provider	None	7117 BROCKTON AVENUE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
152651	Fee-for-Service	1689753725	1689753725	1	1	DAILEY, DIANE F MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66189	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
152696	Fee-for-Service	1700803418	1700803418	1	30	DIGNITY HEALTH MEDICAL FOUND	7/21/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2110 PROFESSIONAL DRIVE	STE 105	ROSEVILLE	CA	95661	3778	31	06061	38.74234873	-121.2521259	Placer County
152722	Fee-for-Service	1992994487	1992994487	1	1	DRAKE, MACARTHUR JR MD	4/1/2010	2085N0700X	NA	MRI Provider	026	PHYSICIANS	104180	None	None	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5606	34	06067	38.571237	-121.469958	Sacramento County
152752	Fee-for-Service	1689677684	1689677684	1	1	DING, LEI MD APC	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75815	08	Family Practice	0	In state provider	None	1661 HANOVER RD	STE 101	CITY OF INDUSTRY	CA	91748	1796	19	06037	33.99109665	-117.920988	Los Angeles County
152760	Fee-for-Service	1417343732	1417343732	1	1	DJEKIC, KRISTINA DO MD	6/20/2018	207R00000X	NA	Other	026	PHYSICIANS	15063	41	Internal Medicine	0	In state provider	None	2185 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
152799	Fee-for-Service	1306850250	1306850250	1	1	DE LA PENA EYE CLINIC, A MED	12/18/2006	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	139 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06566774	-118.271006	Los Angeles County
152888	Fee-for-Service	1215355938	1215355938	1	1	DEANGELIS, ANTHONY M MD	9/10/2021	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171408	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
152955	Fee-for-Service	1619920949	1619920949	1	2	DUKES HEALTH SYSTEM LLC	5/8/2017	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	275 W 12TH ST	None	PURU	IN	46970	1638	00	None	40.75735047	-86.08302539	Miami County
152976	Fee-for-Service	1013274547	1013274547	1	1	DHIR, NITIKA N MD	9/26/2022	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	132129	None	None	0	In state provider	None	5000 W SUNSET BLVD	FL 4	LOS ANGELES	CA	90027	5861	19	06037	34.0981066	-118.2986382	Los Angeles County
152982	Fee-for-Service	1700803418	1700803418	1	4	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8220 WYMARK DR	STE 101	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
152988	Fee-for-Service	1093327850	1093327850	1	1	DUONG, TRI RCP	9/10/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
152994	Fee-for-Service	1831320852	1831320852	1	1	DE LEON, YEYMI W MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	114611	01	General Practice	0	In state provider	None	201 EAST LAKEVIEW AVENUE	None	WOODLAKE	CA	93286	1301	54	06107	36.4172997	-119.0975768	Tulare County
153031	Fee-for-Service	1578689717	1578689717	1	1	DREW, ROSEMARY S CRNA	6/10/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
153061	Fee-for-Service	1942706825	1942706825	1	1	DHILLON, JOSHPAUL MD	10/4/2023	207RR0500X	NA	Other	026	PHYSICIANS	188194	None	None	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
153067	Fee-for-Service	1598298408	1598298408	1	1	DESOUZA, DISHA A MD	6/30/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174669	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153087	Fee-for-Service	1306850250	1306850250	1	1	DE LA PENA EYE CLINIC, A MED	8/31/1989	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL GROUP	139 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06566774	-118.271006	Los Angeles County
153089	Fee-for-Service	1902182512	1902182512	1	1	DAYANANTHAN, ASHOK J MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125696	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
153092	Fee-for-Service	1679644587	1679644587	1	1	DINWIDDIE, DAVID W MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74985	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
153245	Fee-for-Service	1619920949	1619920949	1	2	DUKES HEALTH SYSTEM LLC	5/8/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	275 W 12TH ST	None	PURU	IN	46970	1638	00	None	40.75735047	-86.08302539	Miami County
153261	Fee-for-Service	1043276231	1043276231	1	1	DESHMUKH, ABHIJIT V MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70530	30	Radiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153273	Fee-for-Service	1700803418	1700803418	1	4	DIGNITY HEALTH MEDICAL FOUND	10/16/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	8220 WYMARK DR	STE 101	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
153277	Fee-for-Service	1659488641	1659488641	1	1	DODD, GERALD D MD	2/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
153283	Fee-for-Service	1134605264	1134605264	1	1	DAVIS, DANIELLE I	9/14/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
153285	Fee-for-Service	1174667158	1174667158	1	1	DIGNITY HEALTH	1/1/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN FRANCISCO	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
153319	Fee-for-Service	1699774737	1699774737	1	1	DAYLAMI, NATALIE R LCSW	9/2/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
153341	Fee-for-Service	1407198948	1407198948	1	1	DANFORTH, DENNIS J MD	7/1/2017	207L00000X	NA	Other	026	PHYSICIANS	134366	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153357	Fee-for-Service	1326312067	1326312067	1	1	DCHS MEDICAL FOUNDATION	5/10/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	227 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36478223	-121.8497978	Santa Clara County
153443	Fee-for-Service	1528032406	1528032406	1	1	DAVID MCCAA HEADLEY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	405 MARKET ST	None	PORT GIBSON	MS	39150	2024	00	None	31.96292749	-90.98336871	Claiborne County
153459	Fee-for-Service	1942317409	1942317409	1	1	DOUGHERTY, RYAN H MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90594	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
153511	Fee-for-Service	1194803130	1194803130	1	1	DIAMOND, LANA D MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	94648	36	Psychiatry	0	In state provider	None	4311 THIRD AVNUE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
153546	Fee-for-Service	1154409910	1154409910	1	1	DESHPANDE, AMRITA S MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65425	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
153548	Fee-for-Service	1043276231	1043276231	1	1	DESHMUKH, ABHIJIT V MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70530	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153559	Fee-for-Service	1700803418	1700803418	1	30	DIGNITY HEALTH MEDICAL FOUND	7/21/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2110 PROFESSIONAL DRIVE	STE 105	ROSEVILLE	CA	95661	3778	31	06061	38.74234873	-121.2521259	Placer County
153572	Fee-for-Service	1174667158	1174667158	1	1	DIGNITY HEALTH	1/1/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SAN FRANCISCO	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
153589	Fee-for-Service	1891841490	1891841490	1	1	DUNHAM, MATTHEW M MD	9/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100037	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
153591	Fee-for-Service	1922493931	1922493931	1	1	DEVEIKIS, CYNTHIA M DO	3/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	16611	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
153619	Fee-for-Service	1902177066	1902177066	1	2	DAO, VIET TRONG MD APMC	6/5/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96409	01	General Practice	0	In state provider	None	2363 ULRIC STREET	SUITE B	SAN DIEGO	CA	92111	6447	37	06073	32.78619268	-117.1693315	San Diego County
153631	Fee-for-Service	1093712457	1093712457	1	1	DARLENE F DALY DO, PC	4/3/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1375 N MAIN ST	None	LAPEER	MI	48446	1350	00	None	43.06301883	-83.31925927	Lapeer County
153637	Fee-for-Service	1336245778	1336245778	1	1	DEMAGNO, ELIZABETH J MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	47902	40	Pediatrics	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
153713	Fee-for-Service	1497399265	1497399265	1	1	DELGADO, JOANNA LCSW	7/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
153730	Fee-for-Service	1396221636	1396221636	1	1	DELIS, CANDACE LPCC	9/17/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
153783	Fee-for-Service	1407946098	1407946098	1	1	DRIES,DAVID C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
153792	Fee-for-Service	1457739732	1457739732	1	1	DESAI, DEEP C MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157450	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365 420 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
153805	Fee-for-Service	1578876199	1578876199	1	1	DENG, JIE MD	2/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	128020	None	None	0	In state provider	None	321 MIDDLEFIELD ROAD	SUITE 165,260	MENLO PARK	CA	94025	3500	41	06081	37.45657153	-122.168099	San Mateo County
153821	Fee-for-Service	1639247364	1639247364	1	1	DIEP, CINDY PUI LAN MA	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
153848	Fee-for-Service	1700803418	1700803418	1	4	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8220 WYMARK DR	STE 101	ELK GROVE	CA	95757	6298	34	06067	38.406888	-121.4100495	Sacramento County
153887	Fee-for-Service	1275626509	1275626509	1	1	DEAKERS, TIMOTHY W MD	6/21/2000	207RC0200X	NA	Other	026	PHYSICIANS	49229	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
153890	Fee-for-Service	1548408735	1548408735	1	2	DUBLIN PHYSICAL THERAPY, INC	5/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY	2600 STANWELL DRIVE	SUITE 104	CONCORD	CA	94520	4862	07	06013	37.98689836	-122.047993	Contra Costa County
153897	Fee-for-Service	1679733760	1679733760	1	1	DO, HULBERT MD	10/16/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162072	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
153904	Fee-for-Service	1376805044	1376805044	2	1	DANE VAN TASSEL	4/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
153926	Fee-for-Service	1336245778	1336245778	1	1	DEMAGNO, ELIZABETH J MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	47902	78	Neoplastic Diseases/Oncology	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
153934	Fee-for-Service	1689805830	1689805830	1	1	DO, NHAN T OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3750 W MCFADDEN AVENUE	SUITE #C	SANTA ANA	CA	92704	1388	30	06059	33.7381617	-117.9185572	Orange County
153939	Fee-for-Service	1760508832	1760508832	1	1	DAVIS, SHERIE E LCSW	10/16/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1316	42	06083	34.444782	-119.7794675	Santa Barbara County
153948	Fee-for-Service	1215149026	1215149026	1	1	DUA, SOHAN L MD FACP AMC	2/28/1988	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8349 RESEDA BLVD	STE G	NORTHRIDGE	CA	91324	4158	19	06037	34.222248	-118.536099	Los Angeles County
153960	Fee-for-Service	1063832277	1063832277	1	1	DUNPHY, TAYLOR R	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129372	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK DR	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
153983	Fee-for-Service	1639182280	1639182280	1	1	DENNIS, DOUGLAS E MD	9/30/1995	207R00000X	NA	Other	026	PHYSICIANS	46533	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
154021	Fee-for-Service	1750308466	1750308466	1	1	DOROTTA, IHAB R MD	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89488	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
154041	Fee-for-Service	1801062625	1801062625	1	1	DEMETROFF, JACQUELYN R AU	2/26/2021	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
154047	Fee-for-Service	1093775900	1093775900	1	1	DAVID ALAN VANENGELENHOVEN M	9/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
154061	Fee-for-Service	1669051785	1669051785	1	1	DO, JESSICA M MD	6/6/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
154073	Fee-for-Service	1669477089	1669477089	1	1	DALLAS COUNTY HOSPITAL	9/27/2008	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	610 10TH ST	None	PERRY	IA	50220	2221	00	None	41.833503	-94.09445197	Dallas County
154109	Fee-for-Service	1578148342	1578148342	1	1	DAVIDSON SUN VALLEY LLC	7/29/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	48 SUN VALLEY CT	None	MERCED	CA	95348	3017	24	06047	37.33053841	-120.4699498	Merced County
154128	Fee-for-Service	1043407208	1043407208	1	1	D'PAJARITOS, INC	2/15/2007	313M00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BIENVENUE ICFDD-N	879 CHEROKEE DR	None	LIVERMORE	CA	94551	1807	01	06001	37.68986452	-121.7863665	Alameda County
154134	Fee-for-Service	1700803418	1700803418	1	30	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2110 PROFESSIONAL DRIVE	STE 105	ROSEVILLE	CA	95661	3778	31	06061	38.74234873	-121.2521259	Placer County
154141	Fee-for-Service	1013310556	1013310556	1	1	DIOKSON RENA MEDICAL	4/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51983	25	Physical Medicine and Rehabilitation	0	In state provider	CORPORATION	500 SUTTER ST	STE 320	SAN FRANCISCO	CA	94102	1120	38	06075	37.78921434	-122.4089415	San Francisco County
154159	Fee-for-Service	1588757074	1588757074	1	1	DADSETAN, MOHAMMAD R MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	49092	30	Radiology	0	In state provider	None	318 W COLORADO ST	STE 2	GLENDALE	CA	91204	1670	19	06037	34.14252447	-118.258893	Los Angeles County
154165	Fee-for-Service	1417038548	1417038548	1	1	DURVASAN, ARVIND MD	1/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4530 E MUIRWOOD DR	STE 105	PHOENIX	AZ	85048	7693	00	None	33.303006	-111.9855375	Maricopa County
154179	Fee-for-Service	1548408735	1548408735	1	2	DUBLIN PHYSICAL THERAPY, INC	11/12/2020	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERAPY	2600 STANWELL DRIVE	SUITE 104	CONCORD	CA	94520	4862	07	06013	37.98689836	-122.047993	Contra Costa County
154192	Fee-for-Service	1700803418	1700803418	1	42	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVE	STE 260	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
154213	Fee-for-Service	1336245778	1336245778	1	1	DEMAGNO, ELIZABETH J MD	8/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	47902	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9920 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
154234	Fee-for-Service	1215149026	1215149026	1	1	DUA, SOHAN L MD FACP AMC	2/28/1988	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	8349 RESEDA BLVD	STE G	NORTHRIDGE	CA	91324	4158	19	06037	34.222248	-118.536099	Los Angeles County
154246	Fee-for-Service	1235269473	1235269473	1	1	DERMATOLOGY & LASER MEDICAL	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	71517	None	None	0	In state provider	CENTER INC	16260 VENTURA BLVD	SUITE 140	ENCINO	CA	91436	5103	19	06037	34.15687678	-118.4876342	Los Angeles County
154276	Fee-for-Service	1811424815	1811424815	1	1	DOEL, JASON MD	10/7/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
154280	Fee-for-Service	1376041459	1376041459	1	1	DEMPSEY, KARINA	4/6/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
154308	Fee-for-Service	1275681298	1275681298	1	1	DO, DUNG MD	10/2/2008	2085B0100X	NA	MRI Provider	026	PHYSICIANS	90025	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
154323	Fee-for-Service	1144471681	1144471681	1	1	DAMIAN, MIHAELA A MD	9/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108637	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
154328	Fee-for-Service	1609890334	1609890334	1	1	DESAI, KAVIN H MD	10/1/1988	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66885	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
154358	Fee-for-Service	1134804941	1134804941	1	1	DE LEON, KATRINA OD	10/1/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
154360	Fee-for-Service	1669477089	1669477089	1	1	DALLAS COUNTY HOSPITAL	9/27/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	610 10TH ST	None	PERRY	IA	50220	2221	00	None	41.833503	-94.09445197	Dallas County
154422	Fee-for-Service	1700803418	1700803418	1	30	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2110 PROFESSIONAL DRIVE	STE 105	ROSEVILLE	CA	95661	3778	31	06061	38.74234873	-121.2521259	Placer County
154478	Fee-for-Service	1902177066	1902177066	1	1	DAO, VIET TRONG MD APMC	2/27/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	96409	08	Family Practice	0	In state provider	None	4616 EL CAJON BLVD	SUITE 9	SAN DIEGO	CA	92115	4426	37	06073	32.75567113	-117.0951834	San Diego County
154483	Fee-for-Service	1700803418	1700803418	1	42	DIGNITY HEALTH MEDICAL FOUND	1/10/2021	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6555 COYLE AVE	STE 260	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
154501	Fee-for-Service	1376638718	1376638718	1	1	DR. JOHNSON, JASON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OBSTETRICS & GYNECOLOGY	850 E 300 S	None	SALT LAKE CTY	UT	84102	2332	00	None	40.76280248	-111.8666565	Salt Lake County
154534	Fee-for-Service	1548219314	1548219314	1	1	DUNBAR, WILLIAM H V MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	112400	20	Orthopedic Surgery	0	In state provider	None	533 E MICHELTORENA ST	STE 204	SANTA BARBARA	CA	93103	2284	42	06083	34.43233822	-119.701775	Santa Barbara County
154568	Fee-for-Service	1982953758	1982953758	1	1	DELTA HOME HEALTH INC	11/7/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9948 HIBERT STREET	SUITE 105	SAN DIEGO	CA	92131	1033	37	06073	32.91386346	-117.112293	San Diego County
154585	Fee-for-Service	1962862052	1962862052	1	1	DIMLA, ROMERSON MD	7/1/2019	207L00000X	NA	Other	026	PHYSICIANS	141073	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
154596	Fee-for-Service	1497058424	1497058424	1	1	DAVID E ROGERS MD A PROFESSI	4/11/2022	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	ONAL CORPORATION	222 W EULALIA ST	SUITE 309	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
154637	Fee-for-Service	1386937977	1386937977	1	9	DIGNITY HEALTH MEDICAL FOUND	12/27/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	550 ST CHARLES DR	STE 200	THOUSAND OAKS	CA	91360	3973	56	06111	34.18543014	-118.8777916	Ventura County
154639	Fee-for-Service	1275726655	1275726655	1	1	DE, MONYA MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102765	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA ST	SUITE 150	BURBANK	CA	91505	4522	19	06037	34.15872557	-118.3283863	Los Angeles County
154647	Fee-for-Service	1477942688	1477942688	1	1	DARROW, SABRINA M PHD	6/1/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
154664	Fee-for-Service	1871567164	1871567164	1	1	DENNO, SHELLEEN E MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50098	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2285 OLIVET LN	None	SANTA ROSA	CA	95401	3828	49	06097	38.47871137	-122.8119411	Sonoma County
154692	Fee-for-Service	1013387562	1013387562	1	1	DIRECTO, SHARI V MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137324	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
154739	Fee-for-Service	1861430456	1861430456	1	1	DA GRACA, RALPH L MD	5/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74313	05	Anesthesiology	0	In state provider	None	1100 W STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
154769	Fee-for-Service	1700803418	1700803418	1	42	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVE	STE 260	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
154811	Fee-for-Service	1588902258	1588902258	1	1	DAWLEY, MONICA T NP	7/29/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
154824	Fee-for-Service	1104981661	1104981661	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
154837	Fee-for-Service	1265454037	1265454037	1	1	DUNLAVEY, DANA C MD	7/1/1995	207P00000X	NA	Other	026	PHYSICIANS	70380	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
154954	Fee-for-Service	1871567164	1871567164	1	1	DENNO, SHELLEEN E MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50098	41	Internal Medicine	0	In state provider	None	2285 OLIVET LN	None	SANTA ROSA	CA	95401	3828	49	06097	38.47871137	-122.8119411	Sonoma County
155001	Fee-for-Service	1982715942	1982715942	1	1	DREW, CHARLOTTE S MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66068	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155003	Fee-for-Service	1043074651	1043074651	1	1	DOULA VINE	2/20/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
155033	Fee-for-Service	1083494629	1083494629	1	1	DYNAMIC PATHWAYS PSYCHOLOGY	11/21/2024	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	2635 CAMINO DEL RIO S	STE 303	SAN DIEGO	CA	92108	3729	37	06073	32.76964954	-117.1361092	San Diego County
155056	Fee-for-Service	1700803418	1700803418	1	42	DIGNITY HEALTH MEDICAL FOUND	4/21/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	6555 COYLE AVE	STE 260	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
155112	Fee-for-Service	1407570898	1407570898	1	1	DURODOLA, HANNAH	11/6/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
155133	Fee-for-Service	1497702971	1497702971	1	1	DAKKAK, ISSA G MD	7/31/1987	207L00000X	NA	Other	026	PHYSICIANS	40784	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
155176	Fee-for-Service	1720303530	1720303530	1	1	DOWD, CASIMIR L MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117198	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 140	LOS ANGELES	CA	90095	3075	19	06037	34.06527974	-118.4462792	Los Angeles County
155197	Fee-for-Service	1679077390	1679077390	1	1	DIMAL, MADELAINE M MD	3/16/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165420	None	None	0	In state provider	None	3833 WORSHAM AVE	STE 301	LONG BEACH	CA	90808	1766	19	06037	33.828552	-118.1462755	Los Angeles County
155316	Fee-for-Service	1083494629	1083494629	1	1	DYNAMIC PATHWAYS PSYCHOLOGY	11/21/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	2635 CAMINO DEL RIO S	STE 303	SAN DIEGO	CA	92108	3729	37	06073	32.76964954	-117.1361092	San Diego County
155368	Fee-for-Service	1245270313	1245270313	1	1	DO, DIANA V MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143489	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155404	Fee-for-Service	1164628384	1164628384	1	1	DATTOMA, LUCIA L MD	12/18/2007	207R00000X	NA	Other	026	PHYSICIANS	87809	38	Geriatrics	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
155409	Fee-for-Service	1750403044	1750403044	1	1	DUA, ANISHA R NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	21263 ERWIN STREET	None	WOODLAND HILLS	CA	91367	3715	19	06037	34.18286951	-118.5949215	Los Angeles County
155542	Fee-for-Service	1356360812	1356360812	1	1	DIETRICH, BRIAN D LMFT	8/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	, LMFT	1531 PURDUE AVE	2	LOS ANGELES	CA	90025	3104	19	06037	34.04643848	-118.4513015	Los Angeles County
155553	Fee-for-Service	1174578025	1174578025	1	1	DR AMY BARUCH	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST LUKE'S REGIONAL MD	520 S EAGLE RD	None	MERIDIAN	ID	83642	0000	00	None	43.600527	-116.3518425	Ada County
155601	Fee-for-Service	1942350491	1942350491	1	1	DONGMEI, JIANG MD	9/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105962	13	Neurology (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
155616	Fee-for-Service	1194037879	1194037879	1	1	DAGHER MD MEDICAL GROUP INC	1/27/2011	207R00000X	NA	Other	026	PHYSICIANS	98565	41	Internal Medicine	0	In state provider	None	376 W BADILLO STREET	None	COVINA	CA	91723	1827	19	06037	34.0862457	-117.8963259	Los Angeles County
155626	Fee-for-Service	1144261116	1144261116	1	1	DELINGER, JENNIFER R DC	3/4/2008	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1445 MARION ST	None	KINGSBURG	CA	93631	1928	10	06019	36.51423529	-119.5523323	Fresno County
155650	Fee-for-Service	1215296231	1215296231	1	1	DUNNING, FRED I JR LMFT	9/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15500 W SAND ST	STE 4	VICTORVILLE	CA	92392	2906	36	06071	34.51317572	-117.3255013	San Bernardino County
155671	Fee-for-Service	1104985712	1104985712	1	1	DURINZI, KAREN L MD	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73474	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
155695	Fee-for-Service	1164628384	1164628384	1	1	DATTOMA, LUCIA L MD	12/18/2007	207R00000X	NA	Other	026	PHYSICIANS	87809	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
155696	Fee-for-Service	1932488566	1932488566	1	1	DIXIT, ANJALI MD	10/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146983	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	1927	31	06061	38.76553806	-121.2497067	Placer County
155699	Fee-for-Service	1124700729	1124700729	1	1	DESERT RHEUMATOLOGY INFUSION	11/1/2023	207RR0500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	S INC	79215 CORPORATE CENTER D	None	LA QUINTA	CA	92253	7232	33	06065	33.71036635	-116.2826037	Riverside County
155715	Fee-for-Service	1518480409	1518480409	1	1	DODD, WILLIAM	3/24/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	17135 VENTURA BLVD	None	ENCINO	CA	91316	4004	19	06037	34.16041981	-118.5065569	Los Angeles County
155731	Fee-for-Service	1295755783	1295755783	1	1	DIPPLE, KATRINA M MD	6/1/2000	2082S0099X	NA	General Surgery	026	PHYSICIANS	61420	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	RM 12430	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
155740	Fee-for-Service	1780953372	1780953372	1	1	DARDEN, MICAH W	1/31/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	420 B ST	None	YUBA CITY	CA	95991	5070	51	06101	39.13415904	-121.6121453	Sutter County
155757	Fee-for-Service	1639346653	1639346653	1	1	DR. GREGORY VIGESAA D.O.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
155859	Fee-for-Service	1649438375	1649438375	1	1	DUNCKEL, JASMINE A LMFT	4/20/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	450 DONDEE WAY	STE 5	PACIFICA	CA	94044	3258	41	06081	37.6099015	-122.4957209	San Mateo County
155870	Fee-for-Service	1548981616	1548981616	1	1	DUFFY'S NAPA VALLEY REHAB, L	7/9/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1406 FAIR WAY	None	CALISTOGA	CA	94515	1305	28	06055	38.5815871	-122.5806005	Napa County
155875	Fee-for-Service	1831428192	1831428192	1	1	DRAZEN, KAREN LMFT	5/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	33 QUAIL CT	STE 200	WALNUT CREEK	CA	94596	5597	07	06013	37.8879924	-122.0553177	Contra Costa County
155884	Fee-for-Service	1063480564	1063480564	1	1	DAVID DONG M.D.	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	751 NE BLAKELY DR	None	ISSAQUAH	WA	98029	6201	00	None	47.53652154	-122.0220045	King County
155887	Fee-for-Service	1386937977	1386937977	1	20	DIGNITY HEALTH MEDICAL FOUND	9/4/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	- VENTURA COUNTY INC	2601 E MAIN ST	STE 100	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
155905	Fee-for-Service	1326113929	1326113929	1	1	DAHLSTROM, ANDERS K MD	5/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52400	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
155906	Fee-for-Service	1669472163	1669472163	2	1	DADABHOY, SHAHIDA M MD	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51315	40	Pediatrics	0	In state provider	None	145 W WILLOW STREET	None	POMONA	CA	91768	1829	19	06037	34.07899674	-117.7533706	Los Angeles County
155922	Fee-for-Service	1104856095	1104856095	1	4	DESERT REGIONAL MEDICAL	3/11/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	47-647 CALEO BAY DRIVE	SUITE 101	LA QUINTA	CA	92253	8857	33	06065	33.70362335	-116.2938105	Riverside County
155936	Fee-for-Service	1598833790	1598833790	1	1	DE LEON, JAVIER L MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87324	41	Internal Medicine	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
155949	Fee-for-Service	1184710550	1184710550	1	1	DIAMOND, LISA C MD	10/15/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	174744	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
156008	Fee-for-Service	1336129469	1336129469	1	1	DEETZ, THOMAS R MD	1/23/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	43367	41	Internal Medicine	0	In state provider	None	850 FREEDOM BLVD	None	WATSONVILLE	CA	95076	3814	44	06087	36.91844072	-121.7600286	Santa Cruz County
156053	Fee-for-Service	1043976525	1043976525	1	1	DE ANDA, ASHLEY PT	1/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8282 WHITE OAK AVE	107, 108, AND 111	RANCHO CUCAMONGA	CA	91730	7680	36	06071	34.10361339	-117.5644472	San Bernardino County
156081	Fee-for-Service	1033297817	1033297817	1	1	DELIUS-MAXWELL, SYLVIA	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52023	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
156114	Fee-for-Service	1184120230	1184120230	1	1	DOBALIAN, PAIGE A MD	4/5/2022	207R00000X	NA	Other	026	PHYSICIANS	163619	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
156124	Fee-for-Service	1629092473	1629092473	1	1	DAVID, TAL MD	4/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	69504	20	Orthopedic Surgery	0	In state provider	None	4910 DIRECTORS PLACE	SUITE 350	SAN DIEGO	CA	92121	3834	37	06073	32.89428695	-117.2115258	San Diego County
156137	Fee-for-Service	1548408735	1548408735	1	3	DUBLIN PHYSICAL THERAPY, INC	5/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ERAPY	2492 NISSEN DRIVE	None	LIVERMORE	CA	94551	7704	01	06001	37.69957314	-121.8152197	Alameda County
156139	Fee-for-Service	1629326566	1629326566	1	1	DEAN, MICHELLE	10/31/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
156173	Fee-for-Service	1700803418	1700803418	1	35	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	STE 364	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
156195	Fee-for-Service	1326113929	1326113929	1	1	DAHLSTROM, ANDERS K MD	5/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52400	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
156213	Fee-for-Service	1376644799	1376644799	1	1	DAVIS, RUSSELL C DPM	1/31/1987	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1460 N CAMINO ALTO	STE 100	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
156238	Fee-for-Service	1790712750	1790712750	1	1	DANWISH,TAREK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	0000	00	None	39.08455286	-94.57578107	Jackson County
156288	Fee-for-Service	1689861353	1689861353	1	1	DR HEEJUNG KOH	10/9/2007	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORPORATION	18337 E COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2762	19	06037	33.9885213	-117.9051368	Los Angeles County
156291	Fee-for-Service	1851377675	1851377675	1	1	DR. EMEM UDONTA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SOUTHEAST TEXAS NEUROLOG	3780 MEMORIAL BLVD	None	PORT ARTHUR	TX	77640	0209	00	None	29.91303546	-93.9479166	Jefferson County
156300	Fee-for-Service	1710065214	1710065214	1	1	DANG, RICKY DO	3/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8368	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
156301	Fee-for-Service	1306266796	1306266796	1	1	DAVID MERRILL	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
156350	Fee-for-Service	1952834616	1952834616	1	1	DHALIWAL, PARVINJIT S DO	8/10/2021	207L00000X	NA	Other	026	PHYSICIANS	18561	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
156375	Fee-for-Service	1790001212	1790001212	1	1	DRIFTWOOD HLTHCRE & WELLNESS	8/3/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4109 EMERALD STREET	None	TORRANCE	CA	90503	3105	19	06037	33.84138658	-118.357126	Los Angeles County
156378	Fee-for-Service	1649226382	1649226382	1	1	DOYLE, CHRISTINE A MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70379	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
156383	Fee-for-Service	1922217637	1922217637	1	1	DREDAR, SERAG MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121430	10	Gastroenterology (M.D. only)	0	In state provider	None	550 B STREET	None	YUBA CITY	CA	95991	5067	51	06101	39.13299265	-121.6155493	Sutter County
156405	Fee-for-Service	1053609834	1053609834	1	1	DIEP, HY S PHD	5/14/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
156424	Fee-for-Service	1548408735	1548408735	1	3	DUBLIN PHYSICAL THERAPY, INC	11/12/2020	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ERAPY	2492 NISSEN DRIVE	None	LIVERMORE	CA	94551	7704	01	06001	37.69957314	-121.8152197	Alameda County
156463	Fee-for-Service	1700803418	1700803418	1	35	DIGNITY HEALTH MEDICAL FOUND	9/21/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J STREET	STE 364	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
156490	Fee-for-Service	1437158425	1437158425	1	1	DINH, TOMMY MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62294	02	General Surgery	0	In state provider	None	1000 E LATHAM AVE	STE B	HEMET	CA	92543	4409	33	06065	33.74942449	-116.961741	Riverside County
156534	Fee-for-Service	1750513644	1750513644	1	1	DO, STEPHANIE T DO	3/1/2019	2080P0204X	NA	Other	026	PHYSICIANS	15967	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
156597	Fee-for-Service	1427150820	1427150820	1	1	DODDAKASHI, VEENA R MD	5/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89355	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
156617	Fee-for-Service	1811341225	1811341225	1	2	DUNCAN, DONNA L LCSW	9/24/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1352 COLUSA HWY	SUITE C	YUBA CITY	CA	95993	9147	51	06101	39.14177255	-121.635963	Sutter County
156656	Fee-for-Service	1871582718	1871582718	1	1	D'ALESSANDRO,MICHEAL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSPITAL &	CLINICS	200 HAWKINS DRIVE	IOWA CITY	IA	52242	0000	00	None	0	0	None
156704	Fee-for-Service	1831129808	1831129808	1	1	DUTHIE, SUSAN E MD	7/31/1987	2080P0203X	NA	Other	026	PHYSICIANS	61247	40	Pediatrics	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
156744	Fee-for-Service	1558344762	1558344762	1	1	DECRISTOFORO, LORA A PHD	6/22/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	None	SACRAMENTO	CA	95820	1532	34	06067	38.546091	-121.447305	Sacramento County
156749	Fee-for-Service	1700803418	1700803418	1	35	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	STE 364	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
156752	Fee-for-Service	1265721708	1265721708	1	1	DIDI HIRSCH PSYCHIATRIC SERV	6/5/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	1540 EAST COLORADO STREE	None	GLENDALE	CA	91205	1514	19	06037	34.1427285	-118.230039	Los Angeles County
156824	Fee-for-Service	1750513644	1750513644	1	1	DO, STEPHANIE T DO	3/1/2019	2080P0204X	NA	Other	026	PHYSICIANS	15967	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
156881	Fee-for-Service	1033441662	1033441662	1	1	DOM, NANCY L MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110370	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
156889	Fee-for-Service	1225682446	1225682446	1	1	DUALAN, GRACE M CNP	4/8/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
156908	Fee-for-Service	1013229707	1013229707	1	1	DURAN-MARTINEZ, CARLOS E MD	5/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119926	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
156964	Fee-for-Service	1134348469	1134348469	1	1	DANIELS,KERRI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	SLOT 663	LITTLE ROCK	AR	72202	0000	00	None	34.742745	-92.2927905	Pulaski County
157020	Fee-for-Service	1427079680	1427079680	1	1	DENNIS, PAUL J MD	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	36296	05	Anesthesiology	0	In state provider	None	2700 DOLBEER STRET	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
157022	Fee-for-Service	1831496942	1831496942	1	1	DHARMADHIKARI, SUSHRUT S MD	5/23/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	176123	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
157045	Fee-for-Service	1114075439	1114075439	1	1	DESAI, TUSHAR J MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89935	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157075	Fee-for-Service	1710941539	1710941539	1	1	DOMENICK J SISTO, MD	9/10/1992	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	LOS ANGELES ORTHO INSTU	4955 VAN NUYS BLVD	STE 615	SHERMAN OAKS	CA	91403	1839	19	06037	34.160805	-118.4487295	Los Angeles County
157194	Fee-for-Service	1750877239	1750877239	1	1	DR. LATISHA PATEL, A PROFESS	4/27/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SOCIATES	5030 HAMNER AVE	None	EASTVALE	CA	91752	1009	36	06071	33.996744	-117.555534	Riverside County
157207	Fee-for-Service	1265581318	1265581318	1	1	DEVELOPMENTAL CLIENT	7/11/1992	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INDUSTRIES INC	13217 RUNNING DEER RD	None	MORENO VALLEY	CA	92553	3258	33	06065	33.92870805	-117.2476338	Riverside County
157223	Fee-for-Service	1780271908	1780271908	1	1	DAVID D GILBERT, MD, INC	9/20/2022	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	350 N WIGET LANE	SUITE 200	WALNUT CREEK	CA	94598	3058	07	06013	37.92948925	-122.0275099	Contra Costa County
157289	Fee-for-Service	1215332010	1215332010	1	1	DAMAVAND, MOHSEN MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146130	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
157290	Fee-for-Service	1053790469	1053790469	1	1	DESAI, TANVI A MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157803	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365 420 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
157331	Fee-for-Service	1114075439	1114075439	1	1	DESAI, TUSHAR J MD	4/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89935	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
157346	Fee-for-Service	1891107231	1891107231	1	1	DIVINE FAMILY CARE LLC	5/15/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8194 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	1535	34	06067	38.714814	-121.271121	Sacramento County
157370	Fee-for-Service	1760801450	1760801450	1	1	DUNAMIS INC GROUP HOME	6/3/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 EAST CHURCH AVE	A1	FRESNO	CA	93706	4344	10	06019	36.7141105	-119.7986445	Fresno County
157386	Fee-for-Service	1679295422	1679295422	1	1	DE LEON, MICHELLE CNP	5/24/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7014 N WHITNEY AVE	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
157387	Fee-for-Service	1457468001	1457468001	1	1	DARGAN-BATRA, SOINA MD	11/6/2007	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	78997	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90801	1701	19	06037	33.808185	-118.1850575	Los Angeles County
157410	Fee-for-Service	1932488566	1932488566	1	2	DIXIT, ANJALI MD	3/21/2023	207R00000X	NA	Other	026	PHYSICIANS	146983	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
157501	Fee-for-Service	1194977652	1194977652	1	1	DEISS, ROBERT MD	4/6/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	111310	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
157508	Fee-for-Service	1780271908	1780271908	1	1	DAVID D GILBERT, MD, INC	9/20/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 N WIGET LANE	SUITE 200	WALNUT CREEK	CA	94598	3058	07	06013	37.92948925	-122.0275099	Contra Costa County
157524	Fee-for-Service	1457385304	1457385304	1	1	DRAYTON, GAIL E MD	7/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	32829	07	Dermatology	0	In state provider	None	11600 WILSHIRE BLVD	STE 516	LOS ANGELES	CA	90025	1788	19	06037	34.05055194	-118.4594619	Los Angeles County
157525	Fee-for-Service	1326196213	1326196213	1	1	DOAN, VY V MD	7/1/1998	2084P0804X	NA	Psychiatry	026	PHYSICIANS	79297	36	Psychiatry	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
157579	Fee-for-Service	1144974676	1144974676	1	1	DR. PATRICK MACLEAMY & ASSOC	5/10/2022	103TM1800X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IATES PSYCHOLOGICAL ASSE	755 BAYWOOD DR	FL 2	PETALUMA	CA	94954	5510	49	06097	38.23130634	-122.6132832	Sonoma County
157611	Fee-for-Service	1790856722	1790856722	1	1	DEA, JEAN K MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	52574	40	Pediatrics	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
157672	Fee-for-Service	1457468001	1457468001	1	1	DARGAN-BATRA, SOINA MD	11/6/2007	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	78997	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90801	1701	19	06037	33.808185	-118.1850575	Los Angeles County
157680	Fee-for-Service	1013392588	1013392588	1	1	DALY, KAITLYN R LMFT	10/6/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119827	-	NOT APPLICABLE	0	In state provider	None	855 3RD AVENUE	SUITE 2230	CHULA VISTA	CA	91911	1350	37	06073	32.62197574	-117.0723222	San Diego County
157685	Fee-for-Service	1194955435	1194955435	1	1	DEFORD, STEVEN M MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
157700	Fee-for-Service	1316066632	1316066632	1	1	DHIR, HARINDER K MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	64262	01	General Practice	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
157725	Fee-for-Service	1235153891	1235153891	1	1	DOLGONOS, ELENA A MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83291	08	Family Practice	0	In state provider	None	2201 MISSION AVE	None	OCEANSIDE	CA	92054	2328	37	06073	33.20742226	-117.3612486	San Diego County
157740	Fee-for-Service	1083304851	1083304851	1	1	DURANT, JAYNE NP	8/20/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2030 W PICO BLVD	None	LOS ANGELES	CA	90006	5011	19	06037	34.04706445	-118.2822723	Los Angeles County
157784	Fee-for-Service	1316951155	1316951155	1	1	DILLON, MITZI A MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
157794	Fee-for-Service	1528648185	1528648185	1	1	DEV, DIVYA MD	9/26/2024	207R00000X	NA	Other	026	PHYSICIANS	191906	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
157847	Fee-for-Service	1578034757	1578034757	1	1	DAGELET, JEFFREY P RCP	7/25/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
157850	Fee-for-Service	1053439463	1053439463	1	1	DAVID GARRISON, M.D.	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	308 STUDENT HEALTH CTR	None	UNIVERSITY PK	PA	16802	2129	00	None	40.8030236	-77.85934948	Centre County
157852	Fee-for-Service	1720036114	1720036114	1	1	DROR, ALAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50927	05	Anesthesiology	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
157864	Fee-for-Service	1144974676	1144974676	1	1	DR. PATRICK MACLEAMY & ASSOC	5/10/2022	103TM1800X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	IATES PSYCHOLOGICAL ASSE	755 BAYWOOD DR	FL 2	PETALUMA	CA	94954	5510	49	06097	38.23130634	-122.6132832	Sonoma County
157888	Fee-for-Service	1134528425	1134528425	1	1	DMMJR INC	10/22/2014	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1730 ALPINE BOULEVARD	SUITE 109	ALPINE	CA	91901	3877	37	06073	32.83771028	-116.7770748	San Diego County
157895	Fee-for-Service	1326312067	1326312067	1	10	DCHS MEDICAL FOUNDATION	11/3/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1145 E COMPTON BLVD	None	COMPTON	CA	90221	3307	19	06037	33.89606151	-118.2106125	Los Angeles County
157897	Fee-for-Service	1790856722	1790856722	1	1	DEA, JEAN K MD	8/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	52574	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
157933	Fee-for-Service	1962962308	1962962308	1	1	DABREO, MARGOT G MD	9/3/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	185502	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
157959	Fee-for-Service	1386757086	1386757086	1	1	DEL CARMEN MEDICAL CTR	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	COMPREMED MED GRP INC	19234 VANOWEN ST	None	RESEDA	CA	91335	5000	19	06037	34.19381648	-118.5527385	Los Angeles County
157972	Fee-for-Service	1386722999	1386722999	1	1	DILDA, ERIC P MD	6/24/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68920	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
158018	Fee-for-Service	1457354003	1457354003	1	1	DAVID RASKIN M.D.	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
158040	Fee-for-Service	1891955027	1891955027	1	1	DAVID BAUER, M.D.	2/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3819 STEPHENS AVE	STE 200	MISSOULA	MT	59801	8522	00	None	46.835955	-114.0137955	Missoula County
158122	Fee-for-Service	1144233610	1144233610	1	1	DECLEVE, GAEL F DO	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	7062	08	Family Practice	0	In state provider	None	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
158128	Fee-for-Service	1144307141	1144307141	1	1	DETATA CYNTHIA L MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61118	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158133	Fee-for-Service	1790727949	1790727949	1	1	DIAZ, JAIME A MD	10/10/2005	207P00000X	NA	Other	026	PHYSICIANS	88200	None	None	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
158165	Fee-for-Service	1093548117	1093548117	1	1	DZIEGIELEWSKI, CLAUDIA B	9/20/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158182	Fee-for-Service	1285033068	1285033068	1	1	DAVIS, GABRIEL MSW LCSW	4/25/2024	163WP0807X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 S MAIN AVE	None	FALLBROOK	CA	92028	2847	37	06073	33.38179393	-117.2513459	San Diego County
158199	Fee-for-Service	1538363676	1538363676	1	1	DELGADILLO, VICTORIA A LCSW	6/13/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
158237	Fee-for-Service	1336193168	1336193168	1	1	DEBELLIS, MICHELLE J CRNA	5/29/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	84626	9225	00	None	35.002656	-114.595893	Mohave County
158253	Fee-for-Service	1982233946	1982233946	1	1	DEMATTEO, CHRISTOPHER MD	3/8/2024	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
158273	Fee-for-Service	1720030638	1720030638	1	1	DUHACHEK-STAPELMAN, AMY L MD	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	EMILE @ 42ND	None	OMAHA	NE	68198	0001	00	None	41.254236	-95.97573	Douglas County
158281	Fee-for-Service	1568142073	1568142073	1	1	DOMINGUEZ, SAVANNAH S CRNA	10/10/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158298	Fee-for-Service	1407934458	1407934458	1	1	DELTA HEALTH CARE AND	12/1/1977	261Q00000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MANAGEMENT SERVICES CORP	1425 SOUTH CENTER ST	None	STOCKTON	CA	95206	2016	39	06077	37.936197	-121.289472	San Joaquin County
158319	Fee-for-Service	1003376716	1003376716	1	1	DEKITANI, KEN MD	8/10/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	176980	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
158339	Fee-for-Service	1063922284	1063922284	1	1	DE CASTRO, DULCE R MD A	12/11/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	PROFESSIONAL CORPORATION	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
158374	Fee-for-Service	1184795148	1184795148	1	1	DUONG ANH MINH MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	75167	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
158396	Fee-for-Service	1487186128	1487186128	1	1	DING, FEIHONG MD	8/19/2020	207R00000X	NA	Other	026	PHYSICIANS	166995	41	Internal Medicine	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
158470	Fee-for-Service	1235163726	1235163726	1	1	DUONG, TAO H MD	8/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68522	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10301 BOLSA AVE	STE 209	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
158519	Fee-for-Service	1700803418	1700803418	1	55	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 200	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
158542	Fee-for-Service	1417086208	1417086208	1	1	DAGAN, LIMOR LMFT	10/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158582	Fee-for-Service	1639606650	1639606650	1	1	DU, XIAOTANG MD	6/9/2023	207ZP0102X	NA	Other	026	PHYSICIANS	186163	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
158599	Fee-for-Service	1508492547	1508492547	1	1	DEFURIA, MEGAN	7/21/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	181136	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
158611	Fee-for-Service	1942454228	1942454228	1	1	DEVRIES, MARILYN S MD	6/30/1989	207P00000X	NA	Other	026	PHYSICIANS	41259	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
158664	Fee-for-Service	1184795148	1184795148	1	1	DUONG ANH MINH MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	75167	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
158677	Fee-for-Service	1609833367	1609833367	1	1	DR CARRIE R KUBOTA AND	4/13/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES AN OPTOMETRIC	1197 E LOS ANGELES AVE	STE D	SIMI VALLEY	CA	93065	2868	56	06111	34.27182946	-118.7778465	Ventura County
158678	Fee-for-Service	1225458227	1225458227	1	1	DISLA, YALINA MD	12/11/2020	207P00000X	NA	Other	026	PHYSICIANS	160664	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
158682	Fee-for-Service	1326544313	1326544313	1	1	DONG, JUSTIN DO	5/6/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17942	08	Family Practice	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
158708	Fee-for-Service	1538106307	1538106307	1	1	DEUTSCH, JASON H MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83031	30	Radiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
158758	Fee-for-Service	1235163726	1235163726	1	1	DUONG, TAO H MD	8/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68522	41	Internal Medicine	0	In state provider	None	10301 BOLSA AVE	STE 209	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
158763	Fee-for-Service	1457008401	1457008401	1	1	DELUXE TRANSPORT SERVICE L.L	2/22/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	.C	900 E HAMILTON AVE	100	CAMPBELL	CA	95008	0664	43	06085	37.29428651	-121.934403	Santa Clara County
158789	Fee-for-Service	1831241280	1831241280	1	1	DEAN, JEFFERY L	12/5/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
158807	Fee-for-Service	1700803418	1700803418	1	43	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
158821	Fee-for-Service	1326059452	1326059452	1	1	DERMENDJIAN, KARAPET MD	2/7/2008	174400000X	NA	Other	026	PHYSICIANS	38999	05	Anesthesiology	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
158829	Fee-for-Service	1700426558	1700426558	1	1	DANIEL COULTER, M.D. INC.	6/10/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	801 SENECA ST	None	VENTURA	CA	93001	1411	56	06111	34.30762576	-119.2837994	Ventura County
158831	Fee-for-Service	1568868065	1568868065	1	1	DALAL, NEIL D MD INC	2/17/2015	2086S0122X	NA	General Surgery	026	PHYSICIANS	130127	24	Plastic Surgery	0	In state provider	None	833 AUTO CENTER DR	STE D AND E	PALMDALE	CA	93551	4488	19	06037	34.59142577	-118.1466519	Los Angeles County
158893	Fee-for-Service	1851396576	1851396576	1	1	DESERT VALLEY HOSPITAL	9/19/1994	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
158899	Fee-for-Service	1942454228	1942454228	1	1	DEVRIES, MARILYN S MD	6/30/1989	207P00000X	NA	Other	026	PHYSICIANS	41259	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
158913	Fee-for-Service	1609041813	1609041813	2	1	DENTAL SURGERY CENTERS OF	5/31/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	AMERICA	1523 E MARCH LN	SUITE A	STOCKTON	CA	95210	5607	39	06077	38.00244788	-121.2897064	San Joaquin County
158929	Fee-for-Service	1750315941	1750315941	1	1	DAVIDSON, ROBERT MD INC	11/10/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	22792	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8635 W 3RD ST	STE 1050W	LOS ANGELES	CA	90048	6105	19	06037	34.07361928	-118.3803143	Los Angeles County
158940	Fee-for-Service	1386937977	1386937977	1	5	DIGNITY HEALTH MEDICAL FOUND	7/5/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	64 E DAILY DRIVE	None	CAMARILLO	CA	93010	5803	56	06111	34.22174543	-119.0683503	Ventura County
158994	Fee-for-Service	1710952346	1710952346	1	1	DOYLE, BRIAN P MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86721	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
159026	Fee-for-Service	1568841278	1568841278	1	1	DUNAMIS INC GROUP HOME	10/27/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2445 WEST DAKOTA AVENUE	None	FRESNO	CA	93705	2611	10	06019	36.78645547	-119.839581	Fresno County
159063	Fee-for-Service	1740210228	1740210228	1	1	DOMINY, STEPHEN S MD	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	62404	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93/95	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159095	Fee-for-Service	1700803418	1700803418	1	55	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 200	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
159119	Fee-for-Service	1568868065	1568868065	1	1	DALAL, NEIL D MD INC	2/17/2015	2086S0122X	NA	General Surgery	026	PHYSICIANS	130127	02	General Surgery	0	In state provider	None	833 AUTO CENTER DR	STE D AND E	PALMDALE	CA	93551	4488	19	06037	34.59142577	-118.1466519	Los Angeles County
159120	Fee-for-Service	1659450187	1659450187	1	1	DALE, KAREN M CRNA	7/7/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
159220	Fee-for-Service	1750315941	1750315941	1	1	DAVIDSON, ROBERT MD INC	11/10/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	22792	01	General Practice	0	In state provider	None	8635 W 3RD ST	STE 1050W	LOS ANGELES	CA	90048	6105	19	06037	34.07361928	-118.3803143	Los Angeles County
159252	Fee-for-Service	1730607417	1730607417	1	1	DUHE, MARTHA LPCC	5/3/2022	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA U	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
159307	Fee-for-Service	1982898870	1982898870	1	1	DON MICHAEL, TANTRIMUDAL	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	25396	41	Internal Medicine	0	In state provider	ADVANCED HEART & MEDICAL	5343 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0641	15	06029	35.36711078	-119.062372	Kern County
159336	Fee-for-Service	1861640997	1861640997	1	1	DOE, MARIAN MD	10/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105109	01	General Practice	0	In state provider	None	7145 N CHESTNUT AVE	101	FRESNO	CA	93720	0359	10	06019	36.84050111	-119.7381232	Fresno County
159338	Fee-for-Service	1275247793	1275247793	1	1	DEMIRCHYAN, TIGRAN PT	2/11/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16573 VENTURA BLVD	5	ENCINO	CA	91436	2022	19	06037	34.1578643	-118.4944187	Los Angeles County
159384	Fee-for-Service	1700803418	1700803418	1	55	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 200	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
159393	Fee-for-Service	1174930085	1174930085	1	1	DUBOS, JONATHAN M PSYD	4/25/2023	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
159452	Fee-for-Service	1386803385	1386803385	1	1	DHILLON MD INC	10/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	89879	77	Infectious Disease	0	In state provider	None	700 17TH ST	SUITE 102	MODESTO	CA	95354	1247	50	06099	37.64283069	-120.9903982	Stanislaus County
159453	Fee-for-Service	1700803418	1700803418	1	41	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	57	06113	38.56097929	-121.7800614	Yolo County
159479	Fee-for-Service	1053503581	1053503581	1	1	DJANBATIAN, MOVSES OD	10/1/2002	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
159508	Fee-for-Service	1033273727	1033273727	1	1	DIBIASE, ARIA MD	10/31/1989	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56433	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
159515	Fee-for-Service	1396312328	1396312328	1	1	DOMINGO, ROGELLYN S NP	1/5/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
159536	Fee-for-Service	1538163886	1538163886	1	1	DAMERON HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATION	525 W ACACIA ST	None	STOCKTON	CA	95203	2484	39	06077	37.9611947	-121.3009489	San Joaquin County
159541	Fee-for-Service	1730542846	1730542846	1	1	DEVANEY, XAN C PSYD	12/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	103 S FOREST RD	None	SONORA	CA	95370	4895	55	06109	37.98049475	-120.3898999	Tuolumne County
159552	Fee-for-Service	1215129416	1215129416	1	1	DATTA, ANUJ MD	6/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102207	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
159562	Fee-for-Service	1275518177	1275518177	1	1	DRENNAN, JAMES P MD	3/15/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	51403	41	Internal Medicine	0	In state provider	None	6815 FIRE STAR BLVD	STE 100	ROCKLIN	CA	95677	0000	31	06061	0	0	None
159567	Fee-for-Service	1891141446	1891141446	1	1	DIAZ, DANIEL DO	6/10/2022	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	16032	None	None	0	In state provider	None	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
159596	Fee-for-Service	1518983543	1518983543	1	1	DE CARVALHO, CARLOS T MD	5/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	38504	66	Emergency Medicine (Urgent Care)	0	In state provider	None	450 4TH AVE	STE 304	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
159621	Fee-for-Service	1831126804	1831126804	1	1	DIAZ-ABARCA, JULIO CNM	6/7/2006	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159649	Fee-for-Service	1851305312	1851305312	1	1	DEVORE, GREGGORY R MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	44446	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	301 S FAIROAKS AVE	STE 206	PASADENA	CA	91105	2536	19	06037	34.140348	-118.1504565	Los Angeles County
159650	Fee-for-Service	1285306456	1285306456	1	1	DUNCAN, DENISE D CNP	2/28/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	38780 TRADE CENTER DR	SUITE 1C	PALMDALE	CA	93551	3641	19	06037	34.58685376	-118.1430494	Los Angeles County
159672	Fee-for-Service	1700803418	1700803418	1	13	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8001 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7901	34	06067	38.664486	-121.266099	Sacramento County
159677	Fee-for-Service	1447787171	1447787171	1	1	DITCH, SCOTT MD	8/7/2020	207R00000X	NA	Other	026	PHYSICIANS	169495	41	Internal Medicine	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
159690	Fee-for-Service	1831898915	1831898915	1	1	DURAN, VENUS T NP	4/7/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
159722	Fee-for-Service	1922267970	1922267970	1	1	DEAFENBAUGH, BRADLEY K MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130245	20	Orthopedic Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
159742	Fee-for-Service	1700803418	1700803418	1	41	DIGNITY HEALTH MEDICAL FOUND	5/11/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	57	06113	38.56097929	-121.7800614	Yolo County
159770	Fee-for-Service	1467880021	1467880021	1	1	DHANOTA, NISHI K DPM	8/17/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
159773	Fee-for-Service	1386750487	1386750487	1	1	DHILLON, SURINDER P MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40688	41	Internal Medicine	0	In state provider	None	6079 N FRESNO ST	STE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
159804	Fee-for-Service	1023080488	1023080488	1	1	DEVLAMING, WILLIAM H MD	2/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	33859	41	Internal Medicine	0	In state provider	None	1441 LIBERTY ST	STE 101	REDDING	CA	96001	0848	45	06089	40.5857177	-122.3870781	Shasta County
159808	Fee-for-Service	1770511040	1770511040	1	1	DEVANE, MATTHEW S DO	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7765	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	365 HAWTHORNE AVE	STE 201	OAKLAND	CA	94609	3114	01	06001	37.82079728	-122.2633226	Alameda County
159816	Fee-for-Service	1538163886	1538163886	1	1	DAMERON HOSPITAL	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATION	525 W ACACIA ST	None	STOCKTON	CA	95203	2484	39	06077	37.9611947	-121.3009489	San Joaquin County
159839	Fee-for-Service	1346250396	1346250396	1	1	DR.MIKEL WALK-IN CLINIC, INC	7/5/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15791 BEAR VALLEY RD.	None	HESPERIA	CA	92345	1746	36	06071	34.47063553	-117.3190095	San Bernardino County
159842	Fee-for-Service	1003820267	1003820267	1	1	DIREDO, CHRISTOPHER N PT	12/31/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2808 PARK AVE	SUITE B	MERCED	CA	95348	3392	24	06047	37.31248834	-120.4716474	Merced County
159858	Fee-for-Service	1417735986	1417735986	1	1	DESANTIAGO, YHAIR OD	12/5/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2446 W. WHITTIER BLVD.	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
159875	Fee-for-Service	1184981953	1184981953	1	1	DOW, ADRIENNE C MD	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127964	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
159884	Fee-for-Service	1518983543	1518983543	1	1	DE CARVALHO, CARLOS T MD	5/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	38504	41	Internal Medicine	0	In state provider	None	450 4TH AVE	STE 304	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
159889	Fee-for-Service	1851464739	1851464739	1	1	DSOUZA, MARINA MD	2/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	36091	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
159936	Fee-for-Service	1851305312	1851305312	1	1	DEVORE, GREGGORY R MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	44446	15	Obstetrics (D.O. only)	0	In state provider	None	301 S FAIROAKS AVE	STE 206	PASADENA	CA	91105	2536	19	06037	34.140348	-118.1504565	Los Angeles County
159960	Fee-for-Service	1700803418	1700803418	1	43	DIGNITY HEALTH MEDICAL FOUND	1/19/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
160026	Fee-for-Service	1700803418	1700803418	1	63	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3939 J STREET	SUITE 330	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
160029	Fee-for-Service	1700803418	1700803418	1	41	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2330 W COVELL BLVD	None	DAVIS	CA	95616	5658	57	06113	38.56097929	-121.7800614	Yolo County
160046	Fee-for-Service	1538161757	1538161757	1	1	DESCANSO DERMATOLOGY	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	MEDICAL GROUP	1346 FOOTHILL BLVD	STE 203	LA CANADA	CA	91011	2141	19	06037	34.20780552	-118.2076252	Los Angeles County
160051	Fee-for-Service	1760192876	1760192876	1	1	DELUXE CARE MEDICAL TRANSPOR	9/13/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TATION INC	1611 E GETTYSBURG AVE	UNIT A	FRESNO	CA	93704	3410	10	06019	36.80131126	-119.7914377	Fresno County
160053	Fee-for-Service	1689614273	1689614273	1	1	DAVID LAWRENCE MD	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
160059	Fee-for-Service	1386750487	1386750487	1	1	DHILLON, SURINDER P MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40688	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6079 N FRESNO ST	STE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
160070	Fee-for-Service	1700803418	1700803418	1	8	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
160075	Fee-for-Service	1811435654	1811435654	1	1	DELA CRUZ, TITUS J CRNA	10/31/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
160098	Fee-for-Service	1629424726	1629424726	1	1	DOWNTOWN DIALYSIS LLC	10/26/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2511 W 3RD ST	None	LOS ANGELES	CA	90057	1923	19	06037	34.0652217	-118.2771726	Los Angeles County
160105	Fee-for-Service	1124285705	1124285705	1	1	DE GENESTE, LISA M LCSW	10/26/2010	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	400 29TH ST	STE 405	OAKLAND	CA	94609	3549	01	06001	37.81784861	-122.2652263	Alameda County
160147	Fee-for-Service	1700803418	1700803418	1	26	DIGNITY HEALTH MEDICAL FOUND	8/16/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	None	1264 HAWKS FLIGHT CRT	STE 100	EL DORADO HILLS	CA	95762	9354	09	06017	38.63773686	-121.0664492	El Dorado County
160150	Fee-for-Service	1679569636	1679569636	1	1	DAVENPORT, MARK B MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	40119	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
160153	Fee-for-Service	1437504990	1437504990	1	1	DESCANSO HOME HEALTH SERVICE	6/7/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	408 S CITRUS AVENUE	None	COVINA	CA	91723	2927	19	06037	34.08229638	-117.8900623	Los Angeles County
160188	Fee-for-Service	1205452232	1205452232	1	1	DAWIDOFF, SOPHIA LCSW	9/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
160247	Fee-for-Service	1700803418	1700803418	1	43	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
160276	Fee-for-Service	1154185833	1154185833	1	1	DRAKE, SARA OD	3/17/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2150 N WATERMAN AVE	STE 201	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
160285	Fee-for-Service	1215015995	1215015995	1	1	DEVENDRA, GEHAN MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60967	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
160288	Fee-for-Service	1942230297	1942230297	1	1	DEITCH, SEAN A MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69367	None	None	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
160295	Fee-for-Service	1972038222	1972038222	1	1	DE-LA-SANCHA-VERDUZCO, CARLO	7/28/2023	207ZC0500X	NA	Other	026	PHYSICIANS	171656	None	None	0	In state provider	A MD	1001 POTRERO AVE	RM 2M14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
160315	Fee-for-Service	1700803418	1700803418	1	63	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FOUNDATION	3939 J STREET	SUITE 330	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
160356	Fee-for-Service	1700803418	1700803418	1	8	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
160366	Fee-for-Service	1033193115	1033193115	1	1	DOBLER, DANIEL W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
160367	Fee-for-Service	1720119852	1720119852	1	1	DANG, ALEXIS B MD	8/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93459	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160368	Fee-for-Service	1043667488	1043667488	1	1	DANIEL, MATTHEW S DPM	12/20/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5020 COMMERCE DR	None	BAKERSFIELD	CA	93309	0631	15	06029	35.36787086	-119.0579597	Kern County
160373	Fee-for-Service	1497773519	1497773519	1	1	DUARTE, DAVID A MD	1/28/1999	2086S0127X	NA	General Surgery	026	PHYSICIANS	60225	None	None	0	In state provider	None	1513 GRAND AVE	STE 300	LOS ANGELES	CA	90015	3075	19	06037	34.03596303	-118.266212	Los Angeles County
160378	Fee-for-Service	1679654248	1679654248	1	1	DIAZ, ANGELICA NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
160432	Fee-for-Service	1659831212	1659831212	1	1	DECAN, COURTNEY L MD	5/16/2023	207R00000X	NA	Other	026	PHYSICIANS	179118	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
160440	Fee-for-Service	1700803418	1700803418	1	26	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1264 HAWKS FLIGHT CRT	STE 100	EL DORADO HILLS	CA	95762	9354	09	06017	38.63773686	-121.0664492	El Dorado County
160537	Fee-for-Service	1700803418	1700803418	1	55	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVENUE	SUITE 200	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
160560	Fee-for-Service	1598832867	1598832867	1	1	DESOER, CRAIG M	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66654	08	Family Practice	0	In state provider	None	112 LA CASA VIA	STE 130	WALNUT CREEK	CA	94598	3016	07	06013	37.91229899	-122.0423696	Contra Costa County
160584	Fee-for-Service	1659548790	1659548790	1	1	DANA KINNEY	5/21/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
160592	Fee-for-Service	1942235833	1942235833	1	1	DANIELS, MARCEL F MD	6/14/2019	174400000X	NA	Other	026	PHYSICIANS	68121	24	Plastic Surgery	0	In state provider	TIVE SURGERY A MEDICAL C	1760 TERMINO AVE	SUITE 207	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
160602	Fee-for-Service	1700803418	1700803418	1	63	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3939 J STREET	SUITE 330	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
160637	Fee-for-Service	1013559962	1013559962	1	1	DESERT SOLEIL FAMILY COUNSEL	10/29/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	TER, PC.	78060 CALLE ESTADO	STE 4	LA QUINTA	CA	92253	2960	33	06065	33.67599507	-116.303034	Riverside County
160644	Fee-for-Service	1700803418	1700803418	1	8	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
160654	Fee-for-Service	1730502360	1730502360	1	1	DR LOUSINE MELIK-ADAMYAN	2/15/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3851 KATELLA AVE	SUITE #315	LOS ALAMITOS	CA	90720	3338	30	06059	33.80319053	-118.0657305	Orange County
160672	Fee-for-Service	1922294834	1922294834	1	1	DEHNAD, SUSAN K MD	10/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100690	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3317 CHANATE RD	STE 2C	SANTA ROSA	CA	95404	1737	49	06097	38.470896	-122.708889	Sonoma County
160718	Fee-for-Service	1215319496	1215319496	1	1	DELOS SANTOS, JACQUELYN V OD	10/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
160723	Fee-for-Service	1700803418	1700803418	1	26	DIGNITY HEALTH MEDICAL FOUND	8/16/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	1264 HAWKS FLIGHT CRT	STE 100	EL DORADO HILLS	CA	95762	9354	09	06017	38.63773686	-121.0664492	El Dorado County
160727	Fee-for-Service	1932373339	1932373339	1	1	DURAND, KARA N MD	10/5/2009	207R00000X	NA	Other	026	PHYSICIANS	103424	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
160731	Fee-for-Service	1770897092	1770897092	1	1	DORCE, JACQUES JR MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122417	22	Pathology (M.D. only)	0	In state provider	None	2615 EYE STREET	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
160749	Fee-for-Service	1174077101	1174077101	1	1	DINH, FRANCIS DPM	3/25/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	425 W BONITA AVE	SUITE 110	SAN DIMAS	CA	91773	2543	19	06037	34.10669347	-117.814932	Los Angeles County
160796	Fee-for-Service	1982793808	1982793808	1	1	DAVID, FREDERICK C MD	1/1/1982	2085R0001X	NA	Other	026	PHYSICIANS	34598	01	General Practice	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
160825	Fee-for-Service	1700803418	1700803418	1	43	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
160875	Fee-for-Service	1841372315	1841372315	1	1	DUONG, THUC H MD	4/12/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51790	01	General Practice	0	In state provider	None	7240 E SOUTHGATE DR	STE D	SACRAMENTO	CA	95823	2627	34	06067	38.494359	-121.438377	Sacramento County
160932	Fee-for-Service	1700803418	1700803418	1	8	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	FOUNDATION	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
161012	Fee-for-Service	1811341225	1811341225	1	1	DUNCAN, DONNA LCSW	10/4/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1130 CONROY LN	SUITE 150	ROSEVILLE	CA	95661	4154	31	06061	38.73792807	-121.2748427	Placer County
161014	Fee-for-Service	1700803418	1700803418	1	26	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1264 HAWKS FLIGHT CRT	STE 100	EL DORADO HILLS	CA	95762	9354	09	06017	38.63773686	-121.0664492	El Dorado County
161016	Fee-for-Service	1235698440	1235698440	1	1	DIAMANT, CARMEL MD	5/4/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	184778	None	None	0	In state provider	None	2601 ALAMEDA AVE	412	BURBANK	CA	91505	4800	19	06037	34.15783817	-118.3293969	Los Angeles County
161028	Fee-for-Service	1083728513	1083728513	1	1	DAVIS, JOHN A PHD	1/23/2008	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 E STATE STREET	SUITE 529	REDLANDS	CA	92373	5389	36	06071	34.0564015	-117.178776	San Bernardino County
161038	Fee-for-Service	1871735464	1871735464	1	1	DE LEON, EDWIN ROMEL S MD	3/18/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	118530	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
161078	Fee-for-Service	1194845206	1194845206	1	1	DHALIWAL, INDERJIT K OD	2/6/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5478 N PALM AVE	None	FRESNO	CA	93704	1940	10	06019	36.81697011	-119.8082669	Fresno County
161080	Fee-for-Service	1609110063	1609110063	1	1	DAVIS, JENNIFER L OT	4/26/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
161085	Fee-for-Service	1982793808	1982793808	1	1	DAVID, FREDERICK C MD	1/1/1982	2085R0001X	NA	Other	026	PHYSICIANS	34598	30	Radiology	0	In state provider	None	510 DOYLE PARK DR	None	SANTA ROSA	CA	95405	4570	49	06097	38.442618	-122.6984265	Sonoma County
161099	Fee-for-Service	1588322960	1588322960	1	1	DAGNE, YETINAYET A NP	9/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
161112	Fee-for-Service	1700803418	1700803418	1	43	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
161113	Fee-for-Service	1407064959	1407064959	1	1	DOBBINS, ROSE M	7/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
161154	Fee-for-Service	1831200526	1831200526	1	1	DOAN, TUAN A MD	1/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	77825	08	Family Practice	0	In state provider	None	6000 FAIRWAY DR	None	ROCKLIN	CA	95677	4244	31	06061	38.79220243	-121.2621624	Placer County
161206	Fee-for-Service	1356540249	1356540249	1	1	DAFFNER, SCOTT D MD	1/4/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	99117	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90024	7002	19	06037	34.0637703	-118.4428198	Los Angeles County
161207	Fee-for-Service	1821652462	1821652462	1	1	DJAZAYERI, SAM DO	7/28/2022	207R00000X	NA	Other	026	PHYSICIANS	20057	None	None	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
161220	Fee-for-Service	1700803418	1700803418	1	8	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	FOUNDATION	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
161228	Fee-for-Service	1053613570	1053613570	1	1	DHAWAN, RAHUL DO	7/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11393	41	Internal Medicine	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
161274	Fee-for-Service	1083971881	1083971881	1	12	DIGNITY HEALTH MEDICAL FOUND	4/18/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-BAKERSFIELD	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5732	15	06029	35.39412578	-119.0082617	Kern County
161325	Fee-for-Service	1538363403	1538363403	1	1	DUTRA, KATHERINE E MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137066	36	Psychiatry	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
161351	Fee-for-Service	1982681151	1982681151	1	1	DEJESUS AVILA, MARIA V	9/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89290	01	General Practice	0	In state provider	MD	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
161364	Fee-for-Service	1639350036	1639350036	1	1	DURAN, TERESA A MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126361	22	Pathology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
161367	Fee-for-Service	1467501304	1467501304	1	1	DEVELOPMENTAL CLIENT	10/4/1992	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CARE INDUSTRIES INC	12867 FOXDALE DR	None	MORENO VALLEY	CA	92553	5674	33	06065	33.93378369	-117.2502351	Riverside County
161368	Fee-for-Service	1568894624	1568894624	1	1	DUCCINI, STEPHANIE R LMFT	6/27/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
161389	Fee-for-Service	1417123332	1417123332	1	2	DEEN, OMER J MD	6/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110888	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
161399	Fee-for-Service	1700803418	1700803418	1	13	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8001 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7901	34	06067	38.664486	-121.266099	Sacramento County
161408	Fee-for-Service	1326312067	1326312067	1	5	DCHS MEDICAL FOUNDATION	3/20/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3617 MARTIN LUTHER KING	STE 2	LYNWOOD	CA	90262	3504	19	06037	33.93098133	-118.2026027	Los Angeles County
161442	Fee-for-Service	1558119693	1558119693	1	1	DOMINGUEZ, DASON PT	12/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
161469	Fee-for-Service	1174667158	1174667158	1	2	DIGNITY HEALTH	1/17/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2250 HAYES ST	1ST FLOOR	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
161474	Fee-for-Service	1528488970	1528488970	1	1	DOERING, KATIE J MD	8/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138912	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
161501	Fee-for-Service	1528027471	1528027471	1	1	DONG, SAMUEL MD	9/30/1980	207R00000X	NA	Other	026	PHYSICIANS	32972	41	Internal Medicine	0	In state provider	None	2844 SUMMIT ST	STE 106	OAKLAND	CA	94609	3641	01	06001	37.81754276	-122.2646445	Alameda County
161509	Fee-for-Service	1700803418	1700803418	1	8	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
161537	Fee-for-Service	1578776886	1578776886	1	1	DONKOR, KWAME A MD	6/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93576	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
161564	Fee-for-Service	1982698767	1982698767	1	1	DUKE A PHAN MD NEUROLOGY INC	8/24/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	51193	13	Neurology (M.D. only)	0	In state provider	None	17220 NEWHOPE ST	STE 217	FOUNTAIN VALLEY	CA	92708	4287	30	06059	33.713244	-117.923877	Orange County
161598	Fee-for-Service	1093248841	1093248841	1	1	DIZON, MATTHEW MD	10/16/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	170714	None	None	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
161606	Fee-for-Service	1306932165	1306932165	1	1	DALLEY,ROBERTA W MD	5/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE C/O UWP	MS 359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
161642	Fee-for-Service	1023578754	1023578754	1	1	DOUGLAS, CHRISTOPHER R MD	4/20/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181799	None	None	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
161657	Fee-for-Service	1699827816	1699827816	1	1	DURSTON, WILLIAM E MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37662	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
161659	Fee-for-Service	1518085430	1518085430	1	1	DIGNITY HEALTH	9/30/2001	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
161676	Fee-for-Service	1053687764	1053687764	1	1	DHILLON, PARINDER K OD	9/4/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4403 S VERMONT AVE	None	LOS ANGELES	CA	90037	2413	19	06037	34.00342736	-118.2915892	Los Angeles County
161688	Fee-for-Service	1700803418	1700803418	1	13	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	8001 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7901	34	06067	38.664486	-121.266099	Sacramento County
161693	Fee-for-Service	1871799213	1871799213	1	1	DAWKINS, JOHN G MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108324	08	Family Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92307	1027	37	06073	32.89687721	-117.2418677	San Diego County
161695	Fee-for-Service	1326312067	1326312067	1	5	DCHS MEDICAL FOUNDATION	3/20/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	3617 MARTIN LUTHER KING	STE 2	LYNWOOD	CA	90262	3504	19	06037	33.93098133	-118.2026027	Los Angeles County
161744	Fee-for-Service	1902828825	1902828825	1	1	DARRYL G STEIN MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1830 S ALMA SCHOOL RD	STE 108	MESA	AZ	85210	3086	00	None	33.381846	-111.859056	Maricopa County
161769	Fee-for-Service	1699724690	1699724690	1	1	DEFRANG, CAROLINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
161826	Fee-for-Service	1578776886	1578776886	1	1	DONKOR, KWAME A MD	6/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93576	41	Internal Medicine	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
161838	Fee-for-Service	1306877568	1306877568	1	1	DIMSDALE, JOEL MD	7/1/1985	2084P0800X	NA	Psychiatry	026	PHYSICIANS	28627	36	Psychiatry	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
161863	Fee-for-Service	1871892935	1871892935	1	1	DAVIDSON, MARISELA LMFT	2/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2431 W MARCH LANE	STE 200	STOCKTON	CA	95207	8211	39	06077	37.985267	-121.3372349	San Joaquin County
161885	Fee-for-Service	1588152904	1588152904	1	1	DANG, MARY	9/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
161901	Fee-for-Service	1275093403	1275093403	1	1	DIXIT, NEAL M MD	4/2/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	179110	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
161907	Fee-for-Service	1942355854	1942355854	1	1	DORSI, MICHAEL J MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116011	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
161923	Fee-for-Service	1659351013	1659351013	1	1	DIRKS, JARE J. MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	403 BURKARTH RD	None	WARRENSBURG	MO	64093	3101	00	None	38.76599368	-93.72375583	Johnson County
161939	Fee-for-Service	1215237631	1215237631	1	1	DO, DOROTHY H MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114424	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
161944	Fee-for-Service	1518085430	1518085430	1	1	DIGNITY HEALTH	9/30/2001	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
161991	Fee-for-Service	1346432275	1346432275	1	1	DAVIS, AMY E MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96646	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
161992	Fee-for-Service	1366917361	1366917361	1	1	DAVID TAFTIAN DO, INC	12/21/2018	193400000X	NA	Other	026	PHYSICIANS	14852	None	None	0	In state provider	None	1950 SAWTELLE BLVD	STE 138	LOS ANGELES	CA	90025	7014	19	06037	34.04141344	-118.444019	Los Angeles County
162091	Fee-for-Service	1144056367	1144056367	1	1	DO, JENNY LCSW	12/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
162148	Fee-for-Service	1700803418	1700803418	1	45	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	FOUNDATION	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
162278	Fee-for-Service	1407089261	1407089261	1	1	DOUGHERTY, SEAN M DPM	8/29/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
162327	Fee-for-Service	1083971881	1083971881	1	8	DIGNITY HEALTH MEDICAL FOUND	4/22/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-BAKERSFIELD INC.	9500 STOCKDALE HWY	STE 203	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
162350	Fee-for-Service	1023109766	1023109766	1	1	DAS, ASHA MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
162362	Fee-for-Service	1457676330	1457676330	1	1	DO, TAM T DO	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11964	01	General Practice	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
162406	Fee-for-Service	1841798667	1841798667	1	1	DEVANSH LAB WERKS,INC	3/26/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	234 AQUARIUS DR	STE 111	HOMEWOOD	AL	35209	5867	00	None	33.4605365	-86.8368905	Jefferson County
162436	Fee-for-Service	1700803418	1700803418	1	45	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
162442	Fee-for-Service	1922080860	1922080860	1	1	DAVID WILKETT	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	802 S JACKSON AVE	None	TULSA	OK	74127	9015	00	None	36.14663862	-95.99923752	Tulsa County
162519	Fee-for-Service	1700803418	1700803418	1	7	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
162540	Fee-for-Service	1639601222	1639601222	1	1	DAVIS, BRITTANY N MD	4/26/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160976	None	None	0	In state provider	None	2001 SANTA MONICA	370W, 380W, 860W, 1070	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
162574	Fee-for-Service	1659340115	1659340115	1	1	DOYKOS, MARK MD INC	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37845	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	STE 150	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
162635	Fee-for-Service	1023109766	1023109766	1	1	DAS, ASHA MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
162692	Fee-for-Service	1306183421	1306183421	1	1	DHP OF SUTTER SOLANO MEDICAL	2/6/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	GROUP INC	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
162694	Fee-for-Service	1083971881	1083971881	1	2	DIGNITY HEALTH MEDICAL FOUND	8/10/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	3807 UNION AVE	STE A	BAKERSFIELD	CA	93305	2400	15	06029	35.394102	-119.0030165	Kern County
162697	Fee-for-Service	1790128759	1790128759	1	1	DELCORE, LAURA M MD	3/28/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	133536	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2600 VIA DE LA VALLE	SUITE 200	DEL MAR	CA	92014	1192	37	06073	32.98053969	-117.2508471	San Diego County
162719	Fee-for-Service	1841618634	1841618634	1	1	DAY, ROBERT C MD	4/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139689	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
162725	Fee-for-Service	1700803418	1700803418	1	45	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	FOUNDATION	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
162753	Fee-for-Service	1710279518	1710279518	1	1	DALTON, JULEE H MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125695	05	Anesthesiology	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
162762	Fee-for-Service	1124282843	1124282843	1	1	DHILLON, NAVNEET MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100345	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
162804	Fee-for-Service	1700803418	1700803418	1	47	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3000 Q ST	6TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
162839	Fee-for-Service	1548656358	1548656358	1	1	DIMMITT, EVAN MD	8/1/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	159342	25	Physical Medicine and Rehabilitation	0	In state provider	None	5001 COMMERCE DR	None	BAKERSFIELD	CA	93309	0648	15	06029	35.36784468	-119.0578744	Kern County
162849	Fee-for-Service	1760611628	1760611628	1	1	DAVIS, CLIFTON I LMFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82029	-	NOT APPLICABLE	0	In state provider	None	161 W VICTORIA	SUITE 255	LONG BEACH	CA	90805	2162	19	06037	33.86489618	-118.2026866	Los Angeles County
162854	Fee-for-Service	1235424722	1235424722	1	1	DOIRON-MIN, MELISSA M LMFT	1/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
162857	Fee-for-Service	1174086508	1174086508	1	1	DHANJAN, PALWINDER S MD	12/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181238	None	None	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
162864	Fee-for-Service	1093007809	1093007809	1	1	DIAZ, VINCENT A MD	10/29/2021	207L00000X	NA	Other	026	PHYSICIANS	172439	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3522	48	06095	38.26109552	-122.0470245	Solano County
162866	Fee-for-Service	1912443649	1912443649	1	1	DESOUSA, MICHELLE M PT	10/11/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
162868	Fee-for-Service	1033670567	1033670567	1	1	DEMIGILLO, MA PAMELA G MD	9/27/2022	207R00000X	NA	Other	026	PHYSICIANS	181094	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
162880	Fee-for-Service	1376741223	1376741223	1	1	DELAY, CATHERINE M CRNA	9/19/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	173 E WEBSTER ST	None	COLUSA	CA	95932	2949	06	06011	39.20739708	-122.0006099	Colusa County
162894	Fee-for-Service	1043547482	1043547482	1	1	DR ARLENE T YEPREMIAN OD A	2/18/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	839 NORTH GLENDALE AVE	None	GLENDALE	CA	91206	2128	19	06037	34.15874733	-118.2401453	Los Angeles County
162900	Fee-for-Service	1770516155	1770516155	1	1	DIALYSIS CLINIC, INC	5/1/1997	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	CARSON CITY	778 BASQUE WAY	None	CARSON CITY	NV	89706	7935	00	None	39.187188	-119.759328	Consolidated Municipality of Carson City
162909	Fee-for-Service	1861587172	1861587172	1	1	DOAN, YEN MD INC	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40613	01	General Practice	0	In state provider	None	1663 BEVERLY BLVD	STE 201	LOS ANGELES	CA	90026	5747	19	06037	34.06426986	-118.2649213	Los Angeles County
162927	Fee-for-Service	1972578052	1972578052	1	1	DR. KONASALE M PRASAD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA ST	None	PITTSBURGH	PA	15213	2593	00	None	40.44350017	-79.95952606	Allegheny County
162951	Fee-for-Service	1649619792	1649619792	1	1	DAVILA, BELEN	10/5/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	148569	-	NOT APPLICABLE	0	In state provider	None	2695 S 4TH ST	None	EL CENTRO	CA	92243	6012	13	06025	32.76973509	-115.5520629	Imperial County
162973	Fee-for-Service	1639403017	1639403017	1	1	DIBBS, LAUREN E MFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50797	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVENUE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
162975	Fee-for-Service	1427106418	1427106418	1	1	DIDEHVARSADR, MOJDEH CRNA	4/20/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
162981	Fee-for-Service	1306183421	1306183421	1	1	DHP OF SUTTER SOLANO MEDICAL	2/6/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP INC	300 HOSPITAL DRIVE	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
163007	Fee-for-Service	1760923445	1760923445	1	1	DIALYSIS ACCESS CENTER	12/20/2017	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL CORPORATION	3012 SUMMIT ST	D WING	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
163012	Fee-for-Service	1700803418	1700803418	1	45	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
163023	Fee-for-Service	1518946672	1518946672	1	1	DISCALA, BRUNO DO	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	8290	05	Anesthesiology	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
163094	Fee-for-Service	1700803418	1700803418	1	7	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FOUNDATION	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
163098	Fee-for-Service	1356820757	1356820757	1	1	DATTA, NANDINI PHD	3/8/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
163137	Fee-for-Service	1194389106	1194389106	1	1	DANCY, MAXCY LMFT	1/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28310 ROADSIDE DR	STE 247	AGOURA HILLS	CA	91301	4952	19	06037	34.14271418	-118.7432847	Los Angeles County
163140	Fee-for-Service	1558449363	1558449363	1	1	DEGAMO, TERESITA Y MD	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	50610	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	RM B200	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
163183	Fee-for-Service	1033452123	1033452123	1	1	DEVABHAKTUNI, ANURADHA MD	10/18/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179327	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
163184	Fee-for-Service	1790120343	1790120343	1	1	DAYA, MICHELLE K MD	6/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143208	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 CESAR E CHAVEZ AVE	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
163203	Fee-for-Service	1578740114	1578740114	1	1	DEVARAKONDA, VEENA S MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114526	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
163221	Fee-for-Service	1780069294	1780069294	1	1	DREDGE, JUSTIN H MD	7/8/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	146754	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
163227	Fee-for-Service	1265554190	1265554190	1	1	DOBSON INTERNATIONAL INC	5/8/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DOBSON MED EQUIP SUPPLY	8040 ALONDRA BLVD	STE C	PARAMOUNT	CA	90723	4355	19	06037	33.88911653	-118.1584035	Los Angeles County
163238	Fee-for-Service	1366797706	1366797706	1	1	DEMAGNO, ELIZABETH J MD APC	9/4/2012	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	47902	08	Family Practice	0	In state provider	None	705 E VIRGINIA WAY	STE A	BARSTOW	CA	92311	3955	36	06071	34.88815781	-117.018543	San Bernardino County
163243	Fee-for-Service	1770790651	1770790651	1	1	DUKES, JONATHAN W MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111313	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	168 N BRENT STREET	SUITE 503	VENTURA	CA	93003	2817	56	06111	34.27448266	-119.2572489	Ventura County
163259	Fee-for-Service	1447754023	1447754023	1	1	DHALIWAL, TARIN S MD	9/23/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164079	None	None	0	In state provider	None	101 ROWLAND WAY	220	NOVATO	CA	94945	5008	21	06041	38.09755172	-122.5591766	Marin County
163301	Fee-for-Service	1700803418	1700803418	1	45	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	FOUNDATION	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
163336	Fee-for-Service	1497901680	1497901680	1	1	DANDURAND, JOHN M DBA	11/28/1995	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	AMERICAN HEARING AID CNT	6229 W 87TH ST	None	LOS ANGELES	CA	90045	3901	19	06037	33.95860798	-118.3941238	Los Angeles County
163379	Fee-for-Service	1700803418	1700803418	1	47	DIGNITY HEALTH MEDICAL FOUND	5/1/1991	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	3000 Q ST	6TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
163382	Fee-for-Service	1588234140	1588234140	1	1	DEACON, KYLE Q MD	11/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
163385	Fee-for-Service	1689770018	1689770018	1	1	DANG, THU-THUY T MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73991	40	Pediatrics	0	In state provider	None	2146 E ANAHEIM ST	None	LONG BEACH	CA	90804	3408	19	06037	33.78257051	-118.165896	Los Angeles County
163406	Fee-for-Service	1245085042	1245085042	1	1	DO AND LE MEDICAL GROUP, PC	5/28/2024	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	991 MONTAGUE EXPY	SUITE 104	MILPITAS	CA	95035	6809	43	06085	37.41304686	-121.8852862	Santa Clara County
163420	Fee-for-Service	1467530907	1467530907	1	1	DUHRA, GURJEET S MD	3/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66605	08	Family Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
163444	Fee-for-Service	1881089829	1881089829	1	1	DISABATINO, STEPHEN V MD	8/8/2019	390200000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
163474	Fee-for-Service	1871881557	1871881557	2	1	DRIFTWOOD HAYWARD OPERATING	8/28/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMPANY LP	19700 HESPERIAN BLVD	None	HAYWARD	CA	94541	4704	01	06001	37.66794557	-122.1184221	Alameda County
163492	Fee-for-Service	1578740114	1578740114	1	1	DEVARAKONDA, VEENA S MD	3/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114526	41	Internal Medicine	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
163497	Fee-for-Service	1407178288	1407178288	1	1	DRY CREEK JOINT	7/19/2009	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ELEMENTARY SCHOOL DIST	8849 COOK RIOLO ROAD	None	ROSEVILLE	CA	95747	9793	31	06061	38.73875566	-121.3368569	Placer County
163501	Fee-for-Service	1851399802	1851399802	1	1	DUFFY, MICHAEL S DO	2/11/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	9616	01	General Practice	0	In state provider	None	1501 5TH AVE	STE 100	SAN DIEGO	CA	92101	3291	37	06073	32.72121489	-117.1601897	San Diego County
163510	Fee-for-Service	1932134111	1932134111	1	1	DELEMOS, CHRISTI D NP	12/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
163528	Fee-for-Service	1851463830	1851463830	1	1	DHILLON, KALWANT S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6079 N FRESNO ST	STE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
163533	Fee-for-Service	1770790651	1770790651	1	1	DUKES, JONATHAN W MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111313	01	General Practice	0	In state provider	None	168 N BRENT STREET	SUITE 503	VENTURA	CA	93003	2817	56	06111	34.27448266	-119.2572489	Ventura County
163588	Fee-for-Service	1700803418	1700803418	1	45	DIGNITY HEALTH MEDICAL FOUND	3/1/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	3000 Q STREET	4TH FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
163606	Fee-for-Service	1700803418	1700803418	1	3	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3301 C STREET	SUITE 500	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
163633	Fee-for-Service	1659531333	1659531333	1	1	DEVARAJ, BIKASH MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	102083	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
163648	Fee-for-Service	1700803418	1700803418	1	70	DIGNITY HEALTH MEDICAL FOUND	12/2/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2800 N CALIFORNIA ST	STE 8	STOCKTON	CA	95204	3757	39	06077	37.97782434	-121.2919633	San Joaquin County
163670	Fee-for-Service	1700803418	1700803418	1	7	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
163693	Fee-for-Service	1245085042	1245085042	1	1	DO AND LE MEDICAL GROUP, PC	5/28/2024	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	991 MONTAGUE EXPY	SUITE 104	MILPITAS	CA	95035	6809	43	06085	37.41304686	-121.8852862	Santa Clara County
163697	Fee-for-Service	1275680738	1275680738	1	3	DAVIS, TRACIE L MD	2/12/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	89865	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
163706	Fee-for-Service	1467530907	1467530907	1	1	DUHRA, GURJEET S MD	3/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	66605	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
163729	Fee-for-Service	1184100752	1184100752	1	1	DUEL, DANIEL A MD	8/2/2021	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	164692	-	NOT APPLICABLE	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
163751	Fee-for-Service	1043398282	1043398282	1	1	DE JAGER, HENDRIK J MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	25255	84	Surgery-Head and Neck	0	In state provider	None	1850 S WATERMAN AVE	STE A	SAN BERNARDINO	CA	92408	2852	36	06071	34.06837701	-117.2788714	San Bernardino County
163816	Fee-for-Service	1851463830	1851463830	1	1	DHILLON, KALWANT S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	30582	02	General Surgery	0	In state provider	None	6079 N FRESNO ST	STE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
163827	Fee-for-Service	1457635559	1457635559	1	1	DELOS SANTOS, RENATO MD	2/20/2024	208M00000X	NA	Other	026	PHYSICIANS	158788	None	None	0	In state provider	None	100 MISSION BLVD	STE 2800	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
163873	Fee-for-Service	1144262395	1144262395	1	1	DINSAY, JOCYLANE M NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1000 S HILL RD	STE 100	VENTURA	CA	93003	4455	56	06111	34.26767279	-119.2067069	Ventura County
163882	Fee-for-Service	1750452728	1750452728	1	1	DOKKO, JOON MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74986	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
163893	Fee-for-Service	1700803418	1700803418	1	3	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3301 C STREET	SUITE 500	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
163897	Fee-for-Service	1184838435	1184838435	1	1	DEANS, REBECCA M MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89313	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
163918	Fee-for-Service	1982633426	1982633426	1	1	DAVIS, CLARENCE MD	4/26/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
163929	Fee-for-Service	1013905389	1013905389	1	1	DESSOUKI, AMR L MD	1/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
163947	Fee-for-Service	1134107667	1134107667	1	1	DURRANI, ASIF S DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	16209 PARAMOUNT BLVD	STE 205	PARAMOUNT	CA	90723	5468	19	06037	33.887565	-118.160169	Los Angeles County
163953	Fee-for-Service	1518105634	1518105634	1	1	DELIA C GUAQUETA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 S ANDREWS AVE	None	FT LAUDERDALE	FL	33316	2510	00	None	26.102142	-80.1408645	Broward County
163958	Fee-for-Service	1700803418	1700803418	1	47	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3000 Q ST	6TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
163967	Fee-for-Service	1114226867	1114226867	1	1	DOWNEY, LUCINDA R	5/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3908 10 STREET	None	RIVERSIDE	CA	92501	3522	33	06065	33.98117228	-117.3785355	Riverside County
163969	Fee-for-Service	1285698902	1285698902	1	1	DARWISH, FOUAD D MD	11/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	34226	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8120 TIMBERLAKE WAY	STE 208	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
163972	Fee-for-Service	1710276266	1710276266	1	1	DIMAIO, MICHAEL A MD	4/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113386	22	Pathology (M.D. only)	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
163984	Fee-for-Service	1275680738	1275680738	1	3	DAVIS, TRACIE L MD	2/12/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	89865	09	Gynecology (D.O. only)	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
164022	Fee-for-Service	1609451921	1609451921	1	1	DIMERY-WILLIAMS, MARY M	10/11/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3551 BLOOMFIELD LN	None	CLOVIS	CA	93619	5054	10	06019	36.86238027	-119.6451973	Fresno County
164041	Fee-for-Service	1043398282	1043398282	1	1	DE JAGER, HENDRIK J MD	9/27/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	25255	04	Otology, Laryngology, Rhinology	0	In state provider	None	1850 S WATERMAN AVE	STE A	SAN BERNARDINO	CA	92408	2852	36	06071	34.06837701	-117.2788714	San Bernardino County
164050	Fee-for-Service	1144648106	1144648106	1	1	DORA, AMY V MD	7/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141311	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
164081	Fee-for-Service	1679598064	1679598064	1	1	DOBKIN, BRUCE H MD	8/8/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	27095	13	Neurology (M.D. only)	0	In state provider	None	710 WESTWOOD PLZ	# C246	LOS ANGELES	CA	90095	8353	19	06037	34.06680182	-118.4450804	Los Angeles County
164092	Fee-for-Service	1649221060	1649221060	1	1	DEERE, ROBERT C MD	1/16/1998	208600000X	NA	General Surgery	026	PHYSICIANS	54147	02	General Surgery	0	In state provider	None	8337 TELEGRAPH RD	STE 102	PICO RIVERA	CA	90660	4930	19	06037	33.96454327	-118.1134473	Los Angeles County
164102	Fee-for-Service	1194052100	1194052100	1	1	DAUDEL, JODY L MD PMC	12/15/2009	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	95421	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 ROSE DR	STE 140	BENICIA	CA	94510	3623	48	06095	38.08145422	-122.1918425	Solano County
164144	Fee-for-Service	1912002544	1912002544	1	1	DUNLAP, MICHAEL T MD	4/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	55983	22	Pathology (M.D. only)	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
164153	Fee-for-Service	1740451566	1740451566	1	1	DESAI, DAVID P	1/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104997	None	None	0	In state provider	None	5016 CHESEBRO RD	STE 200	AGOURA HILLS	CA	91301	2277	19	06037	34.14134802	-118.7392827	Los Angeles County
164170	Fee-for-Service	1750452728	1750452728	1	1	DOKKO, JOON MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74986	30	Radiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
164181	Fee-for-Service	1700803418	1700803418	1	3	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3301 C STREET	SUITE 500	SACRAMENTO	CA	95816	3372	34	06067	38.579877	-121.456143	Sacramento County
164186	Fee-for-Service	1922101963	1922101963	1	1	DUCKER, KENNETH MD	7/18/2002	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	30162	40	Pediatrics	0	In state provider	None	20126 STANTON AVE	STE 200	CASTRO VALLEY	CA	94546	5270	01	06001	37.69722866	-122.090936	Alameda County
164216	Fee-for-Service	1013905389	1013905389	1	1	DESSOUKI, AMR L MD	1/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53889	18	Ophthalmology	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
164243	Fee-for-Service	1700803418	1700803418	1	47	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3000 Q ST	6TH FL	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
164245	Fee-for-Service	1154356871	1154356871	1	1	DAVTYAN, CAMELIA AURA	1/24/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55567	None	None	0	In state provider	None	100 MEDICAL PLAZA SUITE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06544724	-118.4459249	Los Angeles County
164247	Fee-for-Service	1780727446	1780727446	1	1	DANIEL, LAURA A LMFT	5/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1465 G ST	None	ARCATA	CA	95521	5609	12	06023	40.87325308	-124.0841309	Humboldt County
164272	Fee-for-Service	1275680738	1275680738	1	3	DAVIS, TRACIE L MD	2/12/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	89865	15	Obstetrics (D.O. only)	0	In state provider	None	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
164297	Fee-for-Service	1205067543	1205067543	1	1	DO, SHERRY E NP	7/31/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	240 HOSPITAL DR	None	WESTMINSTER	CA	92683	3953	30	06059	33.76421351	-117.99477	Orange County
164309	Fee-for-Service	1609451921	1609451921	1	1	DIMERY-WILLIAMS, MARY M	10/11/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3551 BLOOMFIELD LN	None	CLOVIS	CA	93619	5054	10	06019	36.86238027	-119.6451973	Fresno County
164312	Fee-for-Service	1235328972	1235328972	1	1	DAFTARI, SHERRY L LMFT	6/18/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
164331	Fee-for-Service	1528154986	1528154986	2	1	DENTAL SURGERY CENTERS OF	6/1/2018	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	AMERICA	3605 HOSPITAL RD	SUITE H	ATWATER	CA	95301	5173	24	06047	37.36678073	-120.576731	Merced County
164346	Fee-for-Service	1063919462	1063919462	1	2	DNPA TRANSPORTATION INC	2/25/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6412 MATILIJA AVE	203	VAN NUYS	CA	91401	1576	19	06037	34.187184	-118.433434	Los Angeles County
164386	Fee-for-Service	1215254941	1215254941	1	1	DONATO, MICHAEL A LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
164504	Fee-for-Service	1013905389	1013905389	1	1	DESSOUKI, AMR L MD	1/25/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53889	41	Internal Medicine	0	In state provider	None	616 WITMER ST	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
164538	Fee-for-Service	1700803418	1700803418	1	7	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
164570	Fee-for-Service	1689106700	1689106700	1	1	DYRHOLM, MICHELLE DO	8/23/2021	207L00000X	NA	Other	026	PHYSICIANS	18783	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
164594	Fee-for-Service	1790055705	1790055705	1	1	DASHI, ARBEN MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119142	41	Internal Medicine	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
164597	Fee-for-Service	1194705632	1194705632	1	1	DEWEES, JANET L CRNA	1/12/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
164623	Fee-for-Service	1144602004	1144602004	1	1	DOO, ALEX D MD	8/7/2019	207P00000X	NA	Other	026	PHYSICIANS	144495	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
164659	Fee-for-Service	1922198407	1922198407	1	1	DOSHI, VAISHALI R MD	7/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85639	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
164700	Fee-for-Service	1093137705	1093137705	1	1	DOWNING, MICHAEL C MD	9/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128354	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
164713	Fee-for-Service	1073183612	1073183612	1	1	DORAN, JESSICA MD	8/9/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
164714	Fee-for-Service	1992025431	1992025431	1	1	DEAR, JAMESON C MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133813	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
164730	Fee-for-Service	1558445072	1558445072	1	1	DESAI, AMAR A MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86316	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
164744	Fee-for-Service	1114128626	1114128626	1	1	DHINGSA, KOMAL MD	9/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108408	05	Anesthesiology	0	In state provider	None	2288 AUBURN BLVD	STE 106	SACRAMENTO	CA	95821	1619	34	06067	38.625345	-121.4114985	Sacramento County
164749	Fee-for-Service	1124596382	1124596382	2	1	DOCTORS HOSPITAL OF	7/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE LLC	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
164791	Fee-for-Service	1518953694	1518953694	1	1	DELL, JEFFREY R MD	2/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	39875	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
164793	Fee-for-Service	1942385604	1942385604	1	1	DOWN, KATHY E MD	10/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80543	01	General Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
164822	Fee-for-Service	1700803418	1700803418	1	7	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
164847	Fee-for-Service	1023121837	1023121837	1	1	DYSINGER, WAYNE S MD	7/18/2003	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	72154	08	Family Practice	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
164860	Fee-for-Service	1588610729	1588610729	1	1	DAILEY, PATRICIA A MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	40255	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
164877	Fee-for-Service	1497956080	1497956080	1	1	DR. NOLAN HUGHES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA ST	None	PITTSBURGH	PA	15213	2593	00	None	40.44350017	-79.95952606	Allegheny County
164880	Fee-for-Service	1356423271	1356423271	1	1	DEMBNER, JEFFREY M	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74580	14	Neurological Surgery	0	In state provider	None	1860 PENNSYLVANIA AVE	STE 320	FAIRFIELD	CA	94533	3552	48	06095	38.261952	-122.0498745	Solano County
164887	Fee-for-Service	1962710780	1962710780	1	1	DAVIS, DEMETRICE S MD	8/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	116622	None	None	0	In state provider	None	1524 MCHENRY AVE	STE 100	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
164888	Fee-for-Service	1043931744	1043931744	1	1	DELSHAD, BRIAN LMFT	10/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	922 STATE STREET	STE A, OFFICE #2	SANTA BARBARA	CA	93101	6795	42	06083	34.42108289	-119.7013175	Santa Barbara County
164900	Fee-for-Service	1114066909	1114066909	1	1	DELLING, FRANCESCA N MD	1/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146400	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164906	Fee-for-Service	1932776382	1932776382	1	1	DHILLON, AMANDEEP NP	7/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
164924	Fee-for-Service	1326103391	1326103391	1	1	DAMMEN, JENNIFER L	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
164963	Fee-for-Service	1104308444	1104308444	1	1	DE CERDA, GISELLE LMFT	3/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	505 S VILLA REAL DRIVE	SUITE 117	ANAHEIM	CA	92807	3445	30	06059	33.83712262	-117.8220203	Orange County
165030	Fee-for-Service	1427365733	1427365733	1	1	DURAN, KAREN R LCSW	3/27/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5206 BENITO ST	201	MONTCLAIR	CA	91763	2852	36	06071	34.0740385	-117.6914475	San Bernardino County
165035	Fee-for-Service	1205946639	1205946639	1	1	DE VERA, OSCAR S MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52694	01	General Practice	0	In state provider	None	3131 SANTA ANITA AVE	None	EL MONTE	CA	91733	1369	19	06037	34.064991	-118.0427595	Los Angeles County
165038	Fee-for-Service	1124596382	1124596382	2	1	DOCTORS HOSPITAL OF	7/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	RIVERSIDE LLC	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
165043	Fee-for-Service	1295700219	1295700219	1	1	DVA HLTHCARE RENAL CARE	9/27/1995	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SELMA DIALYSIS	2711 CINEMA WAY	STE 109	SELMA	CA	93662	2662	10	06019	36.57361729	-119.6242123	Fresno County
165057	Fee-for-Service	1104281666	1104281666	1	1	DINSBACH, LAURA LCSW	2/12/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
165063	Fee-for-Service	1093940561	1093940561	1	1	DEAF COMMUNITY SERVICES OF	12/6/2017	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO INC	1545 HOTEL CIRCLE SOUTH	STE 300	SAN DIEGO	CA	92108	3414	37	06073	32.75896365	-117.1774865	San Diego County
165068	Fee-for-Service	1063919298	1063919298	1	1	DESMOND, LISA M MD	9/22/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	181166	None	None	0	In state provider	None	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	01	06001	37.86338897	-122.2698455	Alameda County
165071	Fee-for-Service	1104486208	1104486208	1	1	DONALDSON, BREAHN F MD	10/26/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	177144	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
165110	Fee-for-Service	1700803418	1700803418	1	7	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	FOUNDATION	1700 PRAIRIE CITY RD	None	FOLSOM	CA	95630	9594	34	06067	38.652012	-121.166901	Sacramento County
165133	Fee-for-Service	1023121837	1023121837	1	1	DYSINGER, WAYNE S MD	7/18/2003	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	72154	01	General Practice	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
165155	Fee-for-Service	1285712893	1285712893	1	1	D'SOUZA, ROSAMANI MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66063	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
165164	Fee-for-Service	1730436569	1730436569	1	1	DEAK, GABI L LCSW	7/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
165214	Fee-for-Service	1851496145	1851496145	1	1	DAWESHVARI,SAM F MD	9/18/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60891	41	Internal Medicine	0	In state provider	None	1560 E CHEVY CHASE DR	STE 410	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
165229	Fee-for-Service	1700803418	1700803418	1	57	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
165235	Fee-for-Service	1104006808	1104006808	1	1	DAVIS, DREW J MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92701	24	Plastic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
165321	Fee-for-Service	1205946639	1205946639	1	1	DE VERA, OSCAR S MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52694	40	Pediatrics	0	In state provider	None	3131 SANTA ANITA AVE	None	EL MONTE	CA	91733	1369	19	06037	34.064991	-118.0427595	Los Angeles County
165355	Fee-for-Service	1265784532	1265784532	1	1	DER SARKISSIAN, LAZIK MD APC	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41167	05	Anesthesiology	0	In state provider	None	540 N CENTRAL AVE	STE 205	GLENDALE	CA	91203	3368	19	06037	34.15437	-118.257912	Los Angeles County
165392	Fee-for-Service	1114011186	1114011186	1	1	DE LOS REYES, CIPRIANO	12/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	29537	41	Internal Medicine	0	In state provider	MD	2644 APPIAN WAY	STE 111	PINOLE	CA	94564	2240	07	06013	37.98825138	-122.2989881	Contra Costa County
165416	Fee-for-Service	1740760057	1740760057	1	1	DE LUNA, JASON RCP	8/31/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
165423	Fee-for-Service	1134269772	1134269772	2	1	DONNER, NEIL F MD	7/2/2018	207P00000X	NA	Other	026	PHYSICIANS	90548	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
165446	Fee-for-Service	1619403292	1619403292	1	1	DORILUS, GREGORY MD	9/23/2021	207P00000X	NA	Other	026	PHYSICIANS	171277	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
165484	Fee-for-Service	1952489858	1952489858	1	1	DELA CRUZ, LINA C MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69421	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
165496	Fee-for-Service	1023007168	1023007168	1	1	DENISE J SMITH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5757 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4641	00	None	33.609672	-112.182786	Maricopa County
165498	Fee-for-Service	1801996582	1801996582	1	1	DUQUETTE, JULIE G MD AMC	5/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74262	22	Pathology (M.D. only)	0	In state provider	None	2043 WESTCLIFF DRIVE	SUITE 302	NEWPORT BEACH	CA	92660	5511	30	06059	33.62778819	-117.9079137	Orange County
165513	Fee-for-Service	1700803418	1700803418	1	57	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
165532	Fee-for-Service	1790906527	1790906527	1	1	DANIAL, GEORGE J DO	6/23/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	4720	08	Family Practice	0	In state provider	None	4621 RUBIO AVE	None	ENCINO	CA	91436	3203	19	06037	34.15513416	-118.4945833	Los Angeles County
165585	Fee-for-Service	1780943019	1780943019	1	1	DOO, KATHLEEN MD	2/28/2020	207R00000X	NA	Other	026	PHYSICIANS	127724	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
165675	Fee-for-Service	1467582817	1467582817	1	1	DOWNEY UNIF SCHOOL DIST	9/1/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	11627 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4911	19	06037	33.93480209	-118.1323324	Los Angeles County
165712	Fee-for-Service	1700803418	1700803418	1	9	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	FOUNDATION	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
165745	Fee-for-Service	1467483305	1467483305	1	1	DIAMOND, DANIEL S MD	6/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75588	02	General Surgery	0	In state provider	None	2321 HARRISON AVE	None	EUREKA	CA	95501	3216	12	06023	40.786857	-124.1396125	Humboldt County
165768	Fee-for-Service	1760447676	1760447676	1	1	DANIEL JOSEPH DIRE MD	8/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
165772	Fee-for-Service	1528114741	1528114741	1	1	DONOHUE, KATE T PHD	6/21/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19201 NOYO ACRES DR	None	FORT BRAGG	CA	95437	8240	23	06045	39.41823695	-123.7884645	Mendocino County
165804	Fee-for-Service	1700803418	1700803418	1	57	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
165808	Fee-for-Service	1730135401	1730135401	1	1	DAI, CHARLES B MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75228	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
165861	Fee-for-Service	1487772539	1487772539	1	1	DIXON UNIFIED SCHOOL	6/10/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	180 S 1ST ST, STE 6	None	DIXON	CA	95620	3447	48	06095	38.444715	-121.8225485	Solano County
165874	Fee-for-Service	1780943019	1780943019	1	1	DOO, KATHLEEN MD	2/28/2020	207R00000X	NA	Other	026	PHYSICIANS	127724	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
165881	Fee-for-Service	1730136532	1730136532	1	1	DOCTORS COMMUNITY HOSP	10/29/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8118 GOOD LUCK RD	None	LANHAM	MD	20706	3595	00	None	38.982609	-76.865391	Prince George's County
165938	Fee-for-Service	1871820068	1871820068	1	1	DOUGLASS, BARBARA JEAN A LCS	12/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	3 COMMODORE DR.	UNIT 158	EMERYVILLE	CA	94608	1655	01	06001	37.83796434	-122.3048528	Alameda County
165955	Fee-for-Service	1639478811	1639478811	1	1	DEIS, CRISTINA E MD	6/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123170	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
165963	Fee-for-Service	1467582817	1467582817	1	1	DOWNEY UNIF SCHOOL DIST	2/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	11627 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4911	19	06037	33.93480209	-118.1323324	Los Angeles County
165977	Fee-for-Service	1568428704	1568428704	1	1	DEGUZMAN, JAIME M	6/30/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	214 JUDAH	None	ROSEVILLE	CA	95678	2608	31	06061	38.74500727	-121.2860132	Placer County
166002	Fee-for-Service	1700803418	1700803418	1	9	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
166053	Fee-for-Service	1932117165	1932117165	1	1	DOMA, ANAMIKA K DO	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	11352	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 FOURTH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
166114	Fee-for-Service	1336374487	1336374487	1	1	DANDENELL, ELIZABETH	12/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2223 SANTA CLARA AVE STE	None	ALAMEDA	CA	94501	4469	01	06001	37.76685808	-122.2452973	Alameda County
166115	Fee-for-Service	1437455243	1437455243	1	1	DELTA SLEEP LABS INC	7/21/2014	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1601 EASTMAN AVENUE	STE 203	VENTURA	CA	93003	6471	56	06111	34.25802495	-119.2302433	Ventura County
166148	Fee-for-Service	1811973795	1811973795	1	1	DHATT, AMANJIT K MD	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
166155	Fee-for-Service	1083971881	1083971881	1	4	DIGNITY HEALTH MEDICAL FOUND	1/8/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9500 STOCKDALE HWY	SUITE 201	BAKERSFIELD	CA	93311	3621	15	06029	35.35452448	-119.1074625	Kern County
166166	Fee-for-Service	1730136532	1730136532	1	1	DOCTORS COMMUNITY HOSP	10/29/2004	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8118 GOOD LUCK RD	None	LANHAM	MD	20706	3595	00	None	38.982609	-76.865391	Prince George's County
166202	Fee-for-Service	1891763470	1891763470	1	1	DANG, KEVIN H MD	9/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70939	05	Anesthesiology	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92401	1217	36	06071	34.131303	-117.3225325	San Bernardino County
166219	Fee-for-Service	1871729418	1871729418	1	1	DADAMO, HEATHER M MD	2/22/2019	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	113243	38	Geriatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
166220	Fee-for-Service	1801206180	1801206180	1	1	DRIMMER, DAVID	3/15/2018	207R00000X	NA	Other	026	PHYSICIANS	142730	07	Dermatology	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
166239	Fee-for-Service	1316239544	1316239544	1	1	DAMARVEL CORPORATION	10/7/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9350 FLAIR DR	SUITE 108	EL MONTE	CA	91731	2828	19	06037	34.07192066	-118.0649488	Los Angeles County
166249	Fee-for-Service	1487049185	1487049185	1	1	DOCTOR RETINA	10/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	120462	18	Ophthalmology	0	In state provider	None	8383 WILSHIRE BLVD	SUITE 440	BEVERLY HILLS	CA	90211	2436	19	06037	34.06457438	-118.3736146	Los Angeles County
166270	Fee-for-Service	1295927408	1295927408	1	1	DOUGLAS F. CARRASCO M.D. INC	8/10/2018	261QP2300X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	.	44274 GEORGE CUSHMAN CT	SUITE 210	TEMECULA	CA	92592	5945	33	06065	33.48313254	-117.0888293	Riverside County
166276	Fee-for-Service	1033258736	1033258736	1	1	DESHMUKH, ASHWIN V MD	4/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74504	20	Orthopedic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
166279	Fee-for-Service	1053517300	1053517300	1	1	DAVARYA, SHEKAR L MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113639	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
166287	Fee-for-Service	1700803418	1700803418	1	9	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
166317	Fee-for-Service	1003673815	1003673815	1	1	DEAN PRINCE MD INC	1/6/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	15211 VANOWEN ST	200	VAN NUYS	CA	91405	3606	19	06037	34.19395411	-118.4642527	Los Angeles County
166324	Fee-for-Service	1558724781	1558724781	1	1	DEAS, JESSICA MD	6/6/2022	390200000X	NA	Other	026	PHYSICIANS	151531	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
166338	Fee-for-Service	1962508325	1962508325	1	1	DO, DAT T MD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76728	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
166446	Fee-for-Service	1093006595	1093006595	1	1	DELELLIS, DANA C MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130763	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90059	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
166476	Fee-for-Service	1740639046	1740639046	2	1	DEMIRCHYAN, DANIEL MD	6/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162259	None	None	0	In state provider	None	200 S WELLS RD	100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
166481	Fee-for-Service	1871063339	1871063339	1	1	DOWLOU, ASHLEY E LMFT	1/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
166493	Fee-for-Service	1437220407	1437220407	1	1	DIFRONZO, LOUIS A MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81895	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
166538	Fee-for-Service	1265193130	1265193130	1	1	DURFEE, ELIZABETH M NP	1/11/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166547	Fee-for-Service	1205850641	1205850641	2	1	DER SARKISSIAN, LAZIK MD	7/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	41167	05	Anesthesiology	0	In state provider	None	540 N CENTRAL AVE	STE 205	GLENDALE	CA	91203	3368	19	06037	34.15437	-118.257912	Los Angeles County
166564	Fee-for-Service	1508082157	1508082157	1	1	DORNER, GILLIAN A MD	10/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95216	None	None	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
166577	Fee-for-Service	1700803418	1700803418	1	9	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
166587	Fee-for-Service	1891229613	1891229613	1	1	DELGADO, DANIELA MD	6/12/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157726	08	Family Practice	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
166610	Fee-for-Service	1073832143	1073832143	1	1	DHILLON, TEJVEER S MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120599	02	General Surgery	0	In state provider	None	863 N DOUGLAS STREET	#100	EL SEGUNDO	CA	90245	2801	19	06037	33.92830583	-118.3831669	Los Angeles County
166663	Fee-for-Service	1356667406	1356667406	1	1	DOSHI, ASHMI M MD	7/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119079	03	Allergy	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
166686	Fee-for-Service	1992159941	1992159941	1	1	DIXIT, SHALINI MD	8/14/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	155109	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166730	Fee-for-Service	1457544629	1457544629	1	1	DHARIWAL, MANOJ K MD	4/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	120096	01	General Practice	0	In state provider	None	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
166748	Fee-for-Service	1669129052	1669129052	1	1	DADASHYAN, INNA CNP	10/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7023 OWENSMOUTH AVE	None	CANOGA PARK	CA	91303	2006	19	06037	34.19809485	-118.6015764	Los Angeles County
166751	Fee-for-Service	1104856095	1104856095	1	3	DESERT REGIONAL MEDICAL	1/13/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 N INDIAN CANYON DR	SUITE 100	PALM SPRINGS	CA	92262	4872	33	06065	33.838542	-116.5455735	Riverside County
166782	Fee-for-Service	1699749093	1699749093	1	1	DAHER, SAMIR F DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	319 S BRAND BLVD	None	GLENDALE	CA	91204	1701	19	06037	34.14172735	-118.2550689	Los Angeles County
166788	Fee-for-Service	1790970333	1790970333	1	1	DISDIER, CARLOS M PSYD	3/5/2021	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
166820	Fee-for-Service	1780762286	1780762286	1	1	DESAI, ASHISH V MD	5/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90144	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
166840	Fee-for-Service	1780066373	1780066373	1	2	DR KAMRAN PARSA INC	7/29/2021	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1120 WEST AVENUE M-4	None	PALMDALE	CA	93551	1432	19	06037	34.6457071	-118.155831	Los Angeles County
166842	Fee-for-Service	1578524815	1578524815	1	1	DAVITA-RIVERSIDE, LLC	9/1/2004	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1181 N STATE ST	None	SAN JACINTO	CA	92583	6317	33	06065	33.802461	-116.9720305	Riverside County
166861	Fee-for-Service	1174854038	1174854038	2	1	DONG, LEE H MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124137	41	Internal Medicine	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
166863	Fee-for-Service	1700803418	1700803418	1	34	DIGNITY HEALTH MEDICAL FOUND	9/21/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J STREET	STE 350	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
166864	Fee-for-Service	1891229613	1891229613	1	1	DELGADO, DANIELA MD	6/12/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157726	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
166879	Fee-for-Service	1013576123	1013576123	1	1	DOTSON, CASSANDRA F CRNA	4/9/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
166908	Fee-for-Service	1760731202	1760731202	1	1	DEL RIO-ELIZARRARAZ, ELSA MD	11/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121540	08	Family Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90706	2246	19	06037	33.918975	-118.1291985	Los Angeles County
166913	Fee-for-Service	1750443826	1750443826	2	1	DUCKETT, MARK W	5/29/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1304 NUGGET LANE	None	WEAVERVILLE	CA	96093	0000	53	06105	40.72137374	-122.9289894	Trinity County
166924	Fee-for-Service	1235279571	1235279571	1	1	DROVER, DAVID R MD	7/31/1993	207L00000X	NA	Other	026	PHYSICIANS	54093	05	Anesthesiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
166951	Fee-for-Service	1356667406	1356667406	1	1	DOSHI, ASHMI M MD	7/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119079	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
166971	Fee-for-Service	1023408804	1023408804	1	1	DUARTE, RITA A LCSW	12/30/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
167086	Fee-for-Service	1487816682	1487816682	1	2	DAVID, CHRISTOPHER	8/15/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
167096	Fee-for-Service	1174575245	1174575245	1	1	DAVOUDI, MARJAN PHD	4/8/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
167106	Fee-for-Service	1215149026	1215149026	1	2	DUA, SOHAN L MD FACP AMC	7/21/2009	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18350 ROSCOE BLVD	STE 604	NORTHRIDGE	CA	91325	4190	19	06037	34.22071855	-118.5341175	Los Angeles County
167112	Fee-for-Service	1083971881	1083971881	1	5	DIGNITY HEALTH MEDICAL FOUND	1/11/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	9500 STOCKDALE HWY	SUITE 200	BAKERSFIELD	CA	93311	3621	15	06029	35.35452448	-119.1074625	Kern County
167118	Fee-for-Service	1295069763	1295069763	1	1	DEBORAH M BROOKS	4/5/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 BOWER HILL RD	None	PITTSBURGH	PA	15243	1873	00	None	40.37744491	-80.06601413	Allegheny County
167122	Fee-for-Service	1245709112	1245709112	1	1	DEGUZMAN, DARRELL V NP	8/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1061 TIERRA DEL REY	SUITE 200	CHULA VISTA	CA	91910	7880	37	06073	32.63799018	-117.017426	San Diego County
167130	Fee-for-Service	1780066373	1780066373	1	2	DR KAMRAN PARSA INC	2/29/2024	207T00000X	NA	General Surgery	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1120 WEST AVENUE M-4	None	PALMDALE	CA	93551	1432	19	06037	34.6457071	-118.155831	Los Angeles County
167152	Fee-for-Service	1700803418	1700803418	1	34	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	STE 350	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
167208	Fee-for-Service	1205913142	1205913142	1	1	DOAN, JENNIFER U MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70136	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
167252	Fee-for-Service	1720638208	1720638208	1	1	DEL DIOS CARE LLC	7/6/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1817 AVENIDA DEL DIABLO	None	ESCONDIDO	CA	92029	3112	37	06073	33.1031165	-117.1048275	San Diego County
167264	Fee-for-Service	1528012150	1528012150	1	1	DICKENS, KRISTINA K CRNA	4/21/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	05	Anesthesiology	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
167272	Fee-for-Service	1861814410	1861814410	1	1	DIAMOND MEDICAL TRANSPORT	10/3/2013	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	306 MONTEREY DR	None	CARSON	CA	90745	6446	19	06037	33.7992305	-118.2710947	Los Angeles County
167282	Fee-for-Service	1538351911	1538351911	1	1	DONAHUE, MICHAEL P MD	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	58823	40	Pediatrics	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
167292	Fee-for-Service	1578535027	1578535027	1	1	DILL, GERALD L OD	11/1/2001	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1360 E HERNDON AVE	STE 401	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
167298	Fee-for-Service	1699189852	1699189852	1	1	DOAN, JANET T OD	1/5/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44815 FIG AVE	None	LANCASTER	CA	93534	3144	19	06037	34.69630244	-118.1431105	Los Angeles County
167308	Fee-for-Service	1417199589	1417199589	1	1	DEMICHELE, JENNIFER C MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
167320	Fee-for-Service	1922192103	1922192103	1	1	DUONG, THUAN P MD	2/28/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45409	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
167341	Fee-for-Service	1568080950	1568080950	1	1	DAVIS, BRANDI A LMFT	1/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
167344	Fee-for-Service	1366643371	1366643371	1	1	DAVAMONY, DAVID I PHD	8/5/2008	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	36	Psychiatry	0	In state provider	None	4715 VIEWRIDGE AVE	#230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
167372	Fee-for-Service	1811637416	1811637416	1	1	DOERSTLING, STEVEN S MD	2/4/2025	207R00000X	NA	Other	026	PHYSICIANS	187805	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
167382	Fee-for-Service	1073870747	1073870747	1	1	DANTES, DAVID MD	6/12/2017	207P00000X	NA	Other	026	PHYSICIANS	25478	66	Emergency Medicine (Urgent Care)	0	In state provider	None	650 5TH STREET	STE 502	SAN FRANCISCO	CA	94107	1536	38	06075	37.77575268	-122.3977845	San Francisco County
167394	Fee-for-Service	1215149026	1215149026	1	2	DUA, SOHAN L MD FACP AMC	7/21/2009	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	18350 ROSCOE BLVD	STE 604	NORTHRIDGE	CA	91325	4190	19	06037	34.22071855	-118.5341175	Los Angeles County
167403	Fee-for-Service	1083971881	1083971881	1	5	DIGNITY HEALTH MEDICAL FOUND	1/11/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9500 STOCKDALE HWY	SUITE 200	BAKERSFIELD	CA	93311	3621	15	06029	35.35452448	-119.1074625	Kern County
167419	Fee-for-Service	1780066373	1780066373	1	2	DR KAMRAN PARSA INC	2/25/2025	207T00000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1120 WEST AVENUE M-4	None	PALMDALE	CA	93551	1432	19	06037	34.6457071	-118.155831	Los Angeles County
167443	Fee-for-Service	1700803418	1700803418	1	34	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	STE 350	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
167445	Fee-for-Service	1730150897	1730150897	1	1	DISBROW, ERIC C MD INC	10/1/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21038	01	General Practice	0	In state provider	None	1285 HEIGHTS AVE	None	ATWATER	CA	95301	3654	24	06047	37.35221224	-120.6076864	Merced County
167483	Fee-for-Service	1366731911	1366731911	1	1	DAIGNAULT, MICHAEL C MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142340	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5925 SAN VICENTE BLVD	None	LOS ANGELES	CA	90019	6630	19	06037	34.05682871	-118.360716	Los Angeles County
167506	Fee-for-Service	1043507569	1043507569	1	1	DAVIA, BRIAN DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	11571	05	Anesthesiology	0	In state provider	None	75 NIELSON STREET	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
167521	Fee-for-Service	1023512985	1023512985	1	1	DELGADO, PAUL	6/2/2024	207L00000X	NA	Other	026	PHYSICIANS	165040	05	Anesthesiology	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
167582	Fee-for-Service	1497973358	1497973358	1	1	DEL ROSARIO, BERNADETTE	6/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103196	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
167589	Fee-for-Service	1003258609	1003258609	1	1	DEWBERRY, ANN M LMFT	9/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
167592	Fee-for-Service	1508024126	1508024126	1	1	DEHARI, REZA MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113848	30	Radiology	0	In state provider	None	14900 E IMPERIAL HWY	None	LA MIRADA	CA	90638	2172	19	06037	33.91710433	-118.0132986	Los Angeles County
167617	Fee-for-Service	1235289117	1235289117	2	1	DIGNITY HEALTH	6/30/2006	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	MERCY HOME CARE	2740 M ST	None	MERCED	CA	95340	2813	24	06047	37.31239905	-120.478839	Merced County
167632	Fee-for-Service	1730270323	1730270323	1	1	DAY, KIRSTEN Y MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72692	08	Family Practice	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
167720	Fee-for-Service	1801425392	1801425392	1	1	DE ALMEIDA OKIDA, LUIS FELIP	3/28/2025	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	E MD	205 RIVER PARK CIR	None	FRESNO	CA	93720	1571	10	06019	36.85456375	-119.7863981	Fresno County
167721	Fee-for-Service	1891716023	1891716023	1	1	DEMAR, ANDREW R MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	58869	02	General Surgery	0	In state provider	None	729 SUNRISE AVE	STE 610	ROSEVILLE	CA	95661	4548	31	06061	38.73444822	-121.2720033	Placer County
167729	Fee-for-Service	1700803418	1700803418	1	9	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	2110 PROFESSIONAL DR	STE 120	ROSEVILLE	CA	95661	3779	31	06061	38.74234873	-121.2521259	Placer County
167734	Fee-for-Service	1215336136	1215336136	1	1	DIZON, ERIN N MD	8/16/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	143760	77	Infectious Disease	0	In state provider	None	2251 W ROSECRANS AVE	UNIT 21	COMPTON	CA	90222	3860	19	06037	33.90273823	-118.2557598	Los Angeles County
167739	Fee-for-Service	1588844393	1588844393	1	1	DAWSON, SHUNTAE D LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
167756	Fee-for-Service	1235505611	1235505611	1	1	DELLA GROTTA, KEITH MD	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	160993	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4929 VAN NUYS BLVD	ATTN: EMERGENCY DEPT	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
167798	Fee-for-Service	1518085430	1518085430	1	3	DIGNITY HEALTH	1/31/2024	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
167822	Fee-for-Service	1154044022	1154044022	1	1	DHAMI, RAYMON PT	2/14/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1585 BUTTE HOUSE RD	A	YUBA CITY	CA	95993	2200	51	06101	39.14802201	-121.643823	Sutter County
167853	Fee-for-Service	1245227370	1245227370	1	1	DAVID SULLIVAN M.D.	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W COLUMBIA ST	STE 420	EVANSVILLE	IN	47710	1782	00	None	37.98476683	-87.56872569	Vanderburgh County
167866	Fee-for-Service	1780758896	1780758896	1	1	DENG, WEI NP	6/22/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
167874	Fee-for-Service	1760182042	1760182042	1	1	DEVRIES, BLAKE PT	7/24/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2838 OSWELL ST	None	BAKERSFIELD	CA	93306	2704	15	06029	35.39923633	-118.9499418	Kern County
167912	Fee-for-Service	1942384912	1942384912	1	1	DEBBOLD, LESTER I MD	2/22/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	66081	36	Psychiatry	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
167939	Fee-for-Service	1487636775	1487636775	1	1	DR BRADLEY MARDER	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
167976	Fee-for-Service	1508077355	1508077355	1	1	DRAEGER, MARC K MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115013	30	Radiology	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	7737	10	06019	36.7423511	-119.7834688	Fresno County
167981	Fee-for-Service	1053826792	1053826792	1	1	DESERT PHARMACY	12/21/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1560 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.779782	-115.569736	Imperial County
167986	Fee-for-Service	1891920781	1891920781	1	1	DRAKE, SUMMER L DO	5/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10265	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
168014	Fee-for-Service	1770887481	1770887481	1	1	DRUMMOND, ROBERT MD	10/9/2024	207R00000X	NA	Other	026	PHYSICIANS	129222	41	Internal Medicine	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
168023	Fee-for-Service	1316443534	1316443534	1	1	DAY, ERIC MD	5/4/2021	207R00000X	NA	Other	026	PHYSICIANS	166078	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
168034	Fee-for-Service	1770920407	1770920407	1	1	DOWNTOWN VACAVILLE EYECARE	9/29/2016	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC AN OPTOMETRIC CORP	340 CERNON STREET	None	VACAVILLE	CA	95688	4502	48	06095	38.355291	-121.9910265	Solano County
168056	Fee-for-Service	1922263151	1922263151	1	1	DEANE, ERIN M MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104773	08	Family Practice	0	In state provider	None	568 N SUNRISE AVE	None	ROSEVILLE	CA	95661	3035	31	06061	38.7576732	-121.2534645	Placer County
168089	Fee-for-Service	1730298944	1730298944	1	1	DOUGLASS, CHARLES T LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4126 S DEMAREE ST	STE B	VISALIA	CA	93277	9514	54	06107	36.293562	-119.3304285	Tulare County
168158	Fee-for-Service	1043449655	1043449655	1	1	DEMIRJIAN, MARY OD	7/20/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2915 W MAGNOLIA BLVD	None	BURBANK	CA	91505	3039	19	06037	34.17040349	-118.3395219	Los Angeles County
168172	Fee-for-Service	1003901786	1003901786	1	1	DARIUSH MEHRABANI M.D.	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 N WILMOT RD	None	TUCSON	AZ	85711	2602	00	None	32.227209	-110.8556595	Pima County
168259	Fee-for-Service	1235991498	1235991498	1	1	DOWNEY PARK COUNSELING ASSOC	3/28/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	IATES	1213 COFFEE RD	STE P	MODESTO	CA	95355	4229	50	06099	37.660401	-120.975669	Stanislaus County
168267	Fee-for-Service	1629600515	1629600515	1	1	DAVIDGE, SAMANTHA LCSW	8/18/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
168306	Fee-for-Service	1700803418	1700803418	1	14	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	3939 J ST	STE 320	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
168336	Fee-for-Service	1164498663	1164498663	1	1	DIAMANT, JOEL C MD	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73299	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
168354	Fee-for-Service	1073831582	1073831582	1	1	DECASTRO, ELENA L	6/29/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8545 SIERRA AVE	None	FONTANA	CA	92335	3868	36	06071	34.09849683	-117.4356608	San Bernardino County
168371	Fee-for-Service	1215912910	1215912910	1	1	DEL AMO GARDENS CONV	6/29/1997	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
168411	Fee-for-Service	1619138575	1619138575	1	1	D'ONOFRIO, LINDA D MD	4/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	60347	05	Anesthesiology	0	In state provider	None	5900 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
168466	Fee-for-Service	1548314115	1548314115	1	1	DAWSON, LAUREL G MD	3/7/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49634	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
168517	Fee-for-Service	1235155755	1235155755	1	1	DUNBAR, RICHARD W MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70979	05	Anesthesiology	0	In state provider	None	1 S FOREST RD	None	SONORA	CA	95370	4816	55	06109	37.98218745	-120.3911521	Tuolumne County
168521	Fee-for-Service	1427552454	1427552454	1	1	DENHAM, ZACHARY R MD	9/20/2022	207L00000X	NA	Other	026	PHYSICIANS	181678	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3522	48	06095	38.26109552	-122.0470245	Solano County
168547	Fee-for-Service	1790917631	1790917631	1	1	DANH, DAN T MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112628	10	Gastroenterology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
168553	Fee-for-Service	1235991498	1235991498	1	1	DOWNEY PARK COUNSELING ASSOC	3/28/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	IATES	1213 COFFEE RD	STE P	MODESTO	CA	95355	4229	50	06099	37.660401	-120.975669	Stanislaus County
168559	Fee-for-Service	1619052271	1619052271	1	1	DUGGAL, EENA MD	3/25/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61084	08	Family Practice	0	In state provider	None	4725 FIRST STREET	SUITE 100	PLEASANTON	CA	94566	7366	01	06001	37.65692944	-121.8767827	Alameda County
168563	Fee-for-Service	1841281946	1841281946	1	1	DOTEMOTO, SHARON PHD	5/14/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1081 WESTWOOD BLVD	SUITE 230	LOS ANGELES	CA	90024	2911	19	06037	34.0613619	-118.4454889	Los Angeles County
168592	Fee-for-Service	1700803418	1700803418	1	14	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3939 J ST	STE 320	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
168600	Fee-for-Service	1073655064	1073655064	1	1	DEAN, ANDREW C PHD	5/28/2008	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
168618	Fee-for-Service	1114095726	1114095726	1	1	DEVERA, EMMANUEL L MD	4/7/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	41773	08	Family Practice	0	In state provider	None	1663 BEVERLY BLVD	STE 101	LOS ANGELES	CA	90026	5747	19	06037	34.06426986	-118.2649213	Los Angeles County
168625	Fee-for-Service	1902213283	1902213283	1	1	DANBERG, ANNE D LMFT	8/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	2173 FRANCISCO BLVD E	SUITE F	SAN RAFAEL	CA	94901	5523	21	06041	37.945209	-122.4877278	Marin County
168631	Fee-for-Service	1528393063	1528393063	1	1	DY, IRENE A MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120038	78	Neoplastic Diseases/Oncology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
168633	Fee-for-Service	1780066373	1780066373	1	1	DR KAMRAN PARSA INC	12/21/2015	193400000X	NA	Other	026	PHYSICIANS	11025	None	None	0	In state provider	None	38420 5TH STREET	UNIT E	PALMDALE	CA	93551	4430	19	06037	34.58015195	-118.1384596	Los Angeles County
168643	Fee-for-Service	1053385500	1053385500	1	1	DVA HLTHCARE RENAL CARE	7/1/1993	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	2655 SHATTUCK AVE	None	BERKELEY	CA	94704	3237	01	06001	37.86065651	-122.266844	Alameda County
168661	Fee-for-Service	1568966000	1568966000	1	1	DEL PIERO, JULIET B MD	1/19/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	180019	None	None	0	In state provider	None	14 FORD RD	None	CARMEL VALLEY	CA	93924	9511	27	06053	36.48369939	-121.7364881	Monterey County
168692	Fee-for-Service	1609460963	1609460963	1	1	DVERINA, NATALYA NP	4/26/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4901 BILOXI	None	NORTH HOLLYWOOD	CA	91601	4814	19	06037	34.15962499	-118.3583058	Los Angeles County
168756	Fee-for-Service	1548314115	1548314115	1	1	DAWSON, LAUREL G MD	3/7/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	49634	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
168759	Fee-for-Service	1750840922	1750840922	1	1	DIAZ-ARVIZU, MARIA NP	7/31/2024	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3529 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3031	19	06037	33.95422949	-118.2050894	Los Angeles County
168760	Fee-for-Service	1073907259	1073907259	1	1	DARGER, BRYAN F MD	7/30/2019	207P00000X	NA	Other	026	PHYSICIANS	149278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
168768	Fee-for-Service	1225349459	1225349459	1	1	DINGLASAN, JANICE	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
168770	Fee-for-Service	1588757074	1588757074	1	2	DADSETAN, MOHAMMAD R MD	12/6/2000	174400000X	NA	Other	026	PHYSICIANS	49092	30	Radiology	0	In state provider	None	500 E OLIVE AVE	STE 103	BURBANK	CA	91501	2171	19	06037	34.1845331	-118.3048131	Los Angeles County
168794	Fee-for-Service	1124346697	1124346697	1	1	DERDERIAN, TREVOR J MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148584	02	General Surgery	0	In state provider	None	35800 BOB HOPE DRIVE	SUITE 255	RANCHO MIRAGE	CA	92270	1739	33	06065	33.790527	-116.4058645	Riverside County
168815	Fee-for-Service	1861642357	1861642357	1	1	DHATT, AMANDEEP K MD	4/16/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
168882	Fee-for-Service	1700803418	1700803418	1	14	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3939 J ST	STE 320	SACRAMENTO	CA	95819	3666	34	06067	38.570211	-121.45374	Sacramento County
168917	Fee-for-Service	1467952317	1467952317	1	1	DUMLAO, JOCELYN A L CRNA	4/24/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
168919	Fee-for-Service	1528393063	1528393063	1	1	DY, IRENE A MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	120038	68	Hematology	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
168947	Fee-for-Service	1205917887	1205917887	1	1	DING, SHAO-ZHENG MD	1/11/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	92756	41	Internal Medicine	0	In state provider	None	1722 DESIRE AVE	STE 102	ROWLAND HEIGHTS	CA	91748	2969	19	06037	33.98725948	-117.8963129	Los Angeles County
168949	Fee-for-Service	1215985650	1215985650	1	1	DUBOWITZ, GERALD P MD	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76593	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
168986	Fee-for-Service	1770652299	1770652299	1	1	DHILLON, SURISHAM MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	51651	13	Neurology (M.D. only)	0	In state provider	None	23928 LYONS AVE	STE 204	NEWHALL	CA	91321	2455	19	06037	34.37895689	-118.5532505	Los Angeles County
168994	Fee-for-Service	1932119120	1932119120	1	1	DOAN, KENNETH E MD	8/24/1994	207R00000X	NA	Other	026	PHYSICIANS	52887	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
168996	Fee-for-Service	1699838375	1699838375	1	1	DOMINGUEZ, STEVEN MD	4/23/1990	207P00000X	NA	Other	026	PHYSICIANS	48186	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
169011	Fee-for-Service	1497930903	1497930903	1	1	DHAND, SUBHASH MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	32880	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	1535 W MERCED AVE	STE 308	WEST COVINA	CA	91790	3402	19	06037	34.06295577	-117.9482872	Los Angeles County
169013	Fee-for-Service	1386277143	1386277143	1	1	DEL REAL DELFIN, TERESA PT	3/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
169065	Fee-for-Service	1780813923	1780813923	1	1	DING, HILDA H MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144295	68	Hematology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
169076	Fee-for-Service	1942456322	1942456322	1	1	DOANE, STEPHEN M MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119713	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
169157	Fee-for-Service	1962482489	1962482489	1	1	DOAN, RICHARD L A MD	10/31/1988	174400000X	NA	Other	026	PHYSICIANS	66469	None	None	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
169188	Fee-for-Service	1235889916	1235889916	1	1	DAO, SOPHIE NP	4/29/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
169209	Fee-for-Service	1013303536	1013303536	1	1	DUFOND, CHRISTINE L LMFT	6/8/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	517 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39783697	-122.8208805	Sonoma County
169245	Fee-for-Service	1629403258	1629403258	1	1	DULAY, ROBERT J	4/10/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
169264	Fee-for-Service	1578711446	1578711446	1	1	DALAL, NEIL MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130127	24	Plastic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
169272	Fee-for-Service	1871052688	1871052688	1	1	DIGHE, ISHANEE S DO	9/6/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	20069	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
169281	Fee-for-Service	1023101375	1023101375	1	1	DOWNS, DAVID J MD	12/14/2007	204D00000X	NA	Other	026	PHYSICIANS	84216	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
169355	Fee-for-Service	1780813923	1780813923	1	1	DING, HILDA H MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144295	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
169358	Fee-for-Service	1811999261	1811999261	1	1	DANESH, MOHAMMAD R MD	5/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48943	08	Family Practice	0	In state provider	None	31740-3 RAILROAD CYN RD	None	CANYON LAKE	CA	92587	9490	33	06065	33.67324972	-117.2538921	Riverside County
169366	Fee-for-Service	1700803418	1700803418	1	69	DIGNITY HEALTH MEDICAL FOUND	10/5/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1735 CREEKSIDE	None	FOLSOM	CA	95630	3914	34	06067	38.672028	-121.140198	Sacramento County
169419	Fee-for-Service	1083971881	1083971881	1	13	DIGNITY HEALTH MEDICAL FOUND	5/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-BAKERSFIELD INC.	3838 SAN DIMAS ST	STE B 201	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
169472	Fee-for-Service	1639345804	1639345804	1	1	DANIELLE HART	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
169491	Fee-for-Service	1538221833	1538221833	1	1	DREIFUSS, ALAN R PHD	10/3/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
169517	Fee-for-Service	1588227706	1588227706	1	1	DALIA, ABDELHAMID MD	4/28/2023	207P00000X	NA	Other	026	PHYSICIANS	183377	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
169543	Fee-for-Service	1033537493	1033537493	1	1	DEJONG, TYLER S MD	3/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138668	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
169587	Fee-for-Service	1932587649	1932587649	1	1	DAHOUD, WISSAM MD	6/8/2021	207ZP0102X	NA	Other	026	PHYSICIANS	171655	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
169595	Fee-for-Service	1497814230	1497814230	1	1	DAWSON, LAURA L	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
169642	Fee-for-Service	1780813923	1780813923	1	1	DING, HILDA H MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144295	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
169650	Fee-for-Service	1811999261	1811999261	1	1	DANESH, MOHAMMAD R MD	5/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48943	01	General Practice	0	In state provider	None	31740-3 RAILROAD CYN RD	None	CANYON LAKE	CA	92587	9490	33	06065	33.67324972	-117.2538921	Riverside County
169652	Fee-for-Service	1700803418	1700803418	1	69	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1735 CREEKSIDE	None	FOLSOM	CA	95630	3914	34	06067	38.672028	-121.140198	Sacramento County
169665	Fee-for-Service	1417338674	1417338674	1	1	DROHAN, JULIETTE DO	7/15/2019	207P00000X	NA	Other	026	PHYSICIANS	16938	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
169672	Fee-for-Service	1649765249	1649765249	1	1	DANG, BENJAMIN DO	10/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19050	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
169676	Fee-for-Service	1881004968	1881004968	1	1	DSOUZA, ELISABETH C CNP	11/14/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25880 MCBEAN PKWY	None	SANTA CLARITA	CA	91355	2004	19	06037	34.40360638	-118.5522028	Los Angeles County
169680	Fee-for-Service	1992736847	1992736847	1	1	DEBORAH SEIDEL	9/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10200 NE 132ND ST	None	KIRKLAND	WA	98034	2831	00	None	47.71853274	-122.2042278	King County
169743	Fee-for-Service	1528092459	1528092459	1	1	DALILI, IRADA MD	12/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96583	08	Family Practice	0	In state provider	None	5957 W RAMSEY ST	None	BANNING	CA	92220	3058	33	06065	33.92937645	-116.942463	Riverside County
169759	Fee-for-Service	1891796629	1891796629	1	1	DEANE, CHRISTINA OD	3/1/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 MERIDIAN AVE	None	SAN JOSE	CA	95126	2903	43	06085	37.325295	-121.9137735	Santa Clara County
169861	Fee-for-Service	1518152149	1518152149	1	2	DEUSE, TOBIAS MD	8/28/2018	208G00000X	NA	General Surgery	026	PHYSICIANS	152233	02	General Surgery	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
169862	Fee-for-Service	1730115353	1730115353	1	1	DEVINNEY, CRAIG R MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82204	66	Emergency Medicine (Urgent Care)	0	In state provider	EMERGENCY DEPT.	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
169890	Fee-for-Service	1669498499	1669498499	1	1	DR. MARK E HIBBARD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 HARLOW RD	STE 110	SPRINGFIELD	OR	97477	1190	00	None	44.06977851	-123.0418746	Lane County
169966	Fee-for-Service	1518196708	1518196708	1	1	DETERMAN, SARAH M	3/26/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6991 N STATE ST	None	REDWOOD VALLEY	CA	95470	9629	23	06045	39.2438212	-123.207113	Mendocino County
169994	Fee-for-Service	1558335695	1558335695	1	1	DWEK, JERRY R MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86073	None	None	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
170060	Fee-for-Service	1003048588	1003048588	1	1	DE LA ROSA, ROXANA G OD	11/30/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	842 SOUTH BROADWAY	None	LOS ANGELES	CA	90014	3202	19	06037	34.04274961	-118.2556172	Los Angeles County
170065	Fee-for-Service	1497953590	1497953590	1	1	DANISHWAR, JAMILA MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102800	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
170100	Fee-for-Service	1003994591	1003994591	1	1	DUGAN, CATHY CELIA	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79522	40	Pediatrics	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
170107	Fee-for-Service	1700230430	1700230430	1	1	DELANO KIDNEY CENTER LLC	11/9/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1980 CECIL AVE	None	DELANO	CA	93215	1513	15	06029	35.77581327	-119.2279324	Kern County
170142	Fee-for-Service	1720308869	1720308869	1	1	DORADO, FRANCISCO J MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111950	41	Internal Medicine	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
170166	Fee-for-Service	1730285503	1730285503	1	1	DENNIS, CHAD M NP	2/5/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 W PUEBLO	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
170177	Fee-for-Service	1326312067	1326312067	1	12	DCHS MEDICAL FOUNDATION	12/9/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2039 FOREST AVENUE	STE 304	SAN JOSE	CA	95128	4830	43	06085	37.32711929	-121.934266	Santa Clara County
170186	Fee-for-Service	1417310343	1417310343	1	1	DUONG, TRAMANH T DO	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	17080	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
170214	Fee-for-Service	1295774255	1295774255	1	1	DESMOND, ELIZABETH A MD	8/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83289	20	Orthopedic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
170222	Fee-for-Service	1780047589	1780047589	1	1	DAVID, MARISSA DPM	12/3/2019	390200000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
170234	Fee-for-Service	1588326102	1588326102	1	1	DECASTRO, MARK LENDL B PT	1/21/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
170235	Fee-for-Service	1821349341	1821349341	1	1	DANG PHARMACY GROUP INC	12/10/2014	3336C0004X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1250 S SUNSET AVE	STE 207-B	WEST COVINA	CA	91790	3961	19	06037	34.0610671	-117.9463685	Los Angeles County
170276	Fee-for-Service	1033642608	1033642608	1	1	DORRIZ, DONNA DO	4/29/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18442	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
170279	Fee-for-Service	1417027061	1417027061	1	1	DWIVEDI, RAJENDRA H MD	7/19/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33703	34	Urology and Urological Surgery	0	In state provider	None	623 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3212	54	06107	36.06957452	-119.031165	Tulare County
170292	Fee-for-Service	1679559355	1679559355	1	1	DEACONSON, TIMOTHY MD	10/7/2021	208600000X	NA	General Surgery	026	PHYSICIANS	170395	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
170295	Fee-for-Service	1265921365	1265921365	1	1	DAVIS, DEIRDRE S MD	10/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165432	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
170325	Fee-for-Service	1962538439	1962538439	1	1	DIAZ, JAIME A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1310 MCCULLOUGH AVE	None	SAN ANTONIO	TX	78212	5601	00	None	29.44121482	-98.49181508	Bexar County
170326	Fee-for-Service	1164423174	1164423174	1	1	DAVID LEON BRACKEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 MEDICAL VILLAGE DR	None	EDGEWOOD	KY	41017	3403	00	None	39.01457332	-84.56298791	Kenton County
170345	Fee-for-Service	1972368892	1972368892	1	1	DELAPORTE, AMELIE L MD	10/4/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
170354	Fee-for-Service	1033264395	1033264395	1	1	DEWITT, LEWIS L CRNA	6/3/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
170356	Fee-for-Service	1588646004	1588646004	1	1	DUBEY, ANURADHA	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87166	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95340	0000	24	06047	37.28825369	-120.4963159	Merced County
170359	Fee-for-Service	1487665998	1487665998	1	2	DIAL HEALTHCARE INCORPORATED	1/3/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13001 RAMONA BLVD	SUITE F & G	IRWINDALE	CA	91706	3752	19	06037	34.07969659	-117.9895641	Los Angeles County
170386	Fee-for-Service	1598843492	1598843492	1	1	DE GUZMAN, MARIA L MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64146	40	Pediatrics	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
170465	Fee-for-Service	1326312067	1326312067	1	12	DCHS MEDICAL FOUNDATION	12/9/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	2039 FOREST AVENUE	STE 304	SAN JOSE	CA	95128	4830	43	06085	37.32711929	-121.934266	Santa Clara County
170471	Fee-for-Service	1114243359	1114243359	1	1	DUNN, MAUREEN N MD	6/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124737	None	None	0	In state provider	None	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
170474	Fee-for-Service	1588728448	1588728448	1	1	DAL CORSO, DANIEL PHD	10/3/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3553 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
170475	Fee-for-Service	1710011739	1710011739	1	1	DALY, JILLIAN MD	12/21/2004	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
170512	Fee-for-Service	1396085098	1396085098	1	1	DRISCOLL, KARRIE ANNE W NP	5/20/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
170525	Fee-for-Service	1326279738	1326279738	1	1	DAO, ANH T MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	114217	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
170553	Fee-for-Service	1770657470	1770657470	1	1	DESHMUKH, ANJALI RAJIV MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49243	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
170571	Fee-for-Service	1669931986	1669931986	1	1	DI BELLA, GIULIA DO	7/11/2023	207P00000X	NA	Other	026	PHYSICIANS	20932	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
170603	Fee-for-Service	1528563467	1528563467	1	1	DAMPOG, RONALD RENY CNP	3/29/2024	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
170669	Fee-for-Service	1811221948	1811221948	1	1	DAVIS, APRIL G	11/4/2009	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	311 PROFESSIONAL CTR DR	STE 100	ROHNERT PARK	CA	94928	7931	49	06097	38.35501527	-122.7069494	Sonoma County
170702	Fee-for-Service	1588866248	1588866248	1	1	DEPP, COLIN A PHD	8/24/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
170731	Fee-for-Service	1386167500	1386167500	1	1	DOUGLAS, JENNIFER M PHD	9/1/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
170894	Fee-for-Service	1750860904	1750860904	1	1	DREW, DAVID LCSW	1/21/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
170918	Fee-for-Service	1497190458	1497190458	1	1	DOYLE, LAURA E	5/6/2025	No Taxonomy Provided	NA	None	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	4677 VALLEY EAST BLVD.	SUITE 2	ARCATA	CA	95521	4630	12	06023	40.90085428	-124.0816212	Humboldt County
170960	Fee-for-Service	1588729917	1588729917	1	1	DK DOKIMOS, INC	1/6/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	640 E MAIN ST	STE 2	GRASS VALLEY	CA	95945	5806	29	06057	39.22468602	-121.054005	Nevada County
170994	Fee-for-Service	1386673911	1386673911	1	1	DAWSON, DAVID W MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74315	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
171020	Fee-for-Service	1326466137	1326466137	1	1	DIEFFENBACH, BRYAN V MD	9/1/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	188066	None	None	0	In state provider	None	550 WASHINGTON ST	SUITE 641	SAN DIEGO	CA	92103	2229	37	06073	32.75003652	-117.1603431	San Diego County
171027	Fee-for-Service	1013395607	1013395607	1	1	DU, JENNY NGA T DO	10/1/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15172	08	Family Practice	0	In state provider	None	3000 Q ST	1ST FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
171044	Fee-for-Service	1437213279	1437213279	1	4	DIENTES COMMUNITY DENTAL	9/20/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	44	06087	36.98837145	-121.9802206	Santa Cruz County
171060	Fee-for-Service	1063848182	1063848182	1	1	DALY, ANNA E	12/11/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
171169	Fee-for-Service	1700807708	1700807708	1	1	DIALYSIS CLINIC INC	11/16/2006	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	512 CYPRESS ST	None	FORT BRAGG	CA	95437	5410	23	06045	39.43224713	-123.7982632	Mendocino County
171192	Fee-for-Service	1437541869	1437541869	1	1	DIVVYMED, LLC	12/2/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	4300 44TH AVE	None	MOLINE	IL	61265	6755	00	None	41.4679387	-90.47371439	Rock Island County
171239	Fee-for-Service	1013093558	1013093558	1	1	DIPSIA, ANTOINE G MD	11/10/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40970	41	Internal Medicine	0	In state provider	None	3001 RAMONA AVE	None	SACRAMENTO	CA	95826	3814	34	06067	38.546577	-121.4146395	Sacramento County
171263	Fee-for-Service	1679021281	1679021281	1	1	DIRLAM, SARAH PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
171264	Fee-for-Service	1811256654	1811256654	1	1	DSOUZA, ANISHKA A F MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129249	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
171270	Fee-for-Service	1659788024	1659788024	1	1	DAVIS, CHELSEA LCSW	6/7/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3393 14TH ST STE A	None	RIVERSIDE	CA	92501	3857	33	06065	33.97447738	-117.3746729	Riverside County
171286	Fee-for-Service	1114340858	1114340858	1	1	DIAZ TORRUELLAS, ROSALY M MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
171331	Fee-for-Service	1437213279	1437213279	1	4	DIENTES COMMUNITY DENTAL	9/20/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	44	06087	36.98837145	-121.9802206	Santa Cruz County
171366	Fee-for-Service	1700803418	1700803418	1	58	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
171415	Fee-for-Service	1700803418	1700803418	1	64	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	8120 TIMBERLAKE WAY	SUITE 101	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
171425	Fee-for-Service	1003873035	1003873035	1	1	DAUCETT, MICHELLE L DO	12/17/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	6696	08	Family Practice	0	In state provider	None	242 E HARVARD BLVD	# C	SANTA PAULA	CA	93060	3372	56	06111	34.34728904	-119.068761	Ventura County
171429	Fee-for-Service	1356683973	1356683973	1	1	DAFDONY, ISAM V N MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137130	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDREN'S P	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
171495	Fee-for-Service	1164666442	1164666442	1	1	DELAPEDRAJA, KYRA M NP	8/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
171503	Fee-for-Service	1457537649	1457537649	1	1	DHIR, SUNIL MD	6/11/2008	282N00000X	NA	Hospitals	026	PHYSICIANS	102853	41	Internal Medicine	0	In state provider	None	2540 CARMICHAEL WAY	None	CARMICHAEL	CA	95608	5314	34	06067	38.611062	-121.327011	Sacramento County
171527	Fee-for-Service	1013093558	1013093558	1	1	DIPSIA, ANTOINE G MD	11/10/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	40970	08	Family Practice	0	In state provider	None	3001 RAMONA AVE	None	SACRAMENTO	CA	95826	3814	34	06067	38.546577	-121.4146395	Sacramento County
171552	Fee-for-Service	1811256654	1811256654	1	1	DSOUZA, ANISHKA A F MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129249	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
171590	Fee-for-Service	1619984812	1619984812	1	1	DE MATTOS, ANGELO M MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100800	45	Nephrology (Renal-Kidney)	0	In state provider	None	4060 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.5526847	-121.4593512	Sacramento County
171634	Fee-for-Service	1073691168	1073691168	1	1	DECK, JEROME B MD	5/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	72861	01	General Practice	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
171638	Fee-for-Service	1629235825	1629235825	1	1	DANG, VINH Q MD	7/15/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	90287	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	BLDG 10	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
171655	Fee-for-Service	1700803418	1700803418	1	58	DIGNITY HEALTH MEDICAL FOUND	12/9/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
171662	Fee-for-Service	1700803418	1700803418	1	60	DIGNITY HEALTH MEDICAL FOUND	1/17/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3939 J ST	STE 230	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
171668	Fee-for-Service	1336325828	1336325828	1	1	DASTUR, CYRUS K MD	3/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	92914	36	Psychiatry	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
171669	Fee-for-Service	1659375566	1659375566	1	1	DONOHOE, TODD A DC	4/21/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	41880 KALMIA ST STE 135	135	MURRIETA	CA	92562	8825	33	06065	33.55740114	-117.2157733	Riverside County
171685	Fee-for-Service	1770556193	1770556193	1	1	DEBRA A WEIMERSKIRCH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
171703	Fee-for-Service	1700803418	1700803418	1	64	DIGNITY HEALTH MEDICAL FOUND	1/16/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	FOUNDATION	8120 TIMBERLAKE WAY	SUITE 101	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
171722	Fee-for-Service	1780903666	1780903666	1	1	DI ROCCO, DARYL J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
171773	Fee-for-Service	1639325053	1639325053	1	1	DARA, LILY MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106549	10	Gastroenterology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	SUITE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
171793	Fee-for-Service	1457537649	1457537649	1	1	DHIR, SUNIL MD	6/11/2008	282N00000X	NA	Hospitals	026	PHYSICIANS	102853	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2540 CARMICHAEL WAY	None	CARMICHAEL	CA	95608	5314	34	06067	38.611062	-121.327011	Sacramento County
171840	Fee-for-Service	1811256654	1811256654	1	1	DSOUZA, ANISHKA A F MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	129249	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
171849	Fee-for-Service	1518196708	1518196708	1	2	DETERMAN, SARAH M	12/30/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
171856	Fee-for-Service	1760862544	1760862544	1	1	DUNCAN, NOAH T MD	11/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149707	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
171861	Fee-for-Service	1194396986	1194396986	1	1	DUPLAN, AMY L LPCC	4/17/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
171877	Fee-for-Service	1619984812	1619984812	1	1	DE MATTOS, ANGELO M MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100800	41	Internal Medicine	0	In state provider	None	4060 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.5526847	-121.4593512	Sacramento County
171940	Fee-for-Service	1215279773	1215279773	1	1	DARLING, AMANDA J MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155019	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
171945	Fee-for-Service	1700803418	1700803418	1	58	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
171949	Fee-for-Service	1700803418	1700803418	1	60	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3939 J ST	STE 230	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
171957	Fee-for-Service	1336325828	1336325828	1	1	DASTUR, CYRUS K MD	3/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	92914	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
171967	Fee-for-Service	1225116098	1225116098	1	1	DURANT, MICHAEL W MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63883	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
171991	Fee-for-Service	1700803418	1700803418	1	64	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	8120 TIMBERLAKE WAY	SUITE 101	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
171993	Fee-for-Service	1831352608	1831352608	1	2	DANIEL, SUBASHINI R MD	6/19/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	96266	33	Thoracic Surgery	0	In state provider	None	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
172004	Fee-for-Service	1982951554	1982951554	1	1	DHALIWAL, GURPREET S MD	2/28/2020	208VP0014X	NA	Other	026	PHYSICIANS	135259	05	Anesthesiology	0	In state provider	None	1530 BESSIE AVE	STE. 104	TRACY	CA	95376	3080	39	06077	37.74570848	-121.4330255	San Joaquin County
172024	Fee-for-Service	1275519084	1275519084	1	1	DUNGAN, DAVID M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSOCI	2525 S DOWNING	None	DENVER	CO	80210	5817	00	None	39.670326	-104.9735195	Denver County
172025	Fee-for-Service	1356328900	1356328900	1	1	DANG, HIEP D	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	7610	08	Family Practice	0	In state provider	None	11700 SOUTH ST	STE 204	ARTESIA	CA	90701	6611	19	06037	33.85835149	-118.084131	Los Angeles County
172029	Fee-for-Service	1386963999	1386963999	1	1	DREISBACH, JEREMIAH D MD	5/15/2019	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	159710	08	Family Practice	0	In state provider	None	47647 CALEO BAY DR	STE 210	LA QUINTA	CA	92253	8858	33	06065	33.70305235	-116.2936509	Riverside County
172061	Fee-for-Service	1639325053	1639325053	1	1	DARA, LILY MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106549	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	SUITE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
172206	Fee-for-Service	1437280641	1437280641	1	1	DUTARET, SYLVIE LMFT	2/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
172237	Fee-for-Service	1700803418	1700803418	1	60	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3939 J ST	STE 230	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
172249	Fee-for-Service	1164955670	1164955670	1	1	DALOYAN, LINDSEY P LCSW	11/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
172426	Fee-for-Service	1386213734	1386213734	1	1	DREYER, CAROLYN M NP	10/21/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8330 RED OAK ST	STE 201	RANCHO CUCAMONGA	CA	91730	0602	36	06071	34.10217525	-117.5693231	San Bernardino County
172436	Fee-for-Service	1811194525	1811194525	1	1	DAVID CHENG	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
172453	Fee-for-Service	1720283625	1720283625	1	1	DHILLON, RAHUL S MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111174	10	Gastroenterology (M.D. only)	0	In state provider	None	5 MEDICAL PLAZA DR	STE 140	ROSEVILLE	CA	95661	2866	31	06061	38.76604411	-121.2466761	Placer County
172482	Fee-for-Service	1639242720	1639242720	1	1	DAVID M LEDER	1/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 S THOMPSON ST	None	FLAGSTAFF	AZ	86001	8759	00	None	35.184573	-111.674529	Coconino County
172495	Fee-for-Service	1780662833	1780662833	1	1	DHUPA, ACHAL MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96411	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9850 GENESEE AVE	STE 780	LA JOLLA	CA	92037	1232	37	06073	32.882913	-117.226341	San Diego County
172528	Fee-for-Service	1245870278	1245870278	1	1	DILANGANI B RATNAYAKE MD INC	5/30/2020	261QP3300X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	73733 FRED WARING DR	205	PALM DESERT	CA	92260	2591	33	06065	33.72876253	-116.3788965	Riverside County
172537	Fee-for-Service	1700803418	1700803418	1	18	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 CREEKSIDE DR	STE 101	FOLSOM	CA	95630	3819	34	06067	38.671011	-121.147218	Sacramento County
172593	Fee-for-Service	1073082798	1073082798	1	1	DOROW, NICOLE OT	10/17/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8282 WHITE OAK AVE	107, 108, AND 111	RANCHO CUCAMONGA	CA	91730	7680	36	06071	34.10361339	-117.5644472	San Bernardino County
172608	Fee-for-Service	1922395292	1922395292	1	1	DAMLAKHI, RAHAF MD	4/9/2020	208M00000X	NA	Other	026	PHYSICIANS	142348	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
172627	Fee-for-Service	1699222950	1699222950	1	1	DR ELLIOTT SHAPIRO FAMILY	5/7/2018	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY INC	4353 LA JOLLA VILLAGE DR	STE H20	SAN DIEGO	CA	92122	1242	37	06073	32.870061	-117.2120625	San Diego County
172690	Fee-for-Service	1679651277	1679651277	1	1	DEMAS, KATHRYN A MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	39609	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
172697	Fee-for-Service	1265773048	1265773048	1	1	DENARO, ASHLEE R	6/9/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25431 CABOT RD	SUITE 118	LAGUNA HILLS	CA	92653	5517	30	06059	33.59115448	-117.6744575	Orange County
172709	Fee-for-Service	1558696039	1558696039	1	1	DEUCHER, ANNE M MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97991	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
172734	Fee-for-Service	1750613329	1750613329	1	1	DESERT HEART RHYTHM	2/18/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	83788	None	None	0	In state provider	CONSULTANTS INC	1100 N PALM CANYON	SUITE 206	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
172762	Fee-for-Service	1013233667	1013233667	1	1	DELTA DRUGS II INC	5/27/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2497 E LAKESHORE DRIVE	UNIT #B	LAKE ELSINORE	CA	92530	4553	33	06065	33.66055154	-117.3021731	Riverside County
172767	Fee-for-Service	1598023988	1598023988	1	1	DENUCCI, CHRISTOPHER C MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126388	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172771	Fee-for-Service	1124014113	1124014113	1	1	DAVID, SAUL J MD INC	7/26/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39568	05	Anesthesiology	0	In state provider	None	841 MOHAWK ST	STE 270	BAKERSFIELD	CA	93309	1547	15	06029	35.36193277	-119.0628694	Kern County
172797	Fee-for-Service	1487795548	1487795548	1	1	DOSHI, AMISH B MD	6/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88365	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
172822	Fee-for-Service	1700803418	1700803418	1	18	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1625 CREEKSIDE DR	STE 101	FOLSOM	CA	95630	3819	34	06067	38.671011	-121.147218	Sacramento County
172837	Fee-for-Service	1841400587	1841400587	1	1	DEETER, MATTHEW J MD	3/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1476	00	None	39.52483792	-119.7968314	Washoe County
172960	Fee-for-Service	1992445647	1992445647	1	1	DATUNARACHCHI, RIMA MD	2/29/2024	390200000X	NA	Other	026	PHYSICIANS	192593	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
172970	Fee-for-Service	1285603621	1285603621	1	2	DOUGLAS, JERRY E MD	4/18/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53653	-	NOT APPLICABLE	0	In state provider	None	810 NORTH STATE STREET	None	UKIAH	CA	95482	3410	23	06045	39.1579762	-123.2085995	Mendocino County
172990	Fee-for-Service	1013058643	1013058643	1	1	DEUTSCH, DAN	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	OPTICAL OUTLOOK INC	200 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
172998	Fee-for-Service	1558696039	1558696039	1	1	DEUCHER, ANNE M MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	97991	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
173010	Fee-for-Service	1962662718	1962662718	1	1	DALUGDUGAN, ESTHER D MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112511	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
173105	Fee-for-Service	1932303070	1932303070	1	1	DE LA CRUZ, KAREN M MD	4/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89354	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
173111	Fee-for-Service	1700803418	1700803418	1	18	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1625 CREEKSIDE DR	STE 101	FOLSOM	CA	95630	3819	34	06067	38.671011	-121.147218	Sacramento County
173169	Fee-for-Service	1508241811	1508241811	1	1	DIAZ, JAENAI LCSW	8/31/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
173221	Fee-for-Service	1780784710	1780784710	1	1	DR.SYAMALA DARIRA	12/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NAZ HOSPITAL	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	0000	00	None	34.558992	-112.481901	Yavapai County
173226	Fee-for-Service	1033429287	1033429287	1	1	DOLORES DIALYSIS LLC	10/17/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	30885 DATE PALM DR	None	CATHEDRAL CITY	CA	92234	2958	33	06065	33.82432858	-116.458266	Riverside County
173248	Fee-for-Service	1366587131	1366587131	3	1	DS DRUGS INC	1/11/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1240 N HACIENDA BLVD	STE 105	LA PUENTE	CA	91744	1663	19	06037	34.0433788	-117.9492771	Los Angeles County
173249	Fee-for-Service	1578711982	1578711982	1	1	DEMIRJIAN, BERJ G MD	12/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97497	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5427	19	06037	34.21980849	-118.4301135	Los Angeles County
173275	Fee-for-Service	1255371480	1255371480	1	1	DUNN, BRIAN A MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78640	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
173295	Fee-for-Service	1558519793	1558519793	1	1	DUBRAY, KARA A MD	1/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95734	40	Pediatrics	0	In state provider	None	1300 BANCROFT AVENUE	None	SAN LEANDRO	CA	94577	5147	01	06001	37.72690979	-122.1477291	Alameda County
173312	Fee-for-Service	1508076944	1508076944	1	1	DIGNITY HEALTH CONNECTED	7/1/1993	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	LIVING	200 MERCY OAKS DR	None	REDDING	CA	96003	8641	45	06089	40.61610977	-122.3286425	Shasta County
173327	Fee-for-Service	1033420070	1033420070	1	1	DANOS, CAMILLE L LCSW	9/10/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
173333	Fee-for-Service	1396825733	1396825733	1	1	DELEMOS, DAVID M MD	8/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
173343	Fee-for-Service	1841362399	1841362399	1	1	DENISE M ADAMS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
173397	Fee-for-Service	1063615185	1063615185	1	1	DELIC, LEJLA MD	9/1/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	99537	78	Neoplastic Diseases/Oncology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
173418	Fee-for-Service	1043338106	1043338106	1	1	DOLAN, JAMES F MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96760	08	Family Practice	0	In state provider	None	401 BICENTENNIAL	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
173426	Fee-for-Service	1154141711	1154141711	1	1	DENNIS, VICTOR E PT	10/28/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	224 N RIVERSIDE AVE	SUITE A	RIALTO	CA	92376	5968	36	06071	34.10345211	-117.3705328	San Bernardino County
173428	Fee-for-Service	1275859043	1275859043	1	1	DAYA, SNEHA S MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142266	40	Pediatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173445	Fee-for-Service	1710204011	1710204011	1	1	DR JOO ACUPUNCTURE INC	7/2/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	8847 IMPERIAL HWY	STE D	DOWNEY	CA	90242	3958	19	06037	33.91715466	-118.138443	Los Angeles County
173473	Fee-for-Service	1184727182	1184727182	1	1	DHAWAN, DEEPAK MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79078	41	Internal Medicine	0	In state provider	None	1532 150TH AVE	None	SAN LEANDRO	CA	94578	1823	01	06001	37.70718429	-122.1274288	Alameda County
173474	Fee-for-Service	1477602662	1477602662	1	1	DAUGHTRY, KATHERINE T PT	4/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
173496	Fee-for-Service	1619034725	1619034725	1	1	DERDERIAN, HRAK MD	12/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92365	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
173520	Fee-for-Service	1376842005	1376842005	1	1	DONG, SHU CNP	4/13/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14330 CULVER DR	None	IRVINE	CA	92604	0303	30	06059	33.70654758	-117.7857461	Orange County
173578	Fee-for-Service	1437579257	1437579257	1	1	DAOUD, NATALIE DO	10/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15037	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
173641	Fee-for-Service	1316902133	1316902133	1	1	DAVID PAUL CHASON MD	12/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE UNIVERSITY OF TEXAS	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7208	00	None	32.812245	-96.841584	Dallas County
173642	Fee-for-Service	1093077604	1093077604	1	1	DANIEL C ANDREOLI	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8300 W 38TH AVE	None	WHEAT RIDGE	CO	80033	6005	00	None	39.76932763	-105.0903492	Jefferson County
173678	Fee-for-Service	1063615185	1063615185	1	1	DELIC, LEJLA MD	9/1/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	99537	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
173699	Fee-for-Service	1578033593	1578033593	1	1	DENT, LATOSHA NP	6/4/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11011 HUSTON ST	205	NORTH HOLLYWOOD	CA	91601	5668	19	06037	34.16011785	-118.3709673	Los Angeles County
173701	Fee-for-Service	1659569234	1659569234	1	1	DUNPHY, JASON CO	4/23/2013	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2147 COURT ST	None	REDDING	CA	96001	2531	45	06089	40.57708561	-122.3931152	Shasta County
173704	Fee-for-Service	1013986959	1013986959	1	1	DUKE, ANDREW T MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74218	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
173716	Fee-for-Service	1275859043	1275859043	1	1	DAYA, SNEHA S MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142266	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173735	Fee-for-Service	1174879738	1174879738	1	1	DRALYUK, IRINA MD	4/29/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	136493	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
173742	Fee-for-Service	1497413892	1497413892	1	1	DHAKAL, KAMALA NP	3/25/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9878 CARMEL MOUNTAIN RD	STE B	SAN DIEGO	CA	92129	2893	37	06073	32.96028359	-117.114844	San Diego County
173747	Fee-for-Service	1689803215	1689803215	1	1	DEL VALLE, JEANNETTE MD INC	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42660	41	Internal Medicine	0	In state provider	None	769 MEDICAL CENTER CT	SUITE 203	CHULA VISTA	CA	91911	6602	37	06073	32.619186	-117.0200925	San Diego County
173758	Fee-for-Service	1184668741	1184668741	1	1	DEWITT, KELLY MD	6/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74873	78	Neoplastic Diseases/Oncology	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
173778	Fee-for-Service	1689134603	1689134603	1	1	DESHPANDE, AKSHAY	9/9/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
173846	Fee-for-Service	1780905273	1780905273	1	1	DER SARKISSIAN, ARIN D MD	6/16/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
173929	Fee-for-Service	1538191077	1538191077	1	1	DERMATOLOGISTS MED GRP O	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	NORTH COUNTY INC	3998 VISTA WAY	STE C100	OCEANSIDE	CA	92056	4515	37	06073	33.18370179	-117.292963	San Diego County
173950	Fee-for-Service	1598293235	1598293235	1	1	DEGERMAN, EDWARD M MD	11/4/2022	2081S0010X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	179721	None	None	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
174001	Fee-for-Service	1316478936	1316478936	1	1	DAMON, LAUREN E MD	5/17/2020	390200000X	NA	Other	026	PHYSICIANS	157494	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
174038	Fee-for-Service	1689803215	1689803215	1	1	DEL VALLE, JEANNETTE MD INC	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	42660	38	Geriatrics	0	In state provider	None	769 MEDICAL CENTER CT	SUITE 203	CHULA VISTA	CA	91911	6602	37	06073	32.619186	-117.0200925	San Diego County
174040	Fee-for-Service	1386978914	1386978914	1	1	DINH, HUNG H DO	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13922	41	Internal Medicine	0	In state provider	None	3610 ATLANTIC AVE	None	LONG BEACH	CA	90807	3418	19	06037	33.822621	-118.185002	Los Angeles County
174114	Fee-for-Service	1124328273	1124328273	1	1	DEOL, SHIVINDER S MD INC	10/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	37723	08	Family Practice	0	In state provider	None	4000 STOCKDALE HWY	SUITE D	BAKERSFIELD	CA	93309	2059	15	06029	35.35429352	-119.0531115	Kern County
174133	Fee-for-Service	1114905031	1114905031	1	1	DENTON, SCOTT L MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	SCHOOL OF MEDICINE	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
174146	Fee-for-Service	1407271257	1407271257	1	1	DUBBS, ELIZABETH M	1/12/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6650 ALTON PKWY	None	IRVINE	CA	92618	2317	30	06059	33.65911992	-117.7737909	Orange County
174172	Fee-for-Service	1932194289	1932194289	1	1	DEUTSCH, GARY M MD	1/20/2016	207R00000X	NA	Other	026	PHYSICIANS	38310	41	Internal Medicine	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
174187	Fee-for-Service	1336582253	1336582253	1	1	DINGER, RALEEN A LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
174210	Fee-for-Service	1164583837	1164583837	1	1	DESCHUTTER, MATHIEU W MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142499	40	Pediatrics	0	In state provider	None	1010 MURRAY AVENUE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
174225	Fee-for-Service	1982870499	1982870499	1	1	DAHAN, JACQUELINE F PHD	11/24/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
174252	Fee-for-Service	1912432378	1912432378	1	1	DUELL, SHANNON LMFT	12/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92563	7906	30	06059	33.62516256	-117.7353393	Orange County
174288	Fee-for-Service	1740711647	1740711647	1	1	DOW, ELIOT R MD	12/6/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	159638	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
174326	Fee-for-Service	1548797103	1548797103	1	1	DWIGHT, KATHRYN D MD	9/5/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	157586	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
174344	Fee-for-Service	1184916082	1184916082	1	1	DOBERNE, DEBORAH B MD	12/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116535	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
174373	Fee-for-Service	1417447327	1417447327	1	1	DIXON, CHRISTINA MD	10/6/2023	207L00000X	NA	Other	026	PHYSICIANS	167196	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
174391	Fee-for-Service	1073678199	1073678199	1	1	DEVILLY, SIMON J	5/24/2007	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5615 WHITTIER BLVD	STE E	LOS ANGELES	CA	90022	4129	19	06037	34.01887108	-118.1499151	Los Angeles County
174419	Fee-for-Service	1144424110	1144424110	1	1	DUKE, PATRICIA ANN	8/1/2007	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10784 SIERRA VIEW ST	None	MADERA	CA	93636	8832	20	06039	36.90722672	-119.7971873	Madera County
174452	Fee-for-Service	1427402445	1427402445	1	1	DUONG, WILLIAM B MD	10/8/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	151071	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
174517	Fee-for-Service	1437798071	1437798071	1	1	DIAZ VELASQUEZ, ENEIDA M	3/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
174525	Fee-for-Service	1801955539	1801955539	1	1	DAVIDIAN, SARO J CRNA	8/25/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	607 N CENTRAL AVENUE	None	GLENDALE	CA	91203	1804	19	06037	34.153974	-118.2579675	Los Angeles County
174536	Fee-for-Service	1487645149	1487645149	1	1	DIAZ-RANGEL, LUIS G MD	10/7/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	777 E 25TH ST	STE 118	HIALEAH	FL	33013	3804	00	None	25.8449845	-80.26837881	Miami-Dade County
174545	Fee-for-Service	1043258544	1043258544	1	1	DAUGHERTY, DREE H MD	2/16/2021	207PE0004X	NA	Other	026	PHYSICIANS	157533	None	None	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
174574	Fee-for-Service	1104922988	1104922988	1	1	DANIEL E. KRAMPITZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEUROLOGY CONSULTANTS	7515 GREENVILLE AVE. 400	None	DALLAS	TX	75231	0000	00	None	32.88377935	-96.75912168	Dallas County
174633	Fee-for-Service	1861619355	1861619355	1	1	DAY, RICHARD G MD	11/9/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55680	01	General Practice	0	In state provider	None	2238 BAYVIEW HEIGHTS DR	STE G	LOS OSOS	CA	93402	3921	40	06079	35.31038553	-120.8334714	San Luis Obispo County
174664	Fee-for-Service	1154366011	1154366011	1	1	DRAYER, JEFFREY A MD	7/19/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	69506	None	None	0	In state provider	None	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	15	06029	35.356203	-119.0612695	Kern County
174707	Fee-for-Service	1144424110	1144424110	1	1	DUKE, PATRICIA ANN	8/1/2007	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10784 SIERRA VIEW ST	None	MADERA	CA	93636	8832	20	06039	36.90722672	-119.7971873	Madera County
174763	Fee-for-Service	1548229875	1548229875	1	1	DANIEL C JOHNSON MD	10/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 BROADWAY AVE	None	YANKTON	SD	57078	2835	00	None	42.88123255	-97.39676171	Yankton County
174777	Fee-for-Service	1477275204	1477275204	1	1	DAFNA AHDOOT MD MEDICAL CORP	3/21/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	17200 VENTURA BLVD	STE 212	ENCINO	CA	91316	4092	19	06037	34.1604965	-118.5075373	Los Angeles County
174815	Fee-for-Service	1083971881	1083971881	1	1	DIGNITY HEALTH MEDICAL FOUND	8/14/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	9300 STOCKDALE HWY	STE 300	BAKERSFIELD	CA	93311	3611	15	06029	35.3545315	-119.1053925	Kern County
174820	Fee-for-Service	1891843827	1891843827	1	1	DAS, JAYANTA R MD	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91850	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
174845	Fee-for-Service	1235719451	1235719451	1	1	DONOVAN INDIVIDUAL AND FAMIL	11/9/2022	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	Y COUNSELING SERVICES, I	18888 US HIGHWAY 18	SUITE 106	APPLE VALLEY	CA	92307	2315	36	06071	34.53770988	-117.252322	San Bernardino County
174856	Fee-for-Service	1740777390	1740777390	1	1	DULKU, AROMA MD	11/14/2021	207R00000X	NA	Other	026	PHYSICIANS	173354	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
174943	Fee-for-Service	1750728911	1750728911	1	1	DIMAS, JORGE A PT	10/28/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1401 EL MONTE WAY	None	DINUBA	CA	93618	9165	54	06107	36.54610751	-119.4108615	Tulare County
174982	Fee-for-Service	1669467015	1669467015	1	1	DICICCO, DAVID A PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5190 GOVERNOR DR	STE 108	SAN DIEGO	CA	92122	2848	37	06073	32.85681284	-117.1855521	San Diego County
175050	Fee-for-Service	1255599015	1255599015	1	1	DANIELS, MATHIAS MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126857	20	Orthopedic Surgery	0	In state provider	None	65 NIELSON STREET	SUITE 125	WATSONVILLE	CA	95076	2491	44	06087	36.9282117	-121.7933197	Santa Cruz County
175051	Fee-for-Service	1205385408	1205385408	1	2	DAVID D SOHN MD APC	6/24/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3663 W 6TH STREET	SUITE 106	LOS ANGELES	CA	90020	3047	19	06037	34.06360557	-118.30199	Los Angeles County
175076	Fee-for-Service	1538553631	1538553631	1	1	DONG, ELIZABETH Y MD	5/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143744	41	Internal Medicine	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
175083	Fee-for-Service	1144634023	1144634023	1	1	DICHTER, DANIEL H MD	12/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147633	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
175108	Fee-for-Service	1891843827	1891843827	1	1	DAS, JAYANTA R MD	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91850	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
175130	Fee-for-Service	1235719451	1235719451	1	1	DONOVAN INDIVIDUAL AND FAMIL	11/9/2022	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	Y COUNSELING SERVICES, I	18888 US HIGHWAY 18	SUITE 106	APPLE VALLEY	CA	92307	2315	36	06071	34.53770988	-117.252322	San Bernardino County
175158	Fee-for-Service	1568218469	1568218469	1	1	DRUG ABUSE ALTERNATIVES CENT	10/14/2024	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	Y CENTER	790 SONOMA AVE	None	SANTA ROSA	CA	95404	4713	49	06097	38.43837	-122.708601	Sonoma County
175202	Fee-for-Service	1285936278	1285936278	1	1	DAVIS, CRESTON A LMFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51024	-	NOT APPLICABLE	0	In state provider	None	4125 ALPHA STREET	SUITE G	SAN DIEGO	CA	92113	4544	37	06073	32.69184649	-117.1053975	San Diego County
175222	Fee-for-Service	1851365852	1851365852	1	1	DVA HEALTHCARE RENAL	7/20/1984	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	4308 W SHAW AVE	SUITE 101	FRESNO	CA	93722	6218	10	06019	36.80837664	-119.8699057	Fresno County
175239	Fee-for-Service	1497335012	1497335012	1	1	DHILLON, KAMINDARA MD	3/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191915	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
175275	Fee-for-Service	1699881938	1699881938	1	1	DONNELLY, ANN MARIE PHD	4/30/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	310 JAMES WAY	110	PISMO BEACH	CA	93449	2877	40	06079	35.1377942	-120.6260995	San Luis Obispo County
175286	Fee-for-Service	1134758774	1134758774	1	1	DUBIN, PAIGE MD	11/1/2023	208M00000X	NA	Other	026	PHYSICIANS	183814	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
175343	Fee-for-Service	1205385408	1205385408	1	2	DAVID D SOHN MD APC	6/24/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3663 W 6TH STREET	SUITE 106	LOS ANGELES	CA	90020	3047	19	06037	34.06360557	-118.30199	Los Angeles County
175352	Fee-for-Service	1104827989	1104827989	1	1	DARIE, SILVIA MD	1/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	61845	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
175411	Fee-for-Service	1922204890	1922204890	1	1	DESERT NEPHROLOGY	12/7/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP	1180 N INDIAN CANYON DR	STE W303	PALM SPRINGS	CA	92262	4856	33	06065	33.839505	-116.5455735	Riverside County
175439	Fee-for-Service	1841580339	1841580339	1	1	DE ANDRADE FILHO, PEDRO A MD	10/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126819	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
175482	Fee-for-Service	1275520967	1275520967	1	1	DO, HOC V LAC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	7138 SHOUP AVE	STE B4	CANOGA PARK	CA	91307	2383	19	06037	34.20022572	-118.6146389	Los Angeles County
175509	Fee-for-Service	1922076116	1922076116	1	1	DONG-LEONG, DAVIDA OD	2/22/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
175521	Fee-for-Service	1548313901	1548313901	1	1	DIXON EYECARE ASSOCIATES	5/19/2008	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	AN OPTOMETRIC CORPORATIO	125 N LINCOLN ST	STE A	DIXON	CA	95620	3259	48	06095	38.44614779	-121.8364229	Solano County
175523	Fee-for-Service	1437226297	1437226297	1	1	DECKER, JAMES W CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
175534	Fee-for-Service	1598761181	1598761181	1	1	DUONG, DUC H MD	8/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84028	13	Neurology (M.D. only)	0	In state provider	None	11480 BROOKSHIRE AVE	STE 106	DOWNEY	CA	90241	3331	19	06037	33.93622932	-118.1311752	Los Angeles County
175543	Fee-for-Service	1194181453	1194181453	1	1	DYER, REBECCA J LMFT	2/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
175555	Fee-for-Service	1285938506	1285938506	1	1	DO, THONG MD INC	1/25/2011	207RN0300X	NA	Nephrology	026	PHYSICIANS	100983	41	Internal Medicine	0	In state provider	None	550 W GRANGEVILLE BLVD	None	HANFORD	CA	93230	2857	16	06031	36.34270548	-119.653191	Kings County
175596	Fee-for-Service	1184931446	1184931446	1	1	DAUGHERTY, RYAN W NP	5/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175629	Fee-for-Service	1295207645	1295207645	1	1	DANNYS HOME HEALTH CARE INC	3/23/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1722 H ST	None	MODESTO	CA	95354	1213	50	06099	37.64410571	-120.9906467	Stanislaus County
175679	Fee-for-Service	1376606293	1376606293	1	1	DAVID D SCHUTTE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5300 TALLMAN AVE NW	None	SEATTLE	WA	98107	3932	00	None	47.6671795	-122.3799151	King County
175689	Fee-for-Service	1508341397	1508341397	1	1	DIGNITY HEALTH	10/29/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
175718	Fee-for-Service	1255835633	1255835633	1	1	DYER, JOSHUA C DO	8/30/2023	390200000X	NA	Other	026	PHYSICIANS	18157	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
175781	Fee-for-Service	1336443282	1336443282	1	1	DIALYSIS CLINIC INC	12/16/2011	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	275 SOUTH ORCHARD AVENUE	None	UKIAH	CA	95482	5016	23	06045	39.14923297	-123.1989298	Mendocino County
175832	Fee-for-Service	1750300661	1750300661	1	1	DOWNEY, SUSAN JEAN MD	11/30/1993	207R00000X	NA	Other	026	PHYSICIANS	78775	41	Internal Medicine	0	In state provider	None	1405 TERESA DR	None	MORRO BAY	CA	93443	2458	40	06079	35.36492306	-120.8250111	San Luis Obispo County
175868	Fee-for-Service	1578260691	1578260691	1	1	DESERT COTTAGES LLC	3/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	83-421 MATADOR COURT	None	INDIO	CA	92203	2825	33	06065	33.74343522	-116.2090674	Riverside County
175878	Fee-for-Service	1821716598	1821716598	1	1	DE GUZMAN, ISIAH PT	8/9/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2820 BELLFLOWER BLVD	None	LONG BEACH	CA	90815	1125	19	06037	33.80733578	-118.125179	Los Angeles County
175880	Fee-for-Service	1942575154	1942575154	1	1	DO, ALBERT DO	9/3/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	185832	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
175913	Fee-for-Service	1760836662	1760836662	1	1	DALIVA, JOHN	7/21/2020	207R00000X	NA	Other	026	PHYSICIANS	17362	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	# 204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
175935	Fee-for-Service	1649076043	1649076043	1	1	DOWDEN, NYLA BIRTH DOULA	4/17/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	41	06081	0	0	None
175939	Fee-for-Service	1811320062	1811320062	1	1	DARROW, MAURA O LCSW	5/24/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
175956	Fee-for-Service	1124384730	1124384730	1	1	DAHA, NOOSHA LMFT	5/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5535 BALBOA BLVD	209	ENCINO	CA	91316	1585	19	06037	34.171632	-118.5011955	Los Angeles County
175965	Fee-for-Service	1730291113	1730291113	1	1	DALRYMPLE, LORIEN S MD	2/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97211	45	Nephrology (Renal-Kidney)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
175975	Fee-for-Service	1508341397	1508341397	1	1	DIGNITY HEALTH	10/29/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
175998	Fee-for-Service	1164569620	1164569620	1	1	DANG, KHANH-LINH V OD	6/4/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4288 DUBLIN BLVD	STE 114	DUBLIN	CA	94568	3172	01	06001	37.70554551	-121.875732	Alameda County
176016	Fee-for-Service	1376804567	1376804567	1	1	DAO, CATHERINE N MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	103782	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
176026	Fee-for-Service	1104232065	1104232065	1	1	DAWOD, YASER MD	2/1/2024	207RC0200X	NA	Other	026	PHYSICIANS	191856	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
176036	Fee-for-Service	1720256761	1720256761	1	1	DEFORD, JULIE G PHD	2/14/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
176047	Fee-for-Service	1790743292	1790743292	1	1	DARBY, EARL MICHAEL MD	7/13/1998	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	38816	10	Gastroenterology (M.D. only)	0	In state provider	None	3300 WEBSTER ST	STE 312	OAKLAND	CA	94609	3118	01	06001	37.82132826	-122.2621843	Alameda County
176129	Fee-for-Service	1619025517	1619025517	1	1	DUNPHY, STEPHEN A MD	2/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
176151	Fee-for-Service	1205405974	1205405974	1	1	DR. JAVIER RIOS A MEDICAL CO	8/9/2022	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IAR INDIO	82935 AVENUE 48	STE 101	INDIO	CA	92201	6757	33	06065	33.7002687	-116.2177115	Riverside County
176157	Fee-for-Service	1730104944	1730104944	1	1	DUNBAR, JENNIFER A MD	8/1/1995	207W00000X	NA	Ophthalmology	026	PHYSICIANS	74890	None	None	0	In state provider	None	1900 E WASHINGTON ST	None	COLTON	CA	92324	4614	36	06071	34.04839685	-117.2950602	San Bernardino County
176186	Fee-for-Service	1386039584	1386039584	1	1	DO, DUY MD	11/6/2020	207L00000X	NA	Other	026	PHYSICIANS	170061	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
176191	Fee-for-Service	1851520126	1851520126	1	1	DASIKA, SAMYUKTA MD	8/30/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	156447	40	Pediatrics	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
176197	Fee-for-Service	1073861712	1073861712	1	1	DO, THAO DO	8/9/2021	207P00000X	NA	Other	026	PHYSICIANS	18606	None	None	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
176203	Fee-for-Service	1194835512	1194835512	1	1	DAVIS, JAMES W MD	7/1/1985	2086S0127X	NA	General Surgery	026	PHYSICIANS	55680	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
176216	Fee-for-Service	1104859594	1104859594	1	1	DIALYSIS CLINIC INC	1/9/2002	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	OROVILLE DIALYSIS CLINIC	3012 OLIVE HWY	None	OROVILLE	CA	95966	6222	04	06007	39.50206626	-121.5378797	Butte County
176266	Fee-for-Service	1083971881	1083971881	1	3	DIGNITY HEALTH MEDICAL FOUND	8/10/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	3807 UNION AVE	STE B	BAKERSFIELD	CA	93305	2400	15	06029	35.394102	-119.0030165	Kern County
176279	Fee-for-Service	1356952618	1356952618	1	1	DAJAJU PHARMACEUTICALS	10/28/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2611 SENTER RD	100	SAN JOSE	CA	95111	1185	43	06085	37.30296795	-121.8429693	Santa Clara County
176289	Fee-for-Service	1770807000	1770807000	1	1	DEUTSCH, ELIANA J NP	9/25/2017	363LX0001X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
176303	Fee-for-Service	1376804567	1376804567	1	1	DAO, CATHERINE N MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	103782	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
176312	Fee-for-Service	1972370427	1972370427	1	1	DE VERA, LAWRENCE N CCC-SLP	10/23/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
176323	Fee-for-Service	1871795021	1871795021	1	1	DUNLAP, KENDRA F LMFT	3/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2029 DURANT AVE	#B204	BERKELEY	CA	94704	1564	01	06001	37.86658278	-122.2687926	Alameda County
176337	Fee-for-Service	1851773063	1851773063	1	1	DAHAL, GANGA DEVI	2/1/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1180 MATMOR ROAD	#144	WOODLAND	CA	95776	6324	57	06113	38.66547204	-121.7564569	Yolo County
176437	Fee-for-Service	1205405974	1205405974	1	1	DR. JAVIER RIOS A MEDICAL CO	8/9/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IAR INDIO	82935 AVENUE 48	STE 101	INDIO	CA	92201	6757	33	06065	33.7002687	-116.2177115	Riverside County
176440	Fee-for-Service	1205969250	1205969250	1	1	D'AGNOLO, ALESSANDRO MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64232	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
176474	Fee-for-Service	1598993461	1598993461	1	1	DANIELLE SNYDER D.O.	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5950 UNIVERSITY AVE	STE 205	WDM	IA	50266	8231	00	None	41.598693	-93.792393	Dallas County
176554	Fee-for-Service	1285051334	1285051334	1	1	DAN, CHRISTOPHER S DO	1/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14279	01	General Practice	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
176626	Fee-for-Service	1851773063	1851773063	1	1	DAHAL, GANGA DEVI	2/1/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1180 MATMOR ROAD	#144	WOODLAND	CA	95776	6324	57	06113	38.66547204	-121.7564569	Yolo County
176679	Fee-for-Service	1417354135	1417354135	1	1	DYSON, ERIC A	12/12/2016	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW ST	SUITE 226	GARDEN GROVE	CA	92845	1738	30	06059	33.78720885	-118.028413	Orange County
176686	Fee-for-Service	1477555845	1477555845	1	1	DWIGHT CLARK S MD	5/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1800 E VAN BUREN ST	None	PHOENIX	AZ	85006	0000	00	None	33.454944	-112.042467	Maricopa County
176750	Fee-for-Service	1427169069	1427169069	1	1	DE LA VEGA, FREDERICK J MD	5/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81923	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
176753	Fee-for-Service	1508110149	1508110149	1	1	DUARTE, EMMA C LCSW	12/26/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
176762	Fee-for-Service	1013131002	1013131002	1	1	DEMARTINI, STEVEN D MD	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86525	22	Pathology (M.D. only)	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
176780	Fee-for-Service	1437124476	1437124476	1	1	DVA HEALTHCARE RENAL	7/14/2004	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	5608 PERSHING AVE	None	STOCKTON	CA	95207	4906	39	06077	37.9984672	-121.3254663	San Joaquin County
176802	Fee-for-Service	1861657975	1861657975	1	2	DR.MOSHE B.KOVACHEVICH M.D.	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G ST	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
176827	Fee-for-Service	1326320003	1326320003	1	1	DARWAZEH, GHALEB A MD	2/16/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	192391	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
176840	Fee-for-Service	1629613393	1629613393	1	1	DRNAT CORP	2/9/2020	207RC0200X	NA	Other	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
176881	Fee-for-Service	1063485357	1063485357	1	1	DAVIES,SANTOSH MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101607	None	None	0	In state provider	None	700 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
176902	Fee-for-Service	1245668623	1245668623	1	1	DECKARD, KELLY NP	10/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
176922	Fee-for-Service	1457001315	1457001315	1	1	DIMAGGIO, MARK A	2/3/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
176956	Fee-for-Service	1104981661	1104981661	1	3	DIGNITY HEALTH	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
176964	Fee-for-Service	1821369943	1821369943	1	1	DUOSS, KRISTIE A NP	10/19/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176986	Fee-for-Service	1932517968	1932517968	1	1	DAVE, PRITI A MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139529	41	Internal Medicine	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
177013	Fee-for-Service	1164163093	1164163093	1	1	DEES, JESSICA L DOULA	3/9/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
177037	Fee-for-Service	1427169069	1427169069	1	1	DE LA VEGA, FREDERICK J MD	5/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81923	13	Neurology (M.D. only)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
177102	Fee-for-Service	1487694857	1487694857	1	4	DIGNITY HEALTH	12/31/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1700 ALHAMBRA BLVD	SUITE 102	SACRAMENTO	CA	95816	7050	34	06067	38.564847	-121.469121	Sacramento County
177110	Fee-for-Service	1487721312	1487721312	1	1	DEBARROS, REGIS M MD	10/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64379	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
177117	Fee-for-Service	1417263922	1417263922	1	1	DIRECT DERMATOLOGY PROFESSIO	9/18/2018	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	NALS, P.C.	165 SAINT DOMINICS DR	SUITE 120	MANTECA	CA	95337	7802	39	06077	37.79882972	-121.2447835	San Joaquin County
177129	Fee-for-Service	1629613393	1629613393	1	1	DRNAT CORP	2/9/2020	207RC0200X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
177165	Fee-for-Service	1922293786	1922293786	1	1	DAHLIN, CHRISTINE E MD	9/21/2020	207R00000X	NA	Other	026	PHYSICIANS	84455	41	Internal Medicine	0	In state provider	None	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
177281	Fee-for-Service	1306226832	1306226832	1	1	DELOREFICE, ALLISON R PHD	6/19/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
177309	Fee-for-Service	1295023646	1295023646	1	1	DUONG, SCOTT MD	12/4/2018	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
177330	Fee-for-Service	1598463226	1598463226	1	1	DRAPER, KE'XIA DOULA	8/3/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
177438	Fee-for-Service	1689680639	1689680639	1	1	DARRAS, ALEXANDRIA M MD	1/31/1995	207L00000X	NA	Other	026	PHYSICIANS	66466	05	Anesthesiology	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
177441	Fee-for-Service	1174639488	1174639488	1	1	DRAGOO, JASON L MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70301	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177470	Fee-for-Service	1568534915	1568534915	1	1	DEAN, JOEL GLENN MD	10/3/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1325 E CHURCH STREET	STE 202	SANTA MARIA	CA	93454	5909	42	06083	34.95209265	-120.4147348	Santa Barbara County
177478	Fee-for-Service	1447585013	1447585013	1	1	DESAI, SHOMA A MD	3/20/2020	207P00000X	NA	Other	026	PHYSICIANS	95214	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10100 CULVER BLVD	STE E	CULVER CITY	CA	90232	3175	19	06037	34.01935201	-118.3979919	Los Angeles County
177485	Fee-for-Service	1215238209	1215238209	1	1	DAVIDZON, GUIDO A MD	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117782	42	Nuclear Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
177507	Fee-for-Service	1326312067	1326312067	1	2	DCHS MEDICAL FOUNDATION	5/10/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
177541	Fee-for-Service	1689993313	1689993313	1	1	DANHASH, MAHER I MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125905	08	Family Practice	0	In state provider	None	300 S HIGHLAND SPRINGS	None	BANNING	CA	92220	6504	33	06065	33.92503257	-116.9467329	Riverside County
177545	Fee-for-Service	1770571234	1770571234	1	1	DERBIN, KELLY S MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53528	01	General Practice	0	In state provider	None	7225 RAINBOW DRIVE	None	SAN JOSE	CA	95129	4552	43	06085	37.30146258	-122.0315034	Santa Clara County
177555	Fee-for-Service	1780259374	1780259374	1	1	DOAN, PATRICIA	2/24/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20984	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
177593	Fee-for-Service	1194103861	1194103861	1	1	DANESHVAR, MICHAEL A MD	6/20/2022	208800000X	NA	Other	026	PHYSICIANS	179126	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
177746	Fee-for-Service	1053312439	1053312439	2	1	DAK HEALTHCARE INC	8/19/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA ROAD	SUITE 1100	WHITTIER	CA	90605	1800	19	06037	33.9505367	-118.0054552	Los Angeles County
177760	Fee-for-Service	1275878159	1275878159	1	1	DE JESUS, DAISY C LMFT	10/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	190 SIERRA CT	# C4	PALMDALE	CA	93550	7600	19	06037	34.64013337	-118.1280539	Los Angeles County
177763	Fee-for-Service	1871127258	1871127258	1	1	DOSHI, PRIYANKA PSYD	4/2/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
177772	Fee-for-Service	1386777910	1386777910	1	1	DAKOTA, SAGE LMFT	3/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
177815	Fee-for-Service	1295268613	1295268613	1	1	DAVIDA ENTERPRISES INC	9/24/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	SUITE 116	NORTH HOLLYWOOD	CA	91601	2245	19	06037	34.1721655	-118.3608315	Los Angeles County
177824	Fee-for-Service	1467776948	1467776948	1	1	DIVER, ELISABETH J MD	8/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149779	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
177883	Fee-for-Service	1649233354	1649233354	1	1	DOLMATCH, BART L MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54715	30	Radiology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	6203	43	06085	37.37715796	-122.0651926	Santa Clara County
177891	Fee-for-Service	1366622078	1366622078	1	1	DEVERA, GEMMIE S MD	7/18/2019	2080P0204X	NA	Other	026	PHYSICIANS	161466	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
177895	Fee-for-Service	1427267608	1427267608	1	1	DE RENARD, STACY M	1/23/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW ST	STE 137	GARDEN GROVE	CA	92845	1741	30	06059	33.78720885	-118.028413	Orange County
177965	Fee-for-Service	1588013858	1588013858	1	1	DANIEL W BARKER	4/3/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 RANCH RD	None	REEDSPORT	OR	97467	1720	00	None	43.69501605	-124.1353967	Douglas County
177969	Fee-for-Service	1033371844	1033371844	1	1	DELANEY, AMY M MD	1/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	121729	07	Dermatology	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
178012	Fee-for-Service	1285130807	1285130807	1	1	DADACHANJI, KAIVAN DO	8/3/2021	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	17808	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
178036	Fee-for-Service	1376963611	1376963611	1	1	D'ATTILIO, JENNIFER CCC-SLP	11/8/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	787 MUNRAS AVE	SUITE 101	MONTEREY	CA	93940	3128	27	06053	36.59424304	-121.8933177	Monterey County
178111	Fee-for-Service	1649492745	1649492745	1	1	DUGAN, MICHAEL C MD	2/13/2025	207ZP0102X	NA	Other	026	PHYSICIANS	71782	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
178160	Fee-for-Service	1184610164	1184610164	1	1	DENHAM, WENDY M MD	1/1/1999	146D00000X	NA	Other	026	PHYSICIANS	61359	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2632 E WASHINGTON BLVD	None	PASADENA	CA	91107	1411	19	06037	34.1691255	-118.096119	Los Angeles County
178179	Fee-for-Service	1366622078	1366622078	1	1	DEVERA, GEMMIE S MD	7/18/2019	2080P0204X	NA	Other	026	PHYSICIANS	161466	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
178229	Fee-for-Service	1003189465	1003189465	1	1	DELTA HOSPICE OF INLAND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	VALLEY INC	41715 WINCHESTER RD	SUITE 106	TEMECULA	CA	92590	4853	33	06065	33.51843041	-117.1680022	Riverside County
178322	Fee-for-Service	1437108636	1437108636	1	1	DURAIPANDIAN, GAYATHRI	7/9/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
178388	Fee-for-Service	1730191875	1730191875	1	1	DANESHGAR, SHAHRAM MD	4/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33755	10	Gastroenterology (M.D. only)	0	In state provider	None	2220 LYNN RD	STE 202	THOUSAND OAKS	CA	91360	8010	56	06111	34.20863046	-118.8852156	Ventura County
178414	Fee-for-Service	1770553950	1770553950	1	1	DEMUTH, BRIAN E MD	10/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	60223	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
178423	Fee-for-Service	1295823409	1295823409	1	1	DUNNICLIFF, GREGORY D	11/8/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2087 GRAND CANAL BLVD	STE 17	STOCKTON	CA	95207	6651	39	06077	37.98552607	-121.3315122	San Joaquin County
178446	Fee-for-Service	1215954235	1215954235	1	1	DASTI, SALMAN K MD	4/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96410	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
178517	Fee-for-Service	1063519668	1063519668	1	1	DOBALIAN, DANIEL D MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41926	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2617 E CHAPMAN AVE	STE 312	ORANGE	CA	92869	3247	30	06059	33.7878445	-117.8254845	Orange County
178519	Fee-for-Service	1003189465	1003189465	1	1	DELTA HOSPICE OF INLAND	12/19/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	VALLEY INC	41715 WINCHESTER RD	SUITE 106	TEMECULA	CA	92590	4853	33	06065	33.51843041	-117.1680022	Riverside County
178585	Fee-for-Service	1619094810	1619094810	1	1	DIAZ, REYNA I LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
178610	Fee-for-Service	1144263732	1144263732	1	1	DR GARRY CAMERON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MALAMA I KE OLA HEALTH	1881 NANI ST	None	WAILUKU	HI	96793	1811	00	None	20.88887385	-156.4998231	Maui County
178618	Fee-for-Service	1609962026	1609962026	1	1	DIKRANIAN, ARA H MD	5/11/2007	207RR0500X	NA	Other	026	PHYSICIANS	62403	None	None	0	In state provider	None	3633 CAMINO DEL RIO S	STE 300	SAN DIEGO	CA	92108	4014	37	06073	32.77798059	-117.1163142	San Diego County
178630	Fee-for-Service	1003015652	1003015652	1	1	DEHQANZADA, ZIA A MD	2/8/2015	208600000X	NA	General Surgery	026	PHYSICIANS	118745	02	General Surgery	0	In state provider	None	ONE MEDICAL PLAZA DRIVE	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
178633	Fee-for-Service	1447285473	1447285473	1	1	DR.GRAHAM HURVITZ, CORPORATI	12/15/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	ON	2936 DE LA VINA ST	FIRST AND SECOND FLOORS	SANTA BARBARA	CA	93105	3354	42	06083	34.4383104	-119.7278207	Santa Barbara County
178648	Fee-for-Service	1194773101	1194773101	1	1	DONG, CHRISTOPHER E MD	9/30/1996	207PE0004X	NA	Other	026	PHYSICIANS	84072	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
178652	Fee-for-Service	1760944904	1760944904	1	1	DAVIS, PAMELA R LCSW	5/16/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10918 HESPERIA RD	STE B	HESPERIA	CA	92345	2151	36	06071	34.44933232	-117.2964082	San Bernardino County
178658	Fee-for-Service	1710306444	1710306444	1	1	DONALDSON, RONALD T CRNA	6/20/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
178664	Fee-for-Service	1740357565	1740357565	1	1	DANG, CHUONG M MD	9/30/1992	2085B0100X	NA	MRI Provider	026	PHYSICIANS	63728	30	Radiology	0	In state provider	None	8135 PAINTER AVE	None	WHITTIER	CA	90602	3102	19	06037	33.965829	-118.032738	Los Angeles County
178711	Fee-for-Service	1629470133	1629470133	1	1	DE OLIVEIRA CAMPOS, JULIANA	8/15/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
178713	Fee-for-Service	1447445176	1447445176	1	1	DAULATZAI, YUSEF S	5/8/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
178733	Fee-for-Service	1386937977	1386937977	1	4	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	5051 VERDUGO WAY	SUITE 110	CAMARILLO	CA	93012	8681	56	06111	34.21524684	-119.0033176	Ventura County
178752	Fee-for-Service	1891759486	1891759486	1	1	DANG, NGHIEM D MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39045	02	General Surgery	0	In state provider	None	14571 MAGNOLIA ST	STE 208	WESTMINSTER	CA	92683	5576	30	06059	33.75097286	-117.9723502	Orange County
178761	Fee-for-Service	1831536481	1831536481	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1520 NORTH GRAND AVE	None	SANTA ANA	CA	92701	2627	30	06059	33.758541	-117.8519485	Orange County
178796	Fee-for-Service	1851645063	1851645063	1	1	DODDS, CLAIRE E NP	2/27/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
178819	Fee-for-Service	1598789026	1598789026	1	1	DAVIS, KENNETH W LMFT	12/26/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1311 E STREET	None	MODESTO	CA	95354	2411	50	06099	37.63815216	-120.9914104	Stanislaus County
178820	Fee-for-Service	1043204605	1043204605	2	1	DE LA PENA, NICOLAS R MD	3/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	61619	77	Infectious Disease	0	In state provider	None	3389 G ST	STE A	MERCED	CA	95340	0964	24	06047	37.32623805	-120.4692747	Merced County
178821	Fee-for-Service	1740418839	1740418839	1	1	DEARLOVE, JOANNA V MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112229	13	Neurology (M.D. only)	0	In state provider	None	1515 NEWELL AVENUE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
178853	Fee-for-Service	1093160327	1093160327	1	1	DACEY, MICHAEL J MD	11/12/2018	208600000X	NA	General Surgery	026	PHYSICIANS	152601	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
178876	Fee-for-Service	1497797906	1497797906	1	1	DAHLE, DANIEL B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53557	66	Emergency Medicine (Urgent Care)	0	In state provider	None	43536 HWY 299 EAST	None	FALL RIVER MILLS	CA	96028	0459	45	06089	41.02316121	-121.4255119	Shasta County
178892	Fee-for-Service	1972860864	1972860864	1	1	DATE, ANIL R MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125970	None	None	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
178896	Fee-for-Service	1306518881	1306518881	1	1	DIAZ, NOHEMI LPCC	11/22/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
178898	Fee-for-Service	1215493044	1215493044	1	1	DE LA ISLA BOLANOS, ANTONIA	8/7/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	M	5540 E LORENA AVE	None	FRESNO	CA	93727	6330	10	06019	36.71942585	-119.7028183	Fresno County
178912	Fee-for-Service	1801451885	1801451885	1	1	DUAN, DEBORAH OD	8/29/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	207 S SANTA ANITA ST	310	SAN GABRIEL	CA	91776	1146	19	06037	34.10072807	-118.1066296	Los Angeles County
178929	Fee-for-Service	1609820950	1609820950	1	1	DAMIANI, STEPHEN M DO	3/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7410	41	Internal Medicine	0	In state provider	None	18092 WIKA RD	STE 110	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
178948	Fee-for-Service	1457515272	1457515272	1	1	DINGLASAN, JOSEPH L JR MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109801	None	None	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
179038	Fee-for-Service	1891759486	1891759486	1	1	DANG, NGHIEM D MD	12/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39045	01	General Practice	0	In state provider	None	14571 MAGNOLIA ST	STE 208	WESTMINSTER	CA	92683	5576	30	06059	33.75097286	-117.9723502	Orange County
179049	Fee-for-Service	1831536481	1831536481	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 NORTH GRAND AVE	None	SANTA ANA	CA	92701	2627	30	06059	33.758541	-117.8519485	Orange County
179053	Fee-for-Service	1770508582	1770508582	1	1	DHEERIYA, UJJWALA S MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71781	40	Pediatrics	0	In state provider	None	1294 W 6TH ST	STE 103	SAN PEDRO	CA	90731	2997	19	06037	33.73885348	-118.3056165	Los Angeles County
179057	Fee-for-Service	1396042149	1396042149	1	1	DOWNEY, JOSEPH M LMFT	7/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	558 B ST	None	SANTA ROSA	CA	95401	5240	49	06097	38.4435	-122.7181185	Sonoma County
179067	Fee-for-Service	1730558750	1730558750	1	1	DALE DIALYSIS LLC	5/21/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	21040 CALIFA	SUITE A	WOODLAND HILLS	CA	91367	5103	19	06037	34.17726182	-118.5915172	Los Angeles County
179091	Fee-for-Service	1336376243	1336376243	1	1	DALTON, THOMAS R MD	8/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119325	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179110	Fee-for-Service	1043204605	1043204605	2	1	DE LA PENA, NICOLAS R MD	3/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	61619	41	Internal Medicine	0	In state provider	None	3389 G ST	STE A	MERCED	CA	95340	0964	24	06047	37.32623805	-120.4692747	Merced County
179116	Fee-for-Service	1679797203	1679797203	1	1	DANG, DAVID NC MD	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102850	30	Radiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
179119	Fee-for-Service	1407223597	1407223597	1	1	DAVOODI, TANIA LMFT	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD.	SUITE 218	SANTA CLARITA	CA	91350	2009	19	06037	34.45052733	-118.497654	Los Angeles County
179149	Fee-for-Service	1427443803	1427443803	1	1	DWORSKY, ZEPHYR D MD	7/6/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	144121	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
179168	Fee-for-Service	1497797906	1497797906	1	1	DAHLE, DANIEL B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53557	08	Family Practice	0	In state provider	None	43536 HWY 299 EAST	None	FALL RIVER MILLS	CA	96028	0459	45	06089	41.02316121	-121.4255119	Shasta County
179187	Fee-for-Service	1215493044	1215493044	1	1	DE LA ISLA BOLANOS, ANTONIA	8/7/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	M	5540 E LORENA AVE	None	FRESNO	CA	93727	6330	10	06019	36.71942585	-119.7028183	Fresno County
179197	Fee-for-Service	1770942203	1770942203	1	1	DESHPANDE, AARTI A	8/31/2015	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2550 23RD ST	BLDG 9, SUITE 119	SAN FRANCISCO	CA	94110	3504	38	06075	37.75436504	-122.4056861	San Francisco County
179199	Fee-for-Service	1407315427	1407315427	1	1	DESLOUCHES, KAREN MD	8/12/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178826	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
179222	Fee-for-Service	1609820950	1609820950	1	1	DAMIANI, STEPHEN M DO	3/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	7410	67	Endocrinology	0	In state provider	None	18092 WIKA RD	STE 110	APPLE VALLEY	CA	92307	2132	36	06071	34.54070062	-117.2694542	San Bernardino County
179226	Fee-for-Service	1164564100	1164564100	1	1	DWYER, BONNIE K MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71242	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179245	Fee-for-Service	1902082803	1902082803	1	1	DEMAS, MONICA B LMFT	5/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	624 W 9TH ST	103	SAN PEDRO	CA	90731	3158	19	06037	33.73607853	-118.290789	Los Angeles County
179263	Fee-for-Service	1073773073	1073773073	1	1	DE LEON, MARIA C B MD	4/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121361	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
179273	Fee-for-Service	1730507567	1730507567	1	1	DRIEBE, AMY MARIE W MD	9/18/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	142172	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
179289	Fee-for-Service	1861418386	1861418386	1	1	DWELLE, TODD MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76923	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
179335	Fee-for-Service	1336790062	1336790062	1	1	DUMOSCH, MILES L PT	1/31/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1519 W YOSEMITE AVE	None	MANTECA	CA	95337	5159	39	06077	37.79738017	-121.2413628	San Joaquin County
179343	Fee-for-Service	1770508582	1770508582	1	1	DHEERIYA, UJJWALA S MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71781	41	Internal Medicine	0	In state provider	None	1294 W 6TH ST	STE 103	SAN PEDRO	CA	90731	2997	19	06037	33.73885348	-118.3056165	Los Angeles County
179377	Fee-for-Service	1275741480	1275741480	2	1	DOWNEY CARE HOMES INC	6/8/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7446 MULLER ST	None	DOWNEY	CA	90241	2136	19	06037	33.95256599	-118.1431498	Los Angeles County
179447	Fee-for-Service	1215094909	1215094909	1	1	DEULEN, CHRISTOPHER R	8/31/1993	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9640 CENTER AVE	STE 120	RANCHO CUCAMONGA	CA	91730	5809	36	06071	34.07851417	-117.5793666	San Bernardino County
179488	Fee-for-Service	1518085430	1518085430	1	2	DIGNITY HEALTH	7/30/2018	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
179494	Fee-for-Service	1720027303	1720027303	1	1	DR. ALICIA ANNE FRANKWITZ D.	9/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ANNE ST NW	None	BEMIDJI	MN	56601	5103	00	None	47.50502202	-94.89949542	Beltrami County
179513	Fee-for-Service	1164564100	1164564100	1	1	DWYER, BONNIE K MD	8/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71242	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
179522	Fee-for-Service	1124447073	1124447073	1	1	DIULIO, JONATHON J MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	154334	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
179534	Fee-for-Service	1376205708	1376205708	1	1	DE LEON, ISABELLA CRNA	9/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
179537	Fee-for-Service	1881655116	1881655116	1	1	DANIELPOUR, MOISE MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	85309	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
179572	Fee-for-Service	1932102241	1932102241	1	1	DOUGHERTY, ROBERT P. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1300 ROANOKE AVE	None	RIVERHEAD	NY	11901	2031	00	None	40.934223	-72.673587	Suffolk County
179576	Fee-for-Service	1922181882	1922181882	1	1	DEMAIN, BRIAN K CPO	12/24/2014	1744P3200X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	3065 RICHMOND PKWY	#112	RICHMOND	CA	94806	1904	07	06013	37.99005286	-122.3297916	Contra Costa County
179579	Fee-for-Service	1861418386	1861418386	1	1	DWELLE, TODD MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76923	40	Pediatrics	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
179582	Fee-for-Service	1568478162	1568478162	1	1	DAILEY, MICHAEL P MD	2/8/2015	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	2	Out of state provider	None	11660 ALPHARETTA HWY	STE 430	ROSWELL	GA	30076	3880	00	None	34.06536	-84.323529	Fulton County
179676	Fee-for-Service	1427062389	1427062389	1	1	DE ASIS, BENILDA R MD	9/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51119	05	Anesthesiology	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
179693	Fee-for-Service	1083863112	1083863112	1	1	DELLAMAGGIORA, LINDSAY Z MD	3/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	108212	None	None	0	In state provider	None	11500 BROOKSHIRE AVE	None	DOWNEY	CA	90241	9965	19	06037	33.93500365	-118.1321119	Los Angeles County
179696	Fee-for-Service	1235162868	1235162868	1	1	DUWAL, RAMILA D MD	8/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70711	36	Psychiatry	0	In state provider	None	11371 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3816	36	06071	34.04703521	-117.2435564	San Bernardino County
179766	Fee-for-Service	1790863512	1790863512	1	1	DEINES, MICHAEL E MD	9/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68740	18	Ophthalmology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
179770	Fee-for-Service	1558701219	1558701219	1	1	DIPARDO, BENJAMIN MD	7/22/2024	208600000X	NA	General Surgery	026	PHYSICIANS	149959	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
179887	Fee-for-Service	1437262813	1437262813	1	1	DAUPHINE, CHRISTINE E MD	12/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76679	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
179914	Fee-for-Service	1205886819	1205886819	1	1	DAVID ASINGER MD	6/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	BLOOMINGTON	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
179925	Fee-for-Service	1124002217	1124002217	1	1	DAVIS, STEVEN W MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87642	None	None	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
179968	Fee-for-Service	1487653531	1487653531	1	1	DAVID, DWIGHT A MD	4/9/1984	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40764	41	Internal Medicine	0	In state provider	None	15111 WHITTIER BLVD	STE 102	WHITTIER	CA	90603	2180	19	06037	33.94841455	-118.0049729	Los Angeles County
180029	Fee-for-Service	1912223199	1912223199	1	1	DZUNDZA, JOHN H MD	7/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125733	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
180039	Fee-for-Service	1972946366	1972946366	1	1	DHANDHA, MAULIK M MD	12/12/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	175293	None	None	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
180137	Fee-for-Service	1659301224	1659301224	1	1	DICKERSON, NANCY S CRNA	12/30/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
180143	Fee-for-Service	1154520427	1154520427	1	1	DOSHI, ARPITA J MD	9/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96465	41	Internal Medicine	0	In state provider	None	3010 COLBY ST	STE 221	BERKELEY	CA	94705	2056	01	06001	37.85492078	-122.2576101	Alameda County
180154	Fee-for-Service	1437213279	1437213279	1	3	DIENTES COMMUNITY DENTAL	12/5/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1500 CAPITOLA ROAD	None	SANTA CRUZ	CA	95062	0000	44	06087	36.97641295	-121.9850639	Santa Cruz County
180181	Fee-for-Service	1306478896	1306478896	1	1	DELARA, KAROLJOHN S CNP	3/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1792 GARNET AVE	None	SAN DIEGO	CA	92109	3350	37	06073	32.80054833	-117.2374979	San Diego County
180202	Fee-for-Service	1669782124	1669782124	1	1	DE NIRO, JENNIFER E MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115886	18	Ophthalmology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
180245	Fee-for-Service	1952344616	1952344616	1	1	DONIACH, TABITHA MD	9/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84644	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1450 MEDICAL CENTER DR	None	ROHNERT PARK	CA	94928	2924	49	06097	38.34758366	-122.6816633	Sonoma County
180249	Fee-for-Service	1396913968	1396913968	1	1	DANN, PHOEBE H MD	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105334	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
180255	Fee-for-Service	1487653531	1487653531	1	1	DAVID, DWIGHT A MD	4/9/1984	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	40764	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	15111 WHITTIER BLVD	STE 102	WHITTIER	CA	90603	2180	19	06037	33.94841455	-118.0049729	Los Angeles County
180295	Fee-for-Service	1205413127	1205413127	1	1	DAS, DEVIKA M MD	3/4/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180395	Fee-for-Service	1386954543	1386954543	1	1	DENMARK, STEVEN M MD INC	4/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	37660	02	General Surgery	0	In state provider	None	505 E ROMIE LANE	STE D	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
180422	Fee-for-Service	1578639639	1578639639	1	1	DICTEROW, MAURICE L MD	1/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	22466	01	General Practice	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
180429	Fee-for-Service	1073976510	1073976510	1	1	DIETZ, BRETT W MD	7/15/2021	207RR0500X	NA	Other	026	PHYSICIANS	153930	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
180435	Fee-for-Service	1760475081	1760475081	1	1	DOUGLAS P DERO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COEUR D ALENE	ID	83814	2611	00	None	47.69465937	-116.7917936	Kootenai County
180443	Fee-for-Service	1437213279	1437213279	1	3	DIENTES COMMUNITY DENTAL	12/5/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1500 CAPITOLA ROAD	None	SANTA CRUZ	CA	95062	0000	44	06087	36.97641295	-121.9850639	Santa Cruz County
180452	Fee-for-Service	1710958798	1710958798	1	1	DRCAR, THAO T NP	2/19/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92193	2410	37	06073	32.7537975	-117.1658298	San Diego County
180460	Fee-for-Service	1659403707	1659403707	1	1	DOLEV, JACQUELINE C MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80239	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
180485	Fee-for-Service	1528090446	1528090446	1	1	DONACHIE, ROBERT J MD	12/9/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
180510	Fee-for-Service	1861413023	1861413023	3	1	DIAGNOSTIC LABORATORY SCIENC	3/14/2024	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	E, INC	7711 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4207	30	06059	33.7738545	-117.9977715	Orange County
180548	Fee-for-Service	1922038512	1922038512	1	1	DEVEREAUX, MICHAEL C MD	2/28/1984	207R00000X	NA	Other	026	PHYSICIANS	52576	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
180554	Fee-for-Service	1396565073	1396565073	1	1	DR. VERONICA LAM, O.D., INC.	1/7/2025	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	210 MAIN ST	SUITE 100	HALF MOON BAY	CA	94019	1722	41	06081	37.46761204	-122.4299265	San Mateo County
180573	Fee-for-Service	1053870386	1053870386	1	1	DONG, CATHY Y MD	5/27/2022	207P00000X	NA	Other	026	PHYSICIANS	176610	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
180592	Fee-for-Service	1093893174	1093893174	1	1	DOSSETOR, FRANCES M MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	48001	18	Ophthalmology	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
180593	Fee-for-Service	1447764410	1447764410	1	1	DRAKE, TIFFANY LMFT	11/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
180604	Fee-for-Service	1750657193	1750657193	1	1	DANG, NGHI T DO	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13061	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
180622	Fee-for-Service	1356398010	1356398010	1	1	DAVID E SKARDA MD	5/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
180646	Fee-for-Service	1174646012	1174646012	1	1	DEMAS, ANITA N MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66065	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
180750	Fee-for-Service	1437622800	1437622800	1	1	DO, BRYAN CRNA	7/26/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
180766	Fee-for-Service	1699877480	1699877480	1	1	DEPALA, VENUGOPAL MD	10/20/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	52648	None	None	0	In state provider	None	23180 HEMLOCK AVE	SUITE 100	MORENO VALLEY	CA	92557	8001	33	06065	33.94245952	-117.2585565	Riverside County
180787	Fee-for-Service	1417554098	1417554098	1	1	DISCOVER LABS LLC	12/11/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	13776 N US HIGHWAY 183	STE 108	AUSTIN	TX	78750	1875	00	None	30.46147982	-97.79480986	Williamson County
180799	Fee-for-Service	1154410165	1154410165	1	1	DITCHMAN,JOHN DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13355 E 10 MILE ROAD	None	WARREN	MI	48089	2048	00	None	42.4783293	-82.98744618	Macomb County
180836	Fee-for-Service	1619301884	1619301884	1	1	DEVICTOR, SAMUEL R MD	7/15/2022	390200000X	NA	Other	026	PHYSICIANS	179603	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
180852	Fee-for-Service	1891286522	1891286522	1	1	DAVIS, KARINA D LMFT	10/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11483 MOURNING DOVE	None	BROWNSVILLE	CA	95918	9645	58	06115	39.29491489	-121.3299822	Yuba County
180924	Fee-for-Service	1346379583	1346379583	1	1	DIAZ, TARCISIO C MD	4/6/2023	174400000X	NA	Other	026	PHYSICIANS	46295	None	None	0	In state provider	None	900 S MAIN ST.	100	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
180952	Fee-for-Service	1679989412	1679989412	1	1	DARDASHTI, FARNAZ LMFT	12/5/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	127 BROADWAY	SUITE 200	SANTA MONICA	CA	90401	2330	19	06037	34.01334753	-118.4957836	Los Angeles County
180960	Fee-for-Service	1902285729	1902285729	1	1	DHANDA, KANTA DO	9/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15198	01	General Practice	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
180961	Fee-for-Service	1427078682	1427078682	1	1	DASHER, ROBERT J MD	9/29/1982	2084P0800X	NA	Psychiatry	026	PHYSICIANS	32705	01	General Practice	0	In state provider	None	100 W ARRELLAGA ST	None	SANTA BARBARA	CA	93101	2916	42	06083	34.42604057	-119.7107766	Santa Barbara County
180971	Fee-for-Service	1649843897	1649843897	1	1	DIGILOV, ANNA CRNA	4/3/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
180989	Fee-for-Service	1760462899	1760462899	1	1	DEGHETALDI, LAWRENCE MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47995	08	Family Practice	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
181006	Fee-for-Service	1558448498	1558448498	1	1	DABADGHAV, NINAD R MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60557	02	General Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
181013	Fee-for-Service	1659365310	1659365310	1	1	DAVID CHARLES LORENZ MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
181189	Fee-for-Service	1285621441	1285621441	1	1	DE CHAVEZ, CARMELITO MD	6/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35554	08	Family Practice	0	In state provider	None	1085 VALENCIA ST	None	SAN FRANCISCO	CA	94110	2405	38	06075	37.75563342	-122.4209694	San Francisco County
181238	Fee-for-Service	1154372951	1154372951	2	1	DE, INDRA MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52396	41	Internal Medicine	0	In state provider	None	2626 N CALIFORNIA ST	STE F	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
181289	Fee-for-Service	1366439051	1366439051	1	1	DO, JACLYNN J MD	7/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78520	01	General Practice	0	In state provider	None	8341 WESTMINSTER BLVD	STE 101B	WESTMINSTER	CA	92683	3306	30	06059	33.75934845	-117.983493	Orange County
181316	Fee-for-Service	1427607647	1427607647	1	1	DAVID A GIRARD A MEDICAL COR	9/22/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	PORATION	50 ALESSANDRO PL	STE 120	PASADENA	CA	91105	4010	19	06037	34.13101049	-118.151532	Los Angeles County
181350	Fee-for-Service	1417211749	1417211749	1	1	DESAI, ANAND H MD	8/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135071	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
181376	Fee-for-Service	1760845671	1760845671	1	1	DESAI, PREEYA MD	9/15/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	152451	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
181381	Fee-for-Service	1376659565	1376659565	1	1	DO, THU N MD	10/31/1985	174400000X	NA	Other	026	PHYSICIANS	38325	08	Family Practice	0	In state provider	None	4712 EL CAJON BLVD	STE F	SAN DIEGO	CA	92115	4557	37	06073	32.75602104	-117.0925411	San Diego County
181408	Fee-for-Service	1700803418	1700803418	1	16	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3427 ROBIN LANE	STE 100	CAMERON PARK	CA	95682	7255	09	06017	38.65580389	-120.9675841	El Dorado County
181414	Fee-for-Service	1306850250	1306850250	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	139 ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06566774	-118.271006	Los Angeles County
181425	Fee-for-Service	1962999615	1962999615	1	1	DESAI, MANAN H MD	10/13/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
181465	Fee-for-Service	1679773311	1679773311	1	1	DONNELLY, MATTHEW L MD	5/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99255	66	Emergency Medicine (Urgent Care)	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
181469	Fee-for-Service	1467884734	1467884734	1	1	DAVIS, JOHN M AU	1/27/2015	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 S MOORPARK RD	None	THOUSAND OAKS	CA	91361	1008	56	06111	34.17369227	-118.8765488	Ventura County
181476	Fee-for-Service	1285621441	1285621441	1	1	DE CHAVEZ, CARMELITO MD	6/30/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	35554	01	General Practice	0	In state provider	None	1085 VALENCIA ST	None	SAN FRANCISCO	CA	94110	2405	38	06075	37.75563342	-122.4209694	San Francisco County
181521	Fee-for-Service	1881700557	1881700557	1	1	DOHM-PALMER,NICOLE A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1121 TOWN CENTER DR	STE 205	EAGAN	MN	55123	1217	00	None	44.831826	-93.148353	Dakota County
181528	Fee-for-Service	1679651335	1679651335	1	1	DARLING, LAURA A MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73267	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
181548	Fee-for-Service	1104182179	1104182179	1	1	DUBIN, ARIEL MD	5/6/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	129009	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
181552	Fee-for-Service	1982703898	1982703898	2	1	DE LA MORA, OSCAR M MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	50769	40	Pediatrics	0	In state provider	None	995 GATEWAY CENTER WAY	STE 202	SAN DIEGO	CA	92102	4545	37	06073	32.71405516	-117.1158459	San Diego County
181570	Fee-for-Service	1285791806	1285791806	1	1	DHILLON, INDERJIT K MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38371	40	Pediatrics	0	In state provider	None	5043 E KINGS CAYON RD	STE 101	FRESNO	CA	93727	3935	10	06019	36.73599961	-119.725504	Fresno County
181579	Fee-for-Service	1366439051	1366439051	1	1	DO, JACLYNN J MD	7/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78520	08	Family Practice	0	In state provider	None	8341 WESTMINSTER BLVD	STE 101B	WESTMINSTER	CA	92683	3306	30	06059	33.75934845	-117.983493	Orange County
181667	Fee-for-Service	1619546322	1619546322	1	1	DEMAREST, MATTHEW A MD	4/14/2025	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
181681	Fee-for-Service	1548283591	1548283591	1	1	DORAISWAMY, ARUL MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71755	05	Anesthesiology	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
181698	Fee-for-Service	1700803418	1700803418	1	16	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3427 ROBIN LANE	STE 100	CAMERON PARK	CA	95682	7255	09	06017	38.65580389	-120.9675841	El Dorado County
181703	Fee-for-Service	1306850250	1306850250	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	139 ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06566774	-118.271006	Los Angeles County
181740	Fee-for-Service	1699928150	1699928150	1	1	DHILLON, SANJAM MD	7/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	148848	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
181779	Fee-for-Service	1275951261	1275951261	1	1	DUAN, SUSAN H MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156314	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
181792	Fee-for-Service	1548550767	1548550767	1	1	DIXON, ANDREW L MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133145	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93456	6406	42	06083	34.95426953	-120.427596	Santa Barbara County
181800	Fee-for-Service	1780850826	1780850826	1	1	DUPPER, MATTHEW E MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109453	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	SUITE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
181804	Fee-for-Service	1316903396	1316903396	1	1	DR. CLIFFORD P BLACK JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 LEIGHTON AVE	None	ANNISTON	AL	36207	0000	00	None	33.66915546	-85.82501513	Calhoun County
181836	Fee-for-Service	1568813988	1568813988	1	1	DAUD, MADIHA MD	10/5/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	161038	40	Pediatrics	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
181863	Fee-for-Service	1043284359	1043284359	1	1	DJANBATIAN, MOVSES OD	10/1/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
181873	Fee-for-Service	1871641829	1871641829	1	1	DARWEESH, FOUAD L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35545	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
181932	Fee-for-Service	1992867766	1992867766	1	1	DOMINGUEZ, EMIL R JR MD	1/29/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	A PROF CORP	409 E MERCED AVENUE	None	WEST COVINA	CA	91790	5061	19	06037	34.05501985	-117.9380648	Los Angeles County
181943	Fee-for-Service	1689344160	1689344160	1	1	DOTZLER, MARISSA N	12/17/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
181956	Fee-for-Service	1144815689	1144815689	1	1	DELA CRUZ PORTUGAL, JOHN LOR	10/11/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ENZ	18145 US HIGHWAY 18	SUITE D	APPLE VALLEY	CA	92307	2210	36	06071	34.5404119	-117.2678454	San Bernardino County
181986	Fee-for-Service	1700803418	1700803418	1	16	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3427 ROBIN LANE	STE 100	CAMERON PARK	CA	95682	7255	09	06017	38.65580389	-120.9675841	El Dorado County
182040	Fee-for-Service	1700803418	1700803418	1	21	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
182042	Fee-for-Service	1235593187	1235593187	1	1	DHILLON, SUKHJIT MD	7/28/2020	207P00000X	NA	Other	026	PHYSICIANS	151136	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
182052	Fee-for-Service	1851425888	1851425888	1	1	DOYLE, NANCY MD	11/9/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	25592	40	Pediatrics	0	In state provider	None	1180 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4802	49	06097	38.443194	-122.699466	Sonoma County
182074	Fee-for-Service	1316938178	1316938178	1	1	DUMLAO, MELODY G MD	8/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74044	45	Nephrology (Renal-Kidney)	0	In state provider	None	443 W MORTON AVE	STE A	PORTERVILLE	CA	93257	3352	54	06107	36.07317626	-119.026942	Tulare County
182079	Fee-for-Service	1396460531	1396460531	1	1	DOCTOR GWENDOLYN YEE CHANG O	9/6/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1925 W TEMPLE ST	STE 202	LOS ANGELES	CA	90026	4970	19	06037	34.06964168	-118.2660274	Los Angeles County
182085	Fee-for-Service	1083122014	1083122014	1	1	DITORO, BERNADETTE PSYD	4/20/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
182087	Fee-for-Service	1346320488	1346320488	1	1	DUONG, DANG K MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86042	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
182153	Fee-for-Service	1770840001	1770840001	1	1	DEL VALLE ESTOPINAL, MARIA D	1/15/2020	207ZP0102X	NA	Other	026	PHYSICIANS	162993	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	MD	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
182203	Fee-for-Service	1053328989	1053328989	1	1	DODSON, LISA G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	557 W WASHINGTON ST	None	BURNS	OR	97720	1441	00	None	43.58870813	-119.060725	Harney County
182238	Fee-for-Service	1275229908	1275229908	1	1	DIMINNO, JODIE P BIRTH DOULA	4/19/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
182243	Fee-for-Service	1477199727	1477199727	1	1	DIXON, CRAIG J CNP	3/9/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
182274	Fee-for-Service	1700803418	1700803418	1	16	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3427 ROBIN LANE	STE 100	CAMERON PARK	CA	95682	7255	09	06017	38.65580389	-120.9675841	El Dorado County
182278	Fee-for-Service	1801393467	1801393467	1	1	DASARI, GOPIKA MD	8/9/2021	207R00000X	NA	Other	026	PHYSICIANS	173416	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
182328	Fee-for-Service	1700803418	1700803418	1	21	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
182362	Fee-for-Service	1316938178	1316938178	1	1	DUMLAO, MELODY G MD	8/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74044	41	Internal Medicine	0	In state provider	None	443 W MORTON AVE	STE A	PORTERVILLE	CA	93257	3352	54	06107	36.07317626	-119.026942	Tulare County
182430	Fee-for-Service	1801183272	1801183272	2	1	DELUXE MEDICAL SUPPLY LLC	7/25/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7950 B UNIVERSITY AVE	None	LA MESA	CA	91942	5579	37	06073	32.76463802	-117.0268334	San Diego County
182440	Fee-for-Service	1518908581	1518908581	1	1	DAVID CHARLES SIMON M.D.	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2035 E 17TH ST	None	IDAHO FALLS	ID	83404	6430	00	None	43.48234148	-111.9930707	Bonneville County
182528	Fee-for-Service	1346240652	1346240652	1	1	DEAN, ALAN M MD	1/17/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	79112	05	Anesthesiology	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
182544	Fee-for-Service	1215954755	1215954755	1	1	DUPRE, NICOLE MD	1/16/2025	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
182561	Fee-for-Service	1700803418	1700803418	1	16	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3427 ROBIN LANE	STE 100	CAMERON PARK	CA	95682	7255	09	06017	38.65580389	-120.9675841	El Dorado County
182616	Fee-for-Service	1700803418	1700803418	1	21	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
182620	Fee-for-Service	1184786832	1184786832	1	1	DEPAOLO, LEONARD M LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
182626	Fee-for-Service	1750687687	1750687687	1	1	DHK MANOR INC	1/12/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4513 AUSUSTUS CT	None	STOCKTON	CA	95207	0000	39	06077	37.98490959	-121.3290372	San Joaquin County
182650	Fee-for-Service	1720188469	1720188469	1	1	DEVOE, DEBRA J MD	10/31/1990	2080P0204X	NA	Other	026	PHYSICIANS	49401	67	Endocrinology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
182669	Fee-for-Service	1538301098	1538301098	1	1	DARI MAGYAR M.D	5/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE#100	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
182679	Fee-for-Service	1689654147	1689654147	1	1	DO, NINA T INC OD	7/24/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1601 W 17TH ST	STE B1	SANTA ANA	CA	92706	3340	30	06059	33.7600735	-117.890325	Orange County
182686	Fee-for-Service	1497922546	1497922546	1	1	DHINGRA, KAPIL R MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106171	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
182688	Fee-for-Service	1952310872	1952310872	1	1	DIAMANT, THOMAS MD	3/6/1997	207RP1001X	NA	Pulmonology	026	PHYSICIANS	43620	41	Internal Medicine	0	In state provider	None	320 SUPERIOR AVE	STE 200	NEWPORT BEACH	CA	92663	2741	30	06059	33.62657138	-117.9330754	Orange County
182757	Fee-for-Service	1962673814	1962673814	1	1	DYER, ROBERT S MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108037	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
182789	Fee-for-Service	1760690200	1760690200	1	1	DEL RIVERO-YAMUY, ADA E	4/12/2005	261QP2300X	NA	Other	026	PHYSICIANS	83694	01	General Practice	0	In state provider	INC	3831 HUGHES AVE	STE 101	CULVER CITY	CA	90232	2751	19	06037	34.02243278	-118.3981492	Los Angeles County
182806	Fee-for-Service	1750636411	1750636411	1	1	DIAZ, ERIC S MD	4/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	154248	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
182820	Fee-for-Service	1922205491	1922205491	1	1	DESGRANGES, PATRICK MD	3/2/2021	207R00000X	NA	Other	026	PHYSICIANS	170129	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
182863	Fee-for-Service	1255419800	1255419800	1	1	DANILYCHEV, MARIA V MD	11/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82520	38	Geriatrics	0	In state provider	None	4311 3RD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
182905	Fee-for-Service	1700803418	1700803418	1	21	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
182913	Fee-for-Service	1578726121	1578726121	1	1	DOHERTY, SEAN D MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115843	07	Dermatology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
182949	Fee-for-Service	1013350073	1013350073	1	1	DETERS, BENJAMIN J DO	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13848	40	Pediatrics	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
182960	Fee-for-Service	1477160588	1477160588	1	1	DEOGUN, SANDEEP CRNA	3/4/2021	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
182965	Fee-for-Service	1760836662	1760836662	1	2	DALIVA, JOHN DO	1/20/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	17362	-	NOT APPLICABLE	0	In state provider	None	1260 E ARROW HIGHWAY	BLDGS B AND C	UPLAND	CA	91786	4982	36	06071	34.09953339	-117.6333297	San Bernardino County
182973	Fee-for-Service	1205100344	1205100344	1	1	DOMINGUEZ, MARIA K L DO	2/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12051	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
182975	Fee-for-Service	1952310872	1952310872	1	1	DIAMANT, THOMAS MD	3/6/1997	207RP1001X	NA	Pulmonology	026	PHYSICIANS	43620	01	General Practice	0	In state provider	None	320 SUPERIOR AVE	STE 200	NEWPORT BEACH	CA	92663	2741	30	06059	33.62657138	-117.9330754	Orange County
183025	Fee-for-Service	1619377942	1619377942	1	1	DHEW IND HTLH SV HLTH SVS &	9/11/2014	261QS1000X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	MNTL HLTH ADM	9010 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92503	4431	33	06065	33.923988	-117.435879	Riverside County
183056	Fee-for-Service	1639143431	1639143431	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	PALM SPRINGS DIALYSIS	1061 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4854	33	06065	33.837129	-116.545626	Riverside County
183130	Fee-for-Service	1548209976	1548209976	1	2	DHAMIJA, KAILASH R MD	12/5/2022	163WG0000X	NA	Other	026	PHYSICIANS	42292	None	None	0	In state provider	None	18326 PIONEER BLVD	None	ARTESIA	CA	90701	5533	19	06037	33.864912	-118.082172	Los Angeles County
183152	Fee-for-Service	1255419800	1255419800	1	1	DANILYCHEV, MARIA V MD	11/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82520	41	Internal Medicine	0	In state provider	None	4311 3RD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
183164	Fee-for-Service	1215017900	1215017900	1	2	DOUGLASS, ERIC S LMFT	2/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1910 S COURT ST	None	VISALIA	CA	93277	5426	54	06107	36.313605	-119.2914765	Tulare County
183190	Fee-for-Service	1700803418	1700803418	1	21	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	6305 COYLE AVE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
183197	Fee-for-Service	1922395979	1922395979	1	1	DESOUSA, VANESSA L DO	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13179	40	Pediatrics	0	In state provider	None	3925 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.482839	-122.7357945	Sonoma County
183201	Fee-for-Service	1205984119	1205984119	1	1	DO, AHN Q MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73994	08	Family Practice	0	In state provider	None	10402 WESTMINSTER AVE	None	GARDEN GROVE	CA	92843	4861	30	06059	33.75951204	-117.9478527	Orange County
183227	Fee-for-Service	1962435479	1962435479	1	1	DR. TROY ZABEL	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	130 RAMPART WAY	STE 300B	DENVER	CO	80230	6451	00	None	39.72047057	-104.8985959	Denver County
183244	Fee-for-Service	1376211490	1376211490	1	1	DAWES, STACIE LMFT	11/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
183263	Fee-for-Service	1952310872	1952310872	1	1	DIAMANT, THOMAS MD	3/6/1997	207RP1001X	NA	Pulmonology	026	PHYSICIANS	43620	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	320 SUPERIOR AVE	STE 200	NEWPORT BEACH	CA	92663	2741	30	06059	33.62657138	-117.9330754	Orange County
183313	Fee-for-Service	1619377942	1619377942	1	1	DHEW IND HTLH SV HLTH SVS &	9/11/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MNTL HLTH ADM	9010 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92503	4431	33	06065	33.923988	-117.435879	Riverside County
183331	Fee-for-Service	1497779334	1497779334	1	1	DIETER LIBBER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DIETER LUBBER MD	910 W 5TH AVE SUITE 300	None	SPOKANE	WA	99204	0000	00	None	47.651544	-117.4252185	Spokane County
183359	Fee-for-Service	1215372529	1215372529	1	1	DARLING, MARISSA L MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136717	25	Physical Medicine and Rehabilitation	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
183363	Fee-for-Service	1306861505	1306861505	1	1	DUNKIN, JENNIFER PHD	9/1/1997	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
183373	Fee-for-Service	1902669864	1902669864	1	1	DAVIS, EMALIA	2/9/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2087 GRAND CANAL BLVD	SUITE 9	STOCKTON	CA	95207	6651	39	06077	37.98552607	-121.3315122	San Joaquin County
183382	Fee-for-Service	1427002427	1427002427	1	1	DANDEKAR, NANDKUMAR V MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25061	02	General Surgery	0	In state provider	None	315 N 3RD AVE	STE 307	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
183402	Fee-for-Service	1871518613	1871518613	1	1	DEKERNION, JEAN B MD	12/11/2002	208800000X	NA	Other	026	PHYSICIANS	35223	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	BLDG 66	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
183453	Fee-for-Service	1609455153	1609455153	1	1	DHILLON, LOVEPREET DO	2/20/2025	207R00000X	NA	Other	026	PHYSICIANS	22666	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
183458	Fee-for-Service	1275086753	1275086753	1	1	DJEUGOUE, NKIEYA BLAISE	10/15/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6136 FLAGSTAFF DR	None	WASTVALE	CA	92880	4611	33	06065	33.97703123	-117.5709506	Riverside County
183498	Fee-for-Service	1871604116	1871604116	1	1	DHAR, NAVEEN K MD	3/14/2001	208G00000X	NA	General Surgery	026	PHYSICIANS	41671	33	Thoracic Surgery	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 614	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
183520	Fee-for-Service	1851504823	1851504823	1	1	DENG, CAISHU MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117270	22	Pathology (M.D. only)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
183521	Fee-for-Service	1649023482	1649023482	1	1	DWELLING, CRAIG PT	7/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
183528	Fee-for-Service	1225088552	1225088552	1	1	DO, JEFFREY M MD	4/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60504	05	Anesthesiology	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
183544	Fee-for-Service	1982728796	1982728796	1	2	DICARLO, BRIAN A MD	8/31/2017	207RH0003X	NA	Oncology	026	PHYSICIANS	98389	68	Hematology	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
183577	Fee-for-Service	1023898079	1023898079	1	1	DAVIS, AIYSHA R CA	10/14/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
183603	Fee-for-Service	1760463103	1760463103	1	1	DILL, DONALD M MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	21783	08	Family Practice	0	In state provider	None	171 C AVE	None	CORONADO	CA	92118	1423	37	06073	32.69705091	-117.1717853	San Diego County
183651	Fee-for-Service	1609440122	1609440122	1	1	DESERT VALLEY MEDICAL GROUP,	7/2/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	12351 MARIPOSA	None	VICTORVILLE	CA	92395	6013	36	06071	34.475166	-117.3393405	San Bernardino County
183663	Fee-for-Service	1902484850	1902484850	1	1	DETWEILER, JOSEPH W MD	8/5/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
183673	Fee-for-Service	1427002427	1427002427	1	1	DANDEKAR, NANDKUMAR V MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25061	33	Thoracic Surgery	0	In state provider	None	315 N 3RD AVE	STE 307	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
183693	Fee-for-Service	1871518613	1871518613	1	1	DEKERNION, JEAN B MD	12/11/2002	208800000X	NA	Other	026	PHYSICIANS	35223	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	BLDG 66	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
183702	Fee-for-Service	1679712780	1679712780	1	1	DANQUE, FLORA I MD INC	12/16/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62874	08	Family Practice	0	In state provider	None	1252 BROADWAY	SUITE E	EL CAJON	CA	92021	4901	37	06073	32.80773453	-116.9381385	San Diego County
183743	Fee-for-Service	1275086753	1275086753	1	1	DJEUGOUE, NKIEYA BLAISE	10/15/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6136 FLAGSTAFF DR	None	WASTVALE	CA	92880	4611	33	06065	33.97703123	-117.5709506	Riverside County
183753	Fee-for-Service	1326734914	1326734914	1	1	DEAR ME PSYCHOTHERAPY	7/3/2023	261QM0850X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2357 RALSTON DR	None	SAN JOSE	CA	95148	4036	43	06085	37.31424668	-121.799332	Santa Clara County
183788	Fee-for-Service	1871604116	1871604116	1	1	DHAR, NAVEEN K MD	3/14/2001	208G00000X	NA	General Surgery	026	PHYSICIANS	41671	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 614	GARDEN GROVE	CA	92843	1920	30	06059	33.77450141	-117.9123364	Orange County
183802	Fee-for-Service	1275692964	1275692964	1	1	DEUTSCH-RIOS, DEBORAH H LMFT	5/16/2020	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
183825	Fee-for-Service	1770736712	1770736712	1	1	DR SOGHOMONIANS MEDICAL	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50159	41	Internal Medicine	0	In state provider	CLINIC INC	2570 JENSEN AVE	#117	SANGER	CA	93657	2269	10	06019	36.70680647	-119.5736715	Fresno County
183832	Fee-for-Service	1982728796	1982728796	1	2	DICARLO, BRIAN A MD	8/31/2017	207RH0003X	NA	Oncology	026	PHYSICIANS	98389	78	Neoplastic Diseases/Oncology	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
183867	Fee-for-Service	1821222852	1821222852	1	1	D'AURIA, ANDREA A	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	10819	None	None	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
183872	Fee-for-Service	1578033593	1578033593	1	2	DENT, LATOSHA NP	7/15/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95010715	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
183881	Fee-for-Service	1710094099	1710094099	1	1	DOSCH, STEVEN E MD	10/31/1982	2083P0500X	NA	Adult Primary Care	026	PHYSICIANS	38680	01	General Practice	0	In state provider	None	765 3RD AVE	None	CHULA VISTA	CA	91910	5841	37	06073	32.62545436	-117.0736724	San Diego County
183893	Fee-for-Service	1760463103	1760463103	1	1	DILL, DONALD M MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	21783	01	General Practice	0	In state provider	None	171 C AVE	None	CORONADO	CA	92118	1423	37	06073	32.69705091	-117.1717853	San Diego County
183960	Fee-for-Service	1427002427	1427002427	1	1	DANDEKAR, NANDKUMAR V MD	9/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25061	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	315 N 3RD AVE	STE 307	COVINA	CA	91723	1916	19	06037	34.08873786	-117.8923869	Los Angeles County
184019	Fee-for-Service	1801206909	1801206909	1	2	DIAMOND, NELSON F MD	7/15/2022	207P00000X	NA	Other	026	PHYSICIANS	140380	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
184112	Fee-for-Service	1770736712	1770736712	1	1	DR SOGHOMONIANS MEDICAL	3/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50159	66	Emergency Medicine (Urgent Care)	0	In state provider	CLINIC INC	2570 JENSEN AVE	#117	SANGER	CA	93657	2269	10	06019	36.70680647	-119.5736715	Fresno County
184117	Fee-for-Service	1982728796	1982728796	1	2	DICARLO, BRIAN A MD	8/31/2017	207RH0003X	NA	Oncology	026	PHYSICIANS	98389	41	Internal Medicine	0	In state provider	None	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	40	06079	35.24853234	-120.642458	San Luis Obispo County
184120	Fee-for-Service	1033422191	1033422191	1	1	DAVIS, KAREL J CRNA	8/28/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
184121	Fee-for-Service	1417986761	1417986761	1	1	DEHAAS, DAVID R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD ST	None	EUGENE	OR	97401	3718	00	None	44.04647879	-123.0820996	Lane County
184146	Fee-for-Service	1831564913	1831564913	1	1	DESERT HOME HEALTH CARE INC	3/19/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13251 GLADSTONE AVE	None	SYLMAR	CA	91342	3116	19	06037	34.311551	-118.429312	Los Angeles County
184154	Fee-for-Service	1699236752	1699236752	1	1	DOMINIC J TEDESCO MD INC.	8/1/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	400 PUEBLO	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
184188	Fee-for-Service	1285770024	1285770024	1	1	DEL NORTE CO UNIFIED SD	3/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	301 W WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8340	08	06015	41.770764	-124.208397	Del Norte County
184211	Fee-for-Service	1487655536	1487655536	1	1	DULLY, KATHLEEN M MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72961	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
184237	Fee-for-Service	1609895671	1609895671	1	1	DANIEL MERRILL MD	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
184243	Fee-for-Service	1811252182	1811252182	1	2	DAPAAH-SIAKWAN, FREDRICK MD	7/18/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	152930	40	Pediatrics	0	In state provider	None	1400 CHURCH	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
184298	Fee-for-Service	1093893869	1093893869	1	1	DAYAL, RAMA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69761	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
184344	Fee-for-Service	1437263134	1437263134	1	1	DUMKE, ROGER E MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39294	02	General Surgery	0	In state provider	None	23451 MADISON ST	STE 340	TORRANCE	CA	90505	4762	19	06037	33.81197627	-118.3478154	Los Angeles County
184358	Fee-for-Service	1669729786	1669729786	1	1	DINKEL, LAURA M CNM	12/18/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6600 BRUCEVILLE BLVD	None	SACRAMENTO	CA	92823	4671	34	06067	38.470392	-121.4223975	Sacramento County
184364	Fee-for-Service	1164873352	1164873352	1	1	DALTON, STEVEN J DO	5/7/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
184370	Fee-for-Service	1679500565	1679500565	1	1	DICKINSON, SHIRLEY L MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	56281	01	General Practice	0	In state provider	None	1150 MAIN STREET	SUITE 3	WATSONVILLE	CA	95076	3760	44	06087	36.9163164	-121.7698107	Santa Cruz County
184383	Fee-for-Service	1023335601	1023335601	1	1	DAVIS, GAVIN R MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137034	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
184407	Fee-for-Service	1619949344	1619949344	1	1	DENISE A HUNNINGHAKE MD	2/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1973 SLOAN PL	STE 100	SAINT PAUL	MN	55117	2085	00	None	45.00074258	-93.08743702	Ramsey County
184427	Fee-for-Service	1093799884	1093799884	1	1	DEW, LINDA L MD	3/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55139	None	None	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
184442	Fee-for-Service	1811913759	1811913759	1	1	DHALIWAL, PARMINDER S MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46401	10	Gastroenterology (M.D. only)	0	In state provider	None	520 SUPERIOR AVENUE	STE 230	NEWPORT BEACH	CA	92663	3642	30	06059	33.628914	-117.9276525	Orange County
184478	Fee-for-Service	1285770024	1285770024	1	1	DEL NORTE CO UNIFIED SD	2/21/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	301 W WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8340	08	06015	41.770764	-124.208397	Del Norte County
184482	Fee-for-Service	1689794083	1689794083	1	1	D'AMICO ANTHONY MD	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3819 STEPHENS AVE	STE 200	MISSOULA	MT	59801	8522	00	None	46.835955	-114.0137955	Missoula County
184514	Fee-for-Service	1720094139	1720094139	1	1	DUNPHY,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	255 N 30TH ST	None	LARAMIE	WY	82072	0000	00	None	41.31237665	-105.5574851	Albany County
184521	Fee-for-Service	1790926632	1790926632	1	1	DAVE, MANEESH MD MPH	6/11/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	160563	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
184538	Fee-for-Service	1922648682	1922648682	1	1	DHS HOSPICE CARE	11/12/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	STE 208	NORTH HOLLYWOOD	CA	91602	1874	19	06037	34.15389329	-118.3679999	Los Angeles County
184555	Fee-for-Service	1013278647	1013278647	1	1	DENEBEIM, EVELYN MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129221	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
184610	Fee-for-Service	1811633753	1811633753	1	1	DEL REAL, MAYRA M	7/19/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1764 MARCO POLO WAY	None	BURLINGAME	CA	94010	4503	41	06081	37.59103278	-122.3859664	San Mateo County
184613	Fee-for-Service	1538468681	1538468681	1	1	DAVID, JED C	4/12/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
184634	Fee-for-Service	1437263134	1437263134	1	1	DUMKE, ROGER E MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39294	01	General Practice	0	In state provider	None	23451 MADISON ST	STE 340	TORRANCE	CA	90505	4762	19	06037	33.81197627	-118.3478154	Los Angeles County
184641	Fee-for-Service	1386737773	1386737773	1	1	DICKINSON, PHILLIP W MD	11/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8851 CENTER DR	STE 408	LA MESA	CA	91942	3076	37	06073	32.78189749	-117.0075062	San Diego County
184707	Fee-for-Service	1013580786	1013580786	1	1	DECHAMBEAU, TYANN J LCSW	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
184708	Fee-for-Service	1710164637	1710164637	1	1	DOLINAR, AMY L MD INC	9/25/2008	193400000X	NA	Other	026	PHYSICIANS	90096	40	Pediatrics	0	In state provider	None	1601 ESPLANADE	STE 4	CHICO	CA	95926	3370	04	06007	39.74323916	-121.8498802	Butte County
184728	Fee-for-Service	1811913759	1811913759	1	1	DHALIWAL, PARMINDER S MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46401	41	Internal Medicine	0	In state provider	None	520 SUPERIOR AVENUE	STE 230	NEWPORT BEACH	CA	92663	3642	30	06059	33.628914	-117.9276525	Orange County
184743	Fee-for-Service	1770658684	1770658684	1	1	DR.DANIEL ALSUP M.D	10/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	48 W 1500 N	None	NEPHI	UT	84648	8900	00	None	39.7306275	-111.83724	Juab County
184780	Fee-for-Service	1063454445	1063454445	1	1	DICKSON, TROY S MD	9/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79321	20	Orthopedic Surgery	0	In state provider	None	4300 GOLDEN CENTER DR	STE C	PLACERVILLE	CA	95667	6278	09	06017	38.70657265	-120.82856	El Dorado County
184796	Fee-for-Service	1326422874	1326422874	1	1	DANI, MRUGA N PT	2/24/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
184820	Fee-for-Service	1922648682	1922648682	1	1	DHS HOSPICE CARE	11/12/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	STE 208	NORTH HOLLYWOOD	CA	91602	1874	19	06037	34.15389329	-118.3679999	Los Angeles County
184828	Fee-for-Service	1528086360	1528086360	1	1	DIMELING, CAROL MD	7/22/1996	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	43924	04	Otology, Laryngology, Rhinology	0	In state provider	UCSF MEDICAL CENTER	400 PARNASSUS AVE	# A717	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184877	Fee-for-Service	1700803418	1700803418	1	17	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6660 COYLE AVE	STE 360	CARMICHAEL	CA	95608	6367	34	06067	38.667447	-121.3091505	Sacramento County
184885	Fee-for-Service	1972844561	1972844561	1	1	DUONG, DAT N K DO	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16433	01	General Practice	0	In state provider	None	11160 WARNER AVE	SUITE 417	FOUNTAIN VALLEY	CA	92708	8703	30	06059	33.71630854	-117.934317	Orange County
184887	Fee-for-Service	1003858481	1003858481	1	1	DIKE, ANTHONY C MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	43519	41	Internal Medicine	0	In state provider	None	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	1619	36	06071	34.24602097	-116.8885243	San Bernardino County
184903	Fee-for-Service	1992368344	1992368344	1	1	DOTSON, AARON D MD	5/24/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184922	Fee-for-Service	1548576366	1548576366	1	1	DIABLO PROSTHETICS &	10/6/2011	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	120 LA CASA VIA	#202	WALNUT CREEK	CA	94597	3007	07	06013	37.91201649	-122.0418499	Contra Costa County
184930	Fee-for-Service	1386737773	1386737773	1	1	DICKINSON, PHILLIP W MD	11/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	86720	02	General Surgery	0	In state provider	None	8851 CENTER DR	STE 408	LA MESA	CA	91942	3076	37	06073	32.78189749	-117.0075062	San Diego County
184972	Fee-for-Service	1447804695	1447804695	1	1	DILLARD, GABRIELLE	1/6/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
184984	Fee-for-Service	1689061046	1689061046	1	1	DOAN HEARING AID CENTER INC	6/29/2015	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	9039 BOLSA AVE	SUITE 203	WESTMINSTER	CA	92683	5595	30	06059	33.7449633	-117.9717088	Orange County
185012	Fee-for-Service	1952125320	1952125320	1	1	DR. YANZHI ZHU MD INC	3/14/2025	163WG0000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9727 ELK GROVE FLORIN RD	SUITE 160	ELK GROVE	CA	95624	2291	34	06067	38.404503	-121.370994	Sacramento County
185013	Fee-for-Service	1477580298	1477580298	1	1	DESIGAN, GNANA MD	5/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41859	41	Internal Medicine	0	In state provider	None	6850 SEPULVEDA BLVD	STE 214	VAN NUYS	CA	91405	4454	19	06037	34.1955	-118.4661705	Los Angeles County
185025	Fee-for-Service	1821778218	1821778218	1	1	DESOTO CAB COMPANY	4/23/2024	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	80 INDUSTRIAL WAY	None	BRISBANE	CA	94005	1002	41	06081	37.69986726	-122.4073515	San Mateo County
185045	Fee-for-Service	1275692998	1275692998	1	1	DILIBERO, CAROL A CRNA	6/24/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
185058	Fee-for-Service	1376743179	1376743179	1	1	DAVIS, WANDA CCC-SLP	10/19/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
185060	Fee-for-Service	1831163245	1831163245	1	1	DVA HEALTHCARE RENAL	9/19/1995	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	636 CLAY ST	None	SAN FRANCISCO	CA	94111	2502	38	06075	37.79464034	-122.4038342	San Francisco County
185076	Fee-for-Service	1265843593	1265843593	1	1	DRUMHELLER, NICHOLE E	7/11/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	420 B STREET	None	YUBA CITY	CA	95991	5070	51	06101	39.13415904	-121.6121453	Sutter County
185102	Fee-for-Service	1235312695	1235312695	1	1	DEXCOM INC	7/5/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6340 SEQUENCE DRIVE	None	SAN DIEGO	CA	92121	4356	37	06073	32.9069143	-117.1854233	San Diego County
185108	Fee-for-Service	1275015190	1275015190	1	1	DANG, JEFFREY S INC	2/2/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16481 MAGNOLIA ST	None	WESTMINSTER	CA	92683	9206	30	06059	33.72334854	-117.9719942	Orange County
185116	Fee-for-Service	1528086360	1528086360	1	1	DIMELING, CAROL MD	7/22/1996	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	43924	84	Surgery-Head and Neck	0	In state provider	UCSF MEDICAL CENTER	400 PARNASSUS AVE	# A717	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
185150	Fee-for-Service	1417100256	1417100256	1	1	DEGUZMAN, JASMINE	4/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9065 HAVEN AVE STE 110	None	RANCHO CUCAMONGA	CA	91730	5429	36	06071	34.089012	-117.5756625	San Bernardino County
185165	Fee-for-Service	1700803418	1700803418	1	17	DIGNITY HEALTH MEDICAL FOUND	10/25/2010	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6660 COYLE AVE	STE 360	CARMICHAEL	CA	95608	6367	34	06067	38.667447	-121.3091505	Sacramento County
185198	Fee-for-Service	1770901746	1770901746	1	1	DAVIS, STEPHANIE N MD	7/22/2021	208600000X	NA	General Surgery	026	PHYSICIANS	172101	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
185241	Fee-for-Service	1891017299	1891017299	1	1	DUNN, BRIGITTE LMFT	3/26/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
185262	Fee-for-Service	1982635058	1982635058	1	1	DALEY, MELITA L MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71939	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
185269	Fee-for-Service	1124385943	1124385943	1	1	DOUD, SHELBY R PT	11/19/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
185270	Fee-for-Service	1598798043	1598798043	1	1	DARAM, VASUKI S MD	2/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93866	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
185288	Fee-for-Service	1487036505	1487036505	1	1	DELUXE HEALTH CARE SERVICES	3/29/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	585 E LOS ANGELES AVE	SUITE G	SIMI VALLEY	CA	93065	1865	56	06111	34.27182353	-118.7858925	Ventura County
185297	Fee-for-Service	1568894855	1568894855	1	1	DERRICK, MARY K	5/11/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
185301	Fee-for-Service	1477580298	1477580298	1	1	DESIGAN, GNANA MD	5/1/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41859	10	Gastroenterology (M.D. only)	0	In state provider	None	6850 SEPULVEDA BLVD	STE 214	VAN NUYS	CA	91405	4454	19	06037	34.1955	-118.4661705	Los Angeles County
185308	Fee-for-Service	1073823332	1073823332	1	1	DIABLO VALLEY PRIMARY CARE	7/29/2015	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	2415 HIGH SCHOOL AVE	STE 800	CONCORD	CA	94520	1858	07	06013	37.98481374	-122.0347555	Contra Costa County
185315	Fee-for-Service	1184100752	1184100752	1	2	DUEL, DANIEL A MD	10/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164692	None	None	0	In state provider	None	120 BIRMINGHAM DRIVE	240A	CARDIFF BY THE SE	CA	92007	1757	37	06073	33.02310224	-117.2826142	San Diego County
185329	Fee-for-Service	1598961245	1598961245	1	17	DIGNITY HEALTH MEDICAL FOUND	7/13/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1667 DOMINICAN WAY	STE 234	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
185370	Fee-for-Service	1285868901	1285868901	1	1	DYLAN G FOLKESTAD MD	4/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 DOUGLAS AVE	None	HENNING	MN	56551	4026	00	None	46.32228093	-95.4466808	Otter Tail County
185400	Fee-for-Service	1124476338	1124476338	1	1	D MELLO, ADRIANNA MD	8/28/2020	207R00000X	NA	Other	026	PHYSICIANS	163267	41	Internal Medicine	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
185443	Fee-for-Service	1578790598	1578790598	1	1	DIXIT, RAVI K MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113799	41	Internal Medicine	0	In state provider	None	25825 VERMONT STREET	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
185453	Fee-for-Service	1700803418	1700803418	1	17	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6660 COYLE AVE	STE 360	CARMICHAEL	CA	95608	6367	34	06067	38.667447	-121.3091505	Sacramento County
185525	Fee-for-Service	1982483186	1982483186	1	1	DHALIWAL, HARVIR NP	10/27/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1317 OAKDALE ROAD	STE. 800	MODESTO	CA	95355	3361	50	06099	37.662489	-120.957588	Stanislaus County
185546	Fee-for-Service	1972663375	1972663375	1	1	DAY, KARIN U PT	1/21/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9230 MARYSVILLE RD	None	OREGON HOUSE	CA	95962	9705	58	06115	39.36447161	-121.2501344	Yuba County
185680	Fee-for-Service	1912007758	1912007758	1	1	DAVID J BARNETTE JR A MEDICA	6/20/2019	291U00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	L CORPORATION	6649 CURLEW TERRACE	None	CARLSBAD	CA	92011	3965	37	06073	33.1090855	-117.294449	San Diego County
185687	Fee-for-Service	1104860519	1104860519	1	1	DICKINSON, DIANE MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	69727	08	Family Practice	0	In state provider	None	2211 HARRISON AVE	None	EUREKA	CA	95501	3214	12	06023	40.7875171	-124.1396062	Humboldt County
185694	Fee-for-Service	1295152445	1295152445	1	1	DOAN, CHRISTINA MD	6/15/2018	207L00000X	NA	Other	026	PHYSICIANS	140812	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
185749	Fee-for-Service	1942331921	1942331921	1	1	DAYENI, ZAHRA H LMFT	7/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1451 QUAIL ST	STE 102	NEWPORT BEACH	CA	90660	2747	30	06059	33.66105363	-117.8688433	Orange County
185752	Fee-for-Service	1316170996	1316170996	1	1	DAVIS, GABRIELLE B MD	7/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108227	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
185764	Fee-for-Service	1891158168	1891158168	1	1	DE CASTRO, CARLOS M MD	6/2/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172102	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185767	Fee-for-Service	1053917609	1053917609	1	2	DYNAMIC TRANSPORTATION AND S	7/1/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ERVICES	25101 THE OLD RD	None	STEVENSON RANCH	CA	91381	2206	19	06037	34.3740128	-118.5631527	Los Angeles County
185885	Fee-for-Service	1174558662	1174558662	1	1	DELLOCA, ROSA L MD	9/9/2024	2086S0122X	NA	General Surgery	026	PHYSICIANS	77010	24	Plastic Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
185907	Fee-for-Service	1740724780	1740724780	1	1	DE CRAIG RANCH, LLC	8/26/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ICAN WEST FLAMINGO CAMPU	9880 W FLAMINGO RD	None	LAS VEGAS	NV	89147	8085	00	None	36.11523146	-115.3080718	Clark County
185913	Fee-for-Service	1255489100	1255489100	1	1	DELEON, DERECK J MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69380	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
185926	Fee-for-Service	1154557890	1154557890	1	1	DIAS, MICHEL-ANN R MD	5/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117271	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
185942	Fee-for-Service	1669453775	1669453775	1	1	DIAZ, ROBERTO MD	9/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53002	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	DIAZ MEDICAL GROUP	1828 EL CAMINO REAL	STE 601	BURLINGAME	CA	94010	3120	41	06081	37.59552262	-122.3838771	San Mateo County
185951	Fee-for-Service	1639763006	1639763006	1	1	DETOUR BEHAVIORAL HEALTH INC	3/8/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2542 EAST FLORENCE AVENU	H	WALNUT PARK	CA	90255	4780	19	06037	33.97430191	-118.2264151	Los Angeles County
186023	Fee-for-Service	1568788834	1568788834	1	1	DOAN, RYAN P MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119276	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
186025	Fee-for-Service	1124802137	1124802137	1	1	DINH, DIEP L NP	11/11/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
186086	Fee-for-Service	1316151632	1316151632	1	1	DIRIENZO, NICOLE DO	7/8/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	20720	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
186123	Fee-for-Service	1639360746	1639360746	1	1	DOLKAS, LAURA M MD	12/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104401	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186126	Fee-for-Service	1346343985	1346343985	1	1	DALAL, RUPAL M MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69705	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
186168	Fee-for-Service	1437437274	1437437274	1	1	DHANOTA, NISHI PA-C	8/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53980	-	NOT APPLICABLE	0	In state provider	None	201 D ST	G, T & W	MARYSVILLE	CA	95901	5952	58	06115	39.13753087	-121.5885645	Yuba County
186182	Fee-for-Service	1962634733	1962634733	1	1	DIALLO, MOFYA S MD	2/4/2022	207LP3000X	NA	Other	026	PHYSICIANS	175425	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
186194	Fee-for-Service	1740724780	1740724780	1	1	DE CRAIG RANCH, LLC	8/26/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ICAN WEST FLAMINGO CAMPU	9880 W FLAMINGO RD	None	LAS VEGAS	NV	89147	8085	00	None	36.11523146	-115.3080718	Clark County
186201	Fee-for-Service	1255489100	1255489100	1	1	DELEON, DERECK J MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69380	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186208	Fee-for-Service	1235812595	1235812595	1	1	DOAN AND CO MEDICAL CORP	8/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
186260	Fee-for-Service	1821670951	1821670951	1	1	DAYANI, FARA	5/20/2024	111NR0200X	NA	Other	026	PHYSICIANS	186232	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
186315	Fee-for-Service	1700803418	1700803418	1	51	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
186328	Fee-for-Service	1093206864	1093206864	1	1	DOSHI, MINAL M LCSW	1/16/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
186366	Fee-for-Service	1194744391	1194744391	2	1	DAWOOD, NAYYARA S MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63743	40	Pediatrics	0	In state provider	None	275 OCONNOR DR	STE C	SAN JOSE	CA	95128	1657	43	06085	37.32543612	-121.9398923	Santa Clara County
186413	Fee-for-Service	1033508353	1033508353	1	1	DOSHI, ANKUR A MD	4/25/2023	2085R0204X	NA	Other	026	PHYSICIANS	158271	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
186441	Fee-for-Service	1265620728	1265620728	1	1	DHALIWAL, GURDAVER MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101525	08	Family Practice	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
186445	Fee-for-Service	1225251606	1225251606	1	1	DE LEON, JESSE M MD	4/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	32517	18	Ophthalmology	0	In state provider	None	16660 PARAMOUNT BLVD	STE 211	PARAMOUNT	CA	90723	5469	19	06037	33.882723	-118.1599535	Los Angeles County
186446	Fee-for-Service	1740308477	1740308477	1	1	DEL VALLE, PATRICIA PSYD	5/9/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
186453	Fee-for-Service	1255455861	1255455861	1	1	DIAMOND, NEIL OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2417 SYCAMORE DR	None	SIMI VALLEY	CA	93065	2301	56	06111	34.279884	-118.743926	Ventura County
186467	Fee-for-Service	1730477811	1730477811	1	1	DRENTEN, CARRIEANN E MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124108	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 L STREET	None	SACRAMENTO	CA	95816	5615	34	06067	38.57202	-121.4692695	Sacramento County
186473	Fee-for-Service	1407276736	1407276736	1	1	DHILLON, NAVPREET MD	9/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	141011	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
186487	Fee-for-Service	1255489100	1255489100	1	1	DELEON, DERECK J MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69380	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186512	Fee-for-Service	1831482629	1831482629	1	1	DIAZ, AMILCAR MD	2/22/2019	2085B0100X	NA	MRI Provider	026	PHYSICIANS	155426	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
186550	Fee-for-Service	1245436930	1245436930	1	1	DELANO ADULT DAY HEALTH	5/16/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	1457 GLENWOOD ST	None	DELANO	CA	93215	2034	15	06029	35.77498296	-119.2502103	Kern County
186581	Fee-for-Service	1154334001	1154334001	1	1	DUBYAK, JOHANNA M MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77484	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
186582	Fee-for-Service	1689782013	1689782013	1	1	DAVIDSON, DANIELLE L MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87599	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
186604	Fee-for-Service	1700803418	1700803418	1	51	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
186621	Fee-for-Service	1396209458	1396209458	1	1	DIAZ, COLLEEN CCC-SLP	11/19/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
186664	Fee-for-Service	1801944624	1801944624	1	1	DAUS, ROBIN S MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	58174	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
186694	Fee-for-Service	1568826378	1568826378	1	1	DANESH, JENNIFER N	5/19/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	151532	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
186701	Fee-for-Service	1073186318	1073186318	1	1	DR AFSHIN POURREZA & ASSOCIA	11/13/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	TES INC	4199 CAMPUS DR	550	IRVINE	CA	92612	4694	30	06059	33.650775	-117.838296	Orange County
186704	Fee-for-Service	1447592555	1447592555	1	1	DE LONG, THERESA M LMFT	7/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2730 WILSHIRE BLVD	STE 660	SANTA MONICA	CA	90403	4746	19	06037	34.037223	-118.4759177	Los Angeles County
186709	Fee-for-Service	1568578250	1568578250	1	1	DE HAAS, DIRK R MD	12/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2827	30	06059	33.45756029	-117.6497373	Orange County
186845	Fee-for-Service	1457768848	1457768848	1	1	DE LEON COUNTRY MAUREENS	8/13/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME LLC	3961 WALNUT AVENUE	None	CHINO	CA	91710	2148	36	06071	34.02605022	-117.7189806	San Bernardino County
186858	Fee-for-Service	1245692839	1245692839	1	1	DE KOUCHKOVSKY, IVAN A MD	6/22/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	152456	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
186861	Fee-for-Service	1740512441	1740512441	1	1	DANIELS, MATTHEW C CP	1/25/2010	174400000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	9 GOVERNORS LANE	None	CHICO	CA	95926	1991	04	06007	39.75490536	-121.8582641	Butte County
186893	Fee-for-Service	1700803418	1700803418	1	37	DIGNITY HEALTH MEDICAL FOUND	10/23/2019	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	STE 260	SACRAMENTO	CA	95819	3663	34	06067	38.570652	-121.4535465	Sacramento County
186947	Fee-for-Service	1053700351	1053700351	1	1	DEL ROSARIO, CHRISTA J MD	10/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134057	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
187020	Fee-for-Service	1942248240	1942248240	1	1	DR. HASIT MEHTA M.D.	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 WOODS RD	None	VALHALLA	NY	10595	1530	00	None	41.08902532	-73.80449573	Westchester County
187023	Fee-for-Service	1194027748	1194027748	1	1	DIAMOND VISION OPTOMETRY INC	9/7/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 S LAKE AVE	SUITE 111	PASADENA	CA	91101	3553	19	06037	34.1397069	-118.1322284	Los Angeles County
187034	Fee-for-Service	1447709019	1447709019	1	1	DESIGN FOR CHANGE	3/29/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	44501 16TH ST W	101	LANCASTER	CA	93534	2884	19	06037	34.69103533	-118.1585542	Los Angeles County
187051	Fee-for-Service	1588808943	1588808943	1	1	DAN, DANNY N MD	7/8/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	102928	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
187064	Fee-for-Service	1609978592	1609978592	2	1	DOCHARTY, CARLA I DPM	7/1/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3800 J ST	SUITE 200	SACRAMENTO	CA	95816	5551	34	06067	38.569869	-121.455729	Sacramento County
187073	Fee-for-Service	1144223306	1144223306	1	1	DONOVAN, TIMOTHY B MD	1/24/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
187088	Fee-for-Service	1407505720	1407505720	1	1	DESAI, RUCHI P MD	2/5/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
187093	Fee-for-Service	1558592220	1558592220	1	1	DEAVER, MARK J MD	3/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113798	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
187136	Fee-for-Service	1487694857	1487694857	1	1	DIGNITY HEALTH	12/31/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
187148	Fee-for-Service	1790719482	1790719482	1	1	DARPA, GLENN D DO	7/23/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	4222	01	General Practice	0	In state provider	None	10225 AUSTIN DR	STE 101	SPRING VALLEY	CA	91978	1521	37	06073	32.73081646	-116.9707735	San Diego County
187181	Fee-for-Service	1700803418	1700803418	1	37	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3941 J STREET	STE 260	SACRAMENTO	CA	95819	3663	34	06067	38.570652	-121.4535465	Sacramento County
187197	Fee-for-Service	1215017900	1215017900	1	1	DOUGLASS, ERIC S LMFT	11/30/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	36483	-	NOT APPLICABLE	0	In state provider	None	1393 BAILEY DR	None	HANFORD	CA	93230	5922	16	06031	36.32726257	-119.6663418	Kings County
187210	Fee-for-Service	1194743765	1194743765	1	1	DAVID LIEN MD	5/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1720 UNIVERSITY DR S	None	FARGO	ND	58103	4940	00	None	46.853136	-96.797421	Cass County
187211	Fee-for-Service	1326299868	1326299868	1	1	DIGGS, JOVONA AU	10/21/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	877 W FREMONT AVE	SUITE I4	SUNNYVALE	CA	94087	2319	43	06085	37.35226149	-122.049297	Santa Clara County
187245	Fee-for-Service	1952784126	1952784126	1	1	DACUS, JAMES MD INC A	8/20/2015	207R00000X	NA	Other	026	PHYSICIANS	39808	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	230 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.65837657	-121.6469645	Monterey County
187255	Fee-for-Service	1386937977	1386937977	1	17	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	3901 LAS POSAS RD	STE 10	CAMARILLO	CA	93010	1502	56	06111	34.2415821	-119.0183756	Ventura County
187373	Fee-for-Service	1447856240	1447856240	1	1	DABNEY, COREY LMFT	1/23/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
187379	Fee-for-Service	1841374915	1841374915	1	1	DARROW, VICKI C MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64610	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
187410	Fee-for-Service	1386937977	1386937977	1	3	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1700 N ROSE AVE	STE 210	OXNARD	CA	93030	7639	56	06111	34.21746	-119.155545	Ventura County
187422	Fee-for-Service	1487694857	1487694857	1	1	DIGNITY HEALTH	12/31/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
187426	Fee-for-Service	1972556462	1972556462	1	1	DIFAZIO, MARC P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9715 MEDICAL CENTER DR	STE 233	ROCKVILLE	MD	20850	6302	00	None	39.099105	-77.197896	Montgomery County
187454	Fee-for-Service	1053437293	1053437293	1	1	DRIVER, MARGARET G CRNA	1/4/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
187468	Fee-for-Service	1700803418	1700803418	1	51	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
187487	Fee-for-Service	1659551687	1659551687	1	1	DAVID J FUSCO MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	4434	00	None	33.4805218	-112.0782792	Maricopa County
187532	Fee-for-Service	1376953216	1376953216	1	1	DILLARD, KAMISHA G NP	8/14/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10305 PROMENADE PARKWAY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
187541	Fee-for-Service	1386937977	1386937977	1	17	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	3901 LAS POSAS RD	STE 10	CAMARILLO	CA	93010	1502	56	06111	34.2415821	-119.0183756	Ventura County
187588	Fee-for-Service	1487620662	1487620662	1	1	DURE-SMITH, BELINDA A MD	2/1/1996	207R00000X	NA	Other	026	PHYSICIANS	52257	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	# 3600	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
187590	Fee-for-Service	1538274055	1538274055	1	1	DEWOLF, WILLIAM R MD	5/31/1996	207R00000X	NA	Other	026	PHYSICIANS	40902	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
187605	Fee-for-Service	1871055806	1871055806	1	1	DYREK, PAIGE M DO	6/17/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	19965	20	Orthopedic Surgery	0	In state provider	None	1250 16TH STREET	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
187617	Fee-for-Service	1205831799	1205831799	1	1	DEQUIROZ, MARQUEZ P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29803	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
187649	Fee-for-Service	1134353915	1134353915	1	1	DOSHI, BHAVIN MD	11/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149619	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
187693	Fee-for-Service	1447255740	1447255740	1	1	DUNCAN, LAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87317	77	Infectious Disease	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
187694	Fee-for-Service	1306042304	1306042304	1	1	DELLIS, JAMES DO	2/19/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
187701	Fee-for-Service	1679528947	1679528947	1	1	DOUGLAS R MYERS OD INC	4/30/1993	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	119 YELLOWSTONE DR	None	CHICO	CA	95973	5811	04	06007	39.77004219	-121.875223	Butte County
187722	Fee-for-Service	1134718596	1134718596	1	1	DINA SOVA HOME HEALTH CARE	11/4/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1480 COLORADO BLVD	STE 100	LOS ANGELES	CA	90041	2357	19	06037	34.13925431	-118.1972852	Los Angeles County
187743	Fee-for-Service	1194736074	1194736074	1	1	DANG, DIANA T MD	9/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81703	01	General Practice	0	In state provider	None	718 S 4TH ST	None	EL CENTRO	CA	92243	3319	13	06025	32.786478	-115.552546	Imperial County
187750	Fee-for-Service	1518705904	1518705904	1	3	DR MARVI V RIJHWANI	8/7/2024	193400000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	718 BARTLETT AVE	None	HAYWARD	CA	94541	3698	01	06001	37.66946085	-122.1181444	Alameda County
187755	Fee-for-Service	1538123732	1538123732	1	1	DUNN, JONATHAN A MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62557	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
187757	Fee-for-Service	1700803418	1700803418	1	37	DIGNITY HEALTH MEDICAL FOUND	9/21/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J STREET	STE 260	SACRAMENTO	CA	95819	3663	34	06067	38.570652	-121.4535465	Sacramento County
187802	Fee-for-Service	1457331498	1457331498	1	1	DEFRITAS, DONNA M MD	6/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79667	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
187805	Fee-for-Service	1972500676	1972500676	1	1	DHOND, MILIND R MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	56062	41	Internal Medicine	0	In state provider	None	500 1ST AVE	None	PORTOLA	CA	96122	9406	32	06063	39.80595392	-120.4626723	Plumas County
187808	Fee-for-Service	1922542968	1922542968	1	1	DE CRAIG RANCH, LLC	8/26/2019	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ICAN BLUE DIAMOND CAMPUS	4855 BLUE DIAMOND RD	100	LAS VEGAS	NV	89139	7602	00	None	36.03258913	-115.2074608	Clark County
187872	Fee-for-Service	1609963057	1609963057	1	1	DISANO, MICHAEL J MD	1/31/1992	207P00000X	NA	Other	026	PHYSICIANS	68480	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
187887	Fee-for-Service	1083091425	1083091425	1	1	DOMINGUEZ, DANA MD	11/1/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	146172	None	None	0	In state provider	None	251 COHASSET	None	CHICO	CA	95926	2241	04	06007	39.75090044	-121.8522609	Butte County
187902	Fee-for-Service	1366488850	1366488850	1	1	DY-LIACCO, MARK MD	9/1/2024	204F00000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	25550 HAWTHORNE BLVD	STE 209	TORRANCE	CA	90505	6832	19	06037	33.79398714	-118.3491878	Los Angeles County
187960	Fee-for-Service	1508243163	1508243163	1	1	DOZIER, ALISHA LCSW	12/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1140 RAILROAD ST	None	PASO ROBLES	CA	93446	2532	40	06079	35.62645486	-120.6881426	San Luis Obispo County
187981	Fee-for-Service	1306042304	1306042304	1	1	DELLIS, JAMES DO	2/19/2025	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
187983	Fee-for-Service	1447255740	1447255740	1	1	DUNCAN, LAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	87317	41	Internal Medicine	0	In state provider	None	1125 SIR FRANCIS DRAKE B	None	KENTFIELD	CA	94904	1418	21	06041	37.95921858	-122.5523703	Marin County
187994	Fee-for-Service	1407011521	1407011521	1	1	DUBRAWSKI, JENNIFER L MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107686	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188038	Fee-for-Service	1174896294	1174896294	1	1	DARSHAN, SARIKA CRNA	1/7/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
188039	Fee-for-Service	1538123732	1538123732	1	1	DUNN, JONATHAN A MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62557	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
188045	Fee-for-Service	1700803418	1700803418	1	51	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
188071	Fee-for-Service	1346670718	1346670718	1	1	DIMAIRA, FRANCESCA NP	10/15/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
188081	Fee-for-Service	1336603687	1336603687	1	1	DERENZI-HILT, ANTHONY PT	1/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
188095	Fee-for-Service	1972500676	1972500676	1	1	DHOND, MILIND R MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	56062	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 1ST AVE	None	PORTOLA	CA	96122	9406	32	06063	39.80595392	-120.4626723	Plumas County
188098	Fee-for-Service	1922542968	1922542968	1	1	DE CRAIG RANCH, LLC	8/26/2019	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	ICAN BLUE DIAMOND CAMPUS	4855 BLUE DIAMOND RD	100	LAS VEGAS	NV	89139	7602	00	None	36.03258913	-115.2074608	Clark County
188129	Fee-for-Service	1780903476	1780903476	1	1	DIANE C MEYER	5/30/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 W NORFOLK AVE	None	NORFOLK	NE	68701	4438	00	None	42.034779	-97.452981	Madison County
188139	Fee-for-Service	1821040403	1821040403	1	1	DR. WILLIAM GERSHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
188157	Fee-for-Service	1114318623	1114318623	1	1	DO, KHANG Q CRNA	2/18/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
188163	Fee-for-Service	1588621668	1588621668	1	1	DESHPANDE, MANJUSHREE MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91105	08	Family Practice	0	In state provider	None	350 PARNASSUS AVE	None	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
188227	Fee-for-Service	1023321429	1023321429	1	1	DIONISIO, ROBERT M MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131730	05	Anesthesiology	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
188251	Fee-for-Service	1710155346	1710155346	1	1	DERRINGTON, SABRINA F MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97837	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
188261	Fee-for-Service	1922180470	1922180470	1	1	DAMON E MCBRINN MD	5/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
188300	Fee-for-Service	1285409201	1285409201	1	1	DELGADO, GABRIELA LMFT	2/25/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
188325	Fee-for-Service	1467772228	1467772228	1	1	DUGGAL MEDICAL CORPORATION	8/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42295	08	Family Practice	0	In state provider	INC	1401 SPANOS COURT	SUITE 205	MODESTO	CA	95355	2813	50	06099	37.66975543	-120.9724048	Stanislaus County
188371	Fee-for-Service	1386937977	1386937977	1	2	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FOUNDATION	5051 VERDUGO WAY	STE 100	CAMARILLO	CA	93012	8681	56	06111	34.21524684	-119.0033176	Ventura County
188372	Fee-for-Service	1205051018	1205051018	1	1	DASH, RAJESH MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90849	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188374	Fee-for-Service	1275703852	1275703852	1	1	DEMATTEIS, ANNA K MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102586	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
188380	Fee-for-Service	1073776613	1073776613	1	1	DOHERTY, CHRISTINE B MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115309	07	Dermatology	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
188430	Fee-for-Service	1851435754	1851435754	1	1	DE LA TORRE, ERNEST PT	1/29/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16573 VENTURA BLVD	5	ENCINO	CA	91436	2022	19	06037	34.1578643	-118.4944187	Los Angeles County
188539	Fee-for-Service	1104856095	1104856095	1	1	DESERT REGIONAL MEDICAL	5/31/1997	282NC2000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
188552	Fee-for-Service	1205374527	1205374527	1	1	DEMICHELE, FRANCIS A MD	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	161351	41	Internal Medicine	0	In state provider	None	7677 CENTER AVE	SUITE 214	HUNTINGTON BEACH	CA	92647	3074	30	06059	33.736257	-117.995535	Orange County
188561	Fee-for-Service	1740401116	1740401116	1	1	DORIAN, PETER J	1/1/1979	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5180 N FRESNO ST	# 102	FRESNO	CA	93710	6825	10	06019	36.81188402	-119.7813379	Fresno County
188565	Fee-for-Service	1386937977	1386937977	1	14	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
188593	Fee-for-Service	1487694857	1487694857	1	5	DIGNITY HEALTH	7/1/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3810 J STREET	None	SACRAMENTO	CA	95816	5521	34	06067	38.569743	-121.455378	Sacramento County
188605	Fee-for-Service	1003341314	1003341314	1	1	DOW, DEANNA T PHD	1/6/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
188660	Fee-for-Service	1386937977	1386937977	1	2	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	FOUNDATION	5051 VERDUGO WAY	STE 100	CAMARILLO	CA	93012	8681	56	06111	34.21524684	-119.0033176	Ventura County
188661	Fee-for-Service	1205051018	1205051018	1	1	DASH, RAJESH MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90849	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188680	Fee-for-Service	1386937977	1386937977	1	11	DIGNITY HEALTH MEDICAL FOUND	6/20/2017	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	2901 N VENTURA RD	SUITE 100	OXNARD	CA	93036	1126	56	06111	34.24479149	-119.1814409	Ventura County
188747	Fee-for-Service	1497892772	1497892772	1	1	DAVIGNON, MEGHAN N MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126319	40	Pediatrics	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
188776	Fee-for-Service	1063430916	1063430916	1	1	DEL PUERTO HEALTH CARE DIST	9/22/2004	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1700 KEYSTONE PACIFIC PK	UNIT B	PATTERSON	CA	95363	8862	50	06099	37.47600952	-121.160718	Stanislaus County
188782	Fee-for-Service	1457907123	1457907123	1	1	DIPPEL, KATHRYN S NP	11/13/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
188810	Fee-for-Service	1366589632	1366589632	1	1	DAUGHERTY, STACIE L MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
188828	Fee-for-Service	1104856095	1104856095	1	1	DESERT REGIONAL MEDICAL	6/25/1998	282N00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
188842	Fee-for-Service	1487694857	1487694857	1	3	DIGNITY HEALTH	12/31/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	7777 GREENBACK LANE	SUITE 110	CITRUS HEIGHTS	CA	95610	5800	34	06067	38.678868	-121.2777135	Sacramento County
188875	Fee-for-Service	1932202470	1932202470	1	2	DANG, TZEYU MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	44887	41	Internal Medicine	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
188916	Fee-for-Service	1699765701	1699765701	1	1	DEE, MICHELE CHAN MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60317	05	Anesthesiology	0	In state provider	None	3530 WILSHIRE BLVD	STE 350	LOS ANGELES	CA	90010	2335	19	06037	34.06171652	-118.301427	Los Angeles County
188947	Fee-for-Service	1386937977	1386937977	1	2	DIGNITY HEALTH MEDICAL FOUND	2/8/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	5051 VERDUGO WAY	STE 100	CAMARILLO	CA	93012	8681	56	06111	34.21524684	-119.0033176	Ventura County
188957	Fee-for-Service	1699951251	1699951251	1	1	DEMARTE, CHELSEA LMFT	2/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
188980	Fee-for-Service	1952353773	1952353773	1	1	DOUGLAS A SCHNEIDER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	TRAVIS COUNTRY EMERGENCY	11113 RESEARCH BLVD	None	AUSTIN	TX	78759	5236	00	None	30.40569387	-97.74490655	Travis County
189027	Fee-for-Service	1780650598	1780650598	1	1	DELGADO, RALPH J MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39607	41	Internal Medicine	0	In state provider	None	579 HIGHWAY 49	None	SAN ANDREAS	CA	95249	9688	05	06009	38.1888124	-120.6744204	Calaveras County
189059	Fee-for-Service	1306070453	1306070453	1	1	DELBRIDGE, CHRISOPHER J. DO	9/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
189068	Fee-for-Service	1063430916	1063430916	1	1	DEL PUERTO HEALTH CARE DIST	9/22/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1700 KEYSTONE PACIFIC PK	UNIT B	PATTERSON	CA	95363	8862	50	06099	37.47600952	-121.160718	Stanislaus County
189098	Fee-for-Service	1366589632	1366589632	1	1	DAUGHERTY, STACIE L MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
189115	Fee-for-Service	1104856095	1104856095	1	1	DESERT REGIONAL MEDICAL	5/31/1997	273R00000X	NA	Other	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
189130	Fee-for-Service	1588050702	1588050702	1	1	DAVARI, PARASTOO MD	11/29/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	164311	None	None	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
189169	Fee-for-Service	1194577635	1194577635	1	1	DOULANET	3/12/2025	193400000X	NA	Other	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	41	06081	0	0	None
189255	Fee-for-Service	1538110556	1538110556	1	1	DUPONT HOSPITAL LLC	4/14/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2520 E DUPONT RD	None	FORT WAYNE	IN	46825	1675	00	None	41.17629049	-85.10869713	Allen County
189260	Fee-for-Service	1760473052	1760473052	1	1	DENNIS, DOUGLAS A MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88265	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
189285	Fee-for-Service	1588028534	1588028534	1	1	DESAI, ZALAK MD	11/18/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
189311	Fee-for-Service	1811960339	1811960339	1	1	DORFSMAN,MICHELE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	FORBES TOWER STE 9055	PITTSBURG	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
189346	Fee-for-Service	1093779282	1093779282	1	1	DR. EDWIN WANG MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1165 UNION ST NE	STE 100	SALEM	OR	97301	4693	00	None	44.943138	-123.0249645	Marion County
189367	Fee-for-Service	1225320534	1225320534	1	1	DIETIKER, CAMERON L MD	6/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124735	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2201	38	06075	37.76344756	-122.4581992	San Francisco County
189371	Fee-for-Service	1659540185	1659540185	1	1	DELVENTHAL-WONG, GISCELA L N	10/14/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
189377	Fee-for-Service	1932498011	1932498011	1	1	DEAUGUSTINIS, MATTHEW L MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135519	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
189403	Fee-for-Service	1104856095	1104856095	1	1	DESERT REGIONAL MEDICAL	5/31/1997	261QA1903X	NA	Other	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
189415	Fee-for-Service	1710065883	1710065883	1	1	DERDIARIAN, ALINE T MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	50903	13	Neurology (M.D. only)	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
189507	Fee-for-Service	1306281506	1306281506	1	1	DEANGELO, SHARLEE M MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134052	40	Pediatrics	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
189564	Fee-for-Service	1407144439	1407144439	1	1	DESAI, AMRITA MD	6/22/2021	207RH0000X	NA	Hematology	026	PHYSICIANS	172937	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
189583	Fee-for-Service	1508968223	1508968223	1	1	DONG, NAM SI MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	36978	40	Pediatrics	0	In state provider	None	14082 MAGNOLIA ST	STE 111	WESTMINSTER	CA	92683	4764	30	06059	33.75832207	-117.9723348	Orange County
189590	Fee-for-Service	1881910982	1881910982	1	1	DAVID, ALEXIS D	12/24/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	116 E WALNUT AVE	None	MONROVIA	CA	91016	3431	19	06037	34.14367921	-118.0000903	Los Angeles County
189698	Fee-for-Service	1215497656	1215497656	1	1	DO, MINH-QUAN MD	5/19/2023	390200000X	NA	Other	026	PHYSICIANS	20239	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
189748	Fee-for-Service	1013930791	1013930791	1	1	DENNY, CHRISTOPHER T MD	9/25/1992	2080P0207X	NA	Hematology	026	PHYSICIANS	60785	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG MDC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
189784	Fee-for-Service	1770190555	1770190555	1	1	DEPENDABLE HOSPICE &	10/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	14545 FRIAR STREET	STE 290	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
189792	Fee-for-Service	1699751198	1699751198	1	1	DONALD, JANET E DO	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7645	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
189830	Fee-for-Service	1386937977	1386937977	1	16	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	247 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34910672	-119.0786704	Ventura County
189861	Fee-for-Service	1679804793	1679804793	1	1	DANIELSON, AARON R MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125554	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
189929	Fee-for-Service	1164560579	1164560579	1	1	DILES, WILLIAM S	9/6/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	593 N MCDOWELL BLVD	STE C	PETALUMA	CA	94954	2340	49	06097	38.25848821	-122.6425575	Sonoma County
189980	Fee-for-Service	1346448610	1346448610	1	2	DEMUS, NATALIE D LCSW	4/29/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	81709 DR CARREON BLVD	B1	INDIO	CA	92201	5510	33	06065	33.70733082	-116.2400326	Riverside County
190002	Fee-for-Service	1336335140	1336335140	1	1	DUNNINGTON JR, GANSEVOORT H	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	82962	33	Thoracic Surgery	0	In state provider	MD	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
190009	Fee-for-Service	1730614652	1730614652	1	1	DEBNATH, SHAPAN MD	8/26/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169995	None	None	0	In state provider	None	1220 S CENTRAL AVE	SUITE 105	GLENDALE	CA	91204	3808	19	06037	34.131447	-118.2577905	Los Angeles County
190050	Fee-for-Service	1982708384	1982708384	1	1	DANDAN, IMAD S MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45893	01	General Practice	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
190070	Fee-for-Service	1770190555	1770190555	1	1	DEPENDABLE HOSPICE &	10/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	14545 FRIAR STREET	STE 290	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
190072	Fee-for-Service	1215292867	1215292867	1	1	DOBRIK HEARING CARE INC	10/19/2015	193400000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	440 S BREA BLVD	SUITE A	BREA	CA	92821	5338	30	06059	33.91349865	-117.9019509	Orange County
190110	Fee-for-Service	1619579422	1619579422	1	1	DAVID HORNER PC	5/4/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	2088	36	06071	34.24602097	-116.8885243	San Bernardino County
190158	Fee-for-Service	1164541181	1164541181	1	1	DEARDORFF, MATTHEW A MD	5/7/2020	207SG0201X	NA	Other	026	PHYSICIANS	168510	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
190176	Fee-for-Service	1346557139	1346557139	1	1	DEFTOS, MICHAEL L MD	6/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98387	22	Pathology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
190248	Fee-for-Service	1730365149	1730365149	1	1	DE HIGES, APRIL LMFT	1/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	28494 WESTINGHOUSE PL	SUITE 213	VALENCIA	CA	91355	0930	19	06037	34.44221561	-118.5989564	Los Angeles County
190268	Fee-for-Service	1912903717	1912903717	1	1	DOMINION DIAGNOSTICS LLC	9/21/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	211 CIRCUIT DRIVE	None	NORTH KINGSTOWN	RI	02852	7440	00	None	41.58733655	-71.4317022	Washington County
190295	Fee-for-Service	1164556445	1164556445	1	1	DELOS REYES, MA CRISTINA V P	8/26/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	T	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
190338	Fee-for-Service	1982708384	1982708384	1	1	DANDAN, IMAD S MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45893	89	Surgery-Traumatic	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
190363	Fee-for-Service	1609307180	1609307180	1	1	DHATT, NAVDEEP K DPM	9/3/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
190421	Fee-for-Service	1831777663	1831777663	1	1	DERCON, SAM MD	3/24/2025	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 MARCELA DR	None	WILLITS	CA	95490	5769	23	06045	39.3901086	-123.339055	Mendocino County
190427	Fee-for-Service	1225062052	1225062052	1	1	DANGARAN, KAROL D MD	7/1/1995	207N00000X	NA	Dermatology	026	PHYSICIANS	73555	07	Dermatology	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
190430	Fee-for-Service	1760404859	1760404859	1	1	DUMARS, SEAN M MD	11/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80282	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
190438	Fee-for-Service	1801988431	1801988431	1	1	DINER, RALPH G	1/7/2016	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16944 VENTURA BLVD	STE .10	ENCINO	CA	91311	4590	19	06037	34.15959142	-118.5027242	Los Angeles County
190442	Fee-for-Service	1235357757	1235357757	1	1	DANFORTH, MARK R DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	8854	05	Anesthesiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
190458	Fee-for-Service	1801134994	1801134994	1	1	DE LEON, SCARLETTE M NP	6/30/2022	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
190473	Fee-for-Service	1033446125	1033446125	1	1	DELOREFICE, GUY MD INC	6/16/2011	207R00000X	NA	Other	026	PHYSICIANS	68918	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4806	49	06097	38.443806	-122.701374	Sonoma County
190501	Fee-for-Service	1043321581	1043321581	1	1	DE JESUS PEREZ, VINICIO	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87460	None	None	0	In state provider	A MD	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
190533	Fee-for-Service	1548279599	1548279599	1	1	DEV, ANIL K MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77543	10	Gastroenterology (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
190534	Fee-for-Service	1750566261	1750566261	1	1	DANIELS, STEVEN J CRNA	7/29/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
190538	Fee-for-Service	1972967511	1972967511	1	1	DHANABALAN, LAKSHMI NIRANJAN	7/22/2019	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	161193	40	Pediatrics	0	In state provider	A MD	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
190548	Fee-for-Service	1386673598	1386673598	1	1	DAUBERT, JANELINE T MD	8/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52360	45	Nephrology (Renal-Kidney)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
190586	Fee-for-Service	1669631990	1669631990	1	1	DURAWA, CRYSTAL L	12/30/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
190609	Fee-for-Service	1518650639	1518650639	1	1	DIETZ, MORGAN	6/2/2023	174400000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	04	06007	0	0	None
190627	Fee-for-Service	1982708384	1982708384	1	1	DANDAN, IMAD S MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	45893	02	General Surgery	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
190640	Fee-for-Service	1750332938	1750332938	1	1	DEMMAN, PHILLIP J MD	8/23/1995	207L00000X	NA	Other	026	PHYSICIANS	79058	05	Anesthesiology	0	In state provider	None	101 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3809	30	06059	33.89356031	-117.9271656	Orange County
190667	Fee-for-Service	1205027802	1205027802	1	1	DANESH, HOUMAN MD	9/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55057	41	Internal Medicine	0	In state provider	None	768 MOUNTAIN RANCH ROAD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
190681	Fee-for-Service	1962700187	1962700187	1	1	DE JESUS, EMERSON M MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126743	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
190772	Fee-for-Service	1285932137	1285932137	1	1	DUTTA, RAJA MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115189	36	Psychiatry	0	In state provider	None	2081 ARENA BLVD	SUITE 160	SACRAMENTO	CA	95835	2095	34	06067	38.647737	-121.510467	Sacramento County
190790	Fee-for-Service	1730132606	1730132606	1	1	DEMARANVILLE, DAISY N	9/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43886	36	Psychiatry	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
190793	Fee-for-Service	1033316997	1033316997	1	1	DAVID MELVILLE	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6644 E BAYWOOD AVE	None	MESA	AZ	85206	1747	00	None	33.411159	-111.688686	Maricopa County
190799	Fee-for-Service	1780224659	1780224659	1	1	DXTERITY DIAGNOSTICS, INC.	4/21/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	19500 S RANCHO WAY	STE 116	LOS ANGELES	CA	90220	6017	19	06037	33.85473288	-118.2198078	Los Angeles
190873	Fee-for-Service	1023079936	1023079936	1	1	DAVENPORT,ARTHUR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DRIVE	None	DAVIS	UT	84041	1142	00	None	41.091012	-111.995523	Davis
190928	Fee-for-Service	1356366876	1356366876	1	1	DINH, JACK MD	8/1/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	97273	None	None	0	In state provider	None	40404 CALIFORNIA OAKS RD	STE C	MURRIETA	CA	92562	5786	33	06065	33.57857707	-117.1998797	Riverside County
190948	Fee-for-Service	1316097439	1316097439	1	1	DUNCAN, THOMAS K. MD	6/30/1993	208600000X	NA	General Surgery	026	PHYSICIANS	6490	01	General Practice	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
190949	Fee-for-Service	1144386657	1144386657	1	1	DIAZ, KAREN E LMFT	8/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
190965	Fee-for-Service	1992747158	1992747158	1	1	DREW, WILLIAM L MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	11943	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
190987	Fee-for-Service	1679897219	1679897219	1	1	DEYO, MARY E PHD	3/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
190993	Fee-for-Service	1467516864	1467516864	1	1	DANG, CHRISTINA J CRNA	6/5/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
191033	Fee-for-Service	1295951887	1295951887	1	1	DAVIS, RICHARD EUGENE	2/23/2005	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2571 FULTON SQUARE LN	APT 64	SACRAMENTO	CA	95821	2388	34	06067	38.625111	-121.402494	Sacramento County
191061	Fee-for-Service	1831202233	1831202233	1	1	DAVID, MARIE P MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77541	None	None	0	In state provider	None	2644 M ST	STE H	MERCED	CA	95340	2826	24	06047	37.31137227	-120.4794155	Merced County
191130	Fee-for-Service	1053819508	1053819508	1	1	DOWNTOWN MEDICAL CENTER INC	10/14/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2252 BEVERLY BLVD	STE 102	LOS ANGELES	CA	90057	2246	19	06037	34.06771646	-118.2728448	Los Angeles County
191144	Fee-for-Service	1003103482	1003103482	1	1	DREBY, TIMOTHY C LMFT	12/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
191151	Fee-for-Service	1447303268	1447303268	1	1	DUNFORD, GREG MD	4/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34606	08	Family Practice	0	In state provider	None	1200 SMITH ST	None	KINGSBURG	CA	93631	2216	10	06019	36.51294219	-119.54905	Fresno County
191170	Fee-for-Service	1467807958	1467807958	1	1	DEMAJH, AUBREY MD	8/20/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	152845	36	Psychiatry	0	In state provider	None	1067 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3459	09	06017	38.91384447	-119.9985861	El Dorado County
191185	Fee-for-Service	1821050253	1821050253	1	1	DEMAR, MARK A MD	9/16/2022	208600000X	NA	General Surgery	026	PHYSICIANS	155557	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
191202	Fee-for-Service	1487099628	1487099628	1	1	DANG, ALLEN K MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134085	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
191215	Fee-for-Service	1457610354	1457610354	1	1	D'ANTONI, STEVEN D LMFT	8/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99345	-	NOT APPLICABLE	0	In state provider	None	514 W PACIFIC COAST HWY	None	LONG BEACH	CA	90806	5237	19	06037	33.78983955	-118.1985075	Los Angeles County
191254	Fee-for-Service	1992747158	1992747158	1	1	DREW, WILLIAM L MD	3/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	11943	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
191262	Fee-for-Service	1700811940	1700811940	1	1	DENNIS POPEO,MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
191295	Fee-for-Service	1942319959	1942319959	1	1	DORROS, STEPHEN M MD	5/31/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	29061	30	Radiology	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
191300	Fee-for-Service	1598151771	1598151771	1	1	DOMBROVSKY, INESSA DO	8/15/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14942	09	Gynecology (D.O. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
191307	Fee-for-Service	1346244373	1346244373	1	1	DAVARI, SHAHRYAR MD	8/19/2014	207R00000X	NA	Other	026	PHYSICIANS	76725	41	Internal Medicine	0	In state provider	None	1375 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3382	49	06097	38.627145	-122.863779	Sonoma County
191313	Fee-for-Service	1518442433	1518442433	1	1	DALRYMPLE, HOPE E CCC-SLP	9/17/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25102 JEFFERSON AVE	SUITE D	MURRIETA	CA	92562	1708	33	06065	33.55467403	-117.2033542	Riverside County
191321	Fee-for-Service	1295951887	1295951887	1	1	DAVIS, RICHARD EUGENE	2/23/2005	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2571 FULTON SQUARE LN	APT 64	SACRAMENTO	CA	95821	2388	34	06067	38.625111	-121.402494	Sacramento County
191344	Fee-for-Service	1851168942	1851168942	1	1	DESAI, SHIVANI PHD	1/22/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1359 PARK AVE	None	ALAMEDA	CA	94501	4511	01	06001	37.76329307	-122.2420565	Alameda County
191369	Fee-for-Service	1902331028	1902331028	1	1	DIN, PETER J	7/19/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19428	None	None	0	In state provider	None	4617 FREEPORT BLVD	SUITE F	SACRAMENTO	CA	95822	2015	34	06067	38.533311	-121.4939295	Sacramento County
191385	Fee-for-Service	1437711868	1437711868	1	1	DUGGAN, CASSANDRA R LCSW	8/17/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 HILLTOP MALL RD	STE 34	RICHMOND	CA	94806	1921	07	06013	37.9802423	-122.3244075	Contra Costa County
191441	Fee-for-Service	1912278003	1912278003	1	1	DEPT OF VETERANS AFFAIRS OF	4/18/2018	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THE STATE OF CALIFORNIA	11500 NIMITZ AVENUE	None	LOS ANGELES	CA	90049	3566	19	06037	34.05820203	-118.4637332	Los Angeles County
191544	Fee-for-Service	1952857773	1952857773	1	1	DEVAREDDY, SAI MD	6/19/2023	207R00000X	NA	Other	026	PHYSICIANS	186700	None	None	0	In state provider	None	420 BROADWAY STREET	None	REDWOOD CITY	CA	94063	3132	41	06081	37.48517644	-122.2022111	San Mateo County
191568	Fee-for-Service	1902981848	1902981848	1	1	DELINGER, JENNIFER R DC	12/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	DELINGER CHIROPRACT APC	1445 MARION ST	None	KINGSBURG	CA	93631	1928	10	06019	36.51423529	-119.5523323	Fresno County
191583	Fee-for-Service	1952713802	1952713802	1	1	DUBOIS, JACK P MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144508	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
191589	Fee-for-Service	1598151771	1598151771	1	1	DOMBROVSKY, INESSA DO	8/15/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14942	15	Obstetrics (D.O. only)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
191732	Fee-for-Service	1184966723	1184966723	1	1	DAVIS, NICHOLE R MD	4/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
191773	Fee-for-Service	1417040361	1417040361	2	1	D'SYLVA, YVONNE	8/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	770 MAGNOLIA BLVD	SUITE 2A	CORONA	CA	92879	3120	33	06065	33.85936872	-117.5534605	Riverside County
191799	Fee-for-Service	1184719148	1184719148	1	1	DIMAND, ROBERT J MD	11/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	40588	40	Pediatrics	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
191806	Fee-for-Service	1184941510	1184941510	1	1	DENNISON, TINA R MD	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129470	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
191843	Fee-for-Service	1629031968	1629031968	1	1	DOAN, PHUONG-ANH T MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62766	01	General Practice	0	In state provider	None	3356 W BALL RD	STE 118	ANAHEIM	CA	92804	3727	30	06059	33.81726453	-118.007451	Orange County
191858	Fee-for-Service	1154586543	1154586543	1	1	DANG, MINH MD INC	4/16/2009	207ND0101X	NA	Dermatology	026	PHYSICIANS	61331	07	Dermatology	0	In state provider	None	6155 STONERIDGE RD	STE 150	PLEASANTON	CA	94588	3204	01	06001	37.69087593	-121.9093903	Alameda County
191877	Fee-for-Service	1104822022	1104822022	1	1	DENGERINK, WENDY S MD	10/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91504	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
191947	Fee-for-Service	1811109309	1811109309	1	1	DR. LARRAGOITI'S FOREVER EYE	3/23/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12777 VALLEY VIEW STREET	SUITE 111	GARDEN GROVE	CA	92845	2521	30	06059	33.77676705	-118.035289	Orange County
191951	Fee-for-Service	1861786873	1861786873	1	1	DEHKORDI, BEHRANG H MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138910	None	None	0	In state provider	None	207 WEST LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
192063	Fee-for-Service	1023275773	1023275773	1	1	DAFTARY, RAJESH K MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132765	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	RM1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
192102	Fee-for-Service	1467924159	1467924159	1	1	DOSHI, NAMRATA PHD	6/15/2020	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	220 SANSOME	400	SAN FRANCISCO	CA	94104	2321	38	06075	37.79250132	-122.4009823	San Francisco County
192110	Fee-for-Service	1346632189	1346632189	1	1	DP CARE, INC.	1/27/2020	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11321 STAGG ST	None	SUN VALLEY	CA	91352	4469	19	06037	34.21209846	-118.37763	Los Angeles County
192122	Fee-for-Service	1760624324	1760624324	1	1	DIANA PANG	3/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
192128	Fee-for-Service	1689037111	1689037111	1	1	DAPPEN, AMANDA K MD	7/9/2019	390200000X	NA	Other	026	PHYSICIANS	153414	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
192129	Fee-for-Service	1629031968	1629031968	1	1	DOAN, PHUONG-ANH T MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62766	41	Internal Medicine	0	In state provider	None	3356 W BALL RD	STE 118	ANAHEIM	CA	92804	3727	30	06059	33.81726453	-118.007451	Orange County
192169	Fee-for-Service	1427064088	1427064088	1	1	DANIELS, JAMES D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
192184	Fee-for-Service	1326397571	1326397571	1	1	DR ELLIOTT CAINE OPTOMETRY	6/12/2013	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5016 YORK BLVD	None	LOS ANGELES	CA	90042	1714	19	06037	34.12128894	-118.2062188	Los Angeles County
192204	Fee-for-Service	1841359502	1841359502	1	1	DOBERNE, DOROTHY B MD	1/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	27172	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
192221	Fee-for-Service	1447385232	1447385232	1	1	DORENBAUM, ALEJANDRO	6/24/1992	2080P0201X	NA	Neurology	026	PHYSICIANS	50904	03	Allergy	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
192222	Fee-for-Service	1023257656	1023257656	1	1	DOMINGUEZ, MARCELLE LCSW	12/15/2009	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	576 B STREET	STE 2G	SANTA ROSA	CA	95401	5269	49	06097	38.44377	-122.718393	Sonoma County
192235	Fee-for-Service	1396064408	1396064408	1	1	DE MESA, CHARLES J DO	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13238	25	Physical Medicine and Rehabilitation	0	In state provider	None	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
192274	Fee-for-Service	1336147602	1336147602	1	1	DENNIS KNAPIK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6215 NEW BALLAS RD	None	ST LOUIS	MO	63150	2852	00	None	38.67167729	-90.44320199	St. Louis County
192338	Fee-for-Service	1720027295	1720027295	1	1	DEGOFF, WILLIAM MD	1/1/1982	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42465	40	Pediatrics	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
192350	Fee-for-Service	1023275773	1023275773	1	1	DAFTARY, RAJESH K MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132765	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
192355	Fee-for-Service	1093276115	1093276115	1	1	DELGADO, ADAM DO	11/20/2024	208M00000X	NA	Other	026	PHYSICIANS	22723	02	General Surgery	0	In state provider	None	100 MISSION BLVD	STE 2600	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
192368	Fee-for-Service	1730139239	1730139239	1	1	DAVIDSON, DAN K MD	12/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	66190	08	Family Practice	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
192371	Fee-for-Service	1952126880	1952126880	1	1	DECARVALHO FRANCA, ALINE BI	3/27/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
192455	Fee-for-Service	1831628692	1831628692	1	1	DEL SUR PHARMACY	9/25/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16089 SAN DIEGUITO RD	STE H102	RANCHO SANTA FE	CA	92067	9227	37	06073	32.99076285	-117.1971546	San Diego County
192509	Fee-for-Service	1447385232	1447385232	1	1	DORENBAUM, ALEJANDRO	6/24/1992	2080P0201X	NA	Neurology	026	PHYSICIANS	50904	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	# M696	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
192525	Fee-for-Service	1396064408	1396064408	1	1	DE MESA, CHARLES J DO	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13238	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
192555	Fee-for-Service	1568899417	1568899417	1	1	DESERT MARRIAGE AND FAMILY C	4/3/2020	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	OUNSELING INC	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
192557	Fee-for-Service	1376527432	1376527432	1	1	DIETRICH R THOMAS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	CAREPOINT P.C	2550 S PARKER RD	STE 206	AURORA	CO	80014	1679	00	None	39.670515	-104.8642785	Arapahoe County
192576	Fee-for-Service	1013939008	1013939008	1	1	DUICK, MICHAEL G MD	5/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80423	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
192616	Fee-for-Service	1831232354	1831232354	1	1	DEVOLL, SANDRA KAY	3/11/2005	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	24 NEW DAWN CIR	None	CHICO	CA	95928	6811	04	06007	39.72288722	-121.794314	Butte County
192623	Fee-for-Service	1013379189	1013379189	1	1	DAMENTO, GENA MD	6/24/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	151234	None	None	0	In state provider	None	711 VAN NESS AVE	260	SAN FRANCISCO	CA	94102	3244	38	06075	37.78218473	-122.4208156	San Francisco County
192629	Fee-for-Service	1487034690	1487034690	1	1	DE GA, KRISTOPHER J MD	7/1/2022	390200000X	NA	Other	026	PHYSICIANS	159059	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
192678	Fee-for-Service	1942941836	1942941836	1	1	DUONG, HUY ALEX Q MD	4/30/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	188779	01	General Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
192684	Fee-for-Service	1063655546	1063655546	1	1	DIHEN, KRISZTINA LMFT	1/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
192692	Fee-for-Service	1831110386	1831110386	1	1	DEAN,CHRISTINE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN	None	PORTLAND	OR	97227	0000	00	None	45.54387841	-122.6696022	Multnomah County
192710	Fee-for-Service	1104915081	1104915081	1	1	DINH, JAMES D MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71332	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
192767	Fee-for-Service	1730613969	1730613969	1	1	DIDONATO, SWATI MD	4/27/2020	207R00000X	NA	Other	026	PHYSICIANS	156955	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
192816	Fee-for-Service	1790319325	1790319325	1	1	DANESE, JEFFREY W LPCC	10/25/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
192832	Fee-for-Service	1720196983	1720196983	1	1	DUSARA CORPORATION	11/13/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1329 W WALNUT HILL LN	STE 100	IRVING	TX	75038	3027	00	None	32.88510443	-96.97173394	Dallas County
192841	Fee-for-Service	1568899417	1568899417	1	1	DESERT MARRIAGE AND FAMILY C	4/16/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	OUNSELING INC	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
192881	Fee-for-Service	1619056561	1619056561	1	1	DIAZ FLORES, RAFAEL F MD	2/5/2020	208600000X	NA	General Surgery	026	PHYSICIANS	156787	02	General Surgery	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
192906	Fee-for-Service	1457768848	1457768848	1	2	DE LEON COUNTRY MAUREENS	9/23/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME LLC	3959 WALNUT AVE	None	CHINO	CA	91710	2148	36	06071	34.0260833	-117.7185914	San Bernardino County
192936	Fee-for-Service	1013220136	1013220136	1	1	DAVIS, SARAH J MD	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	133074	01	General Practice	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3326	04	06007	39.741948	-121.848921	Butte County
192945	Fee-for-Service	1255861456	1255861456	1	1	DUZIK, ASHLEY DO	7/1/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16724	None	None	0	In state provider	None	18607 VENTURA BLVD	102	TARZANA	CA	91356	4159	19	06037	34.16995274	-118.5388841	Los Angeles County
192970	Fee-for-Service	1033267976	1033267976	1	1	DRAKE, BETH L MD	2/18/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50529	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
192977	Fee-for-Service	1588767131	1588767131	1	1	DAVID, DONALD SCOTT MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	66286	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
192996	Fee-for-Service	1104915081	1104915081	1	1	DINH, JAMES D MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71332	41	Internal Medicine	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
193032	Fee-for-Service	1699723379	1699723379	1	1	DAVERN, TIMOTHY MD	7/1/1994	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	79521	01	General Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
193051	Fee-for-Service	1568576080	1568576080	1	1	DIESFELD, PATRICK W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48770	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	110 W HARVARD BLVD	STE D	SANTA PAULA	CA	93060	3874	56	06111	34.34617726	-119.0723365	Ventura County
193116	Fee-for-Service	1497126932	1497126932	1	1	DILES, LEE G	5/11/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	52 MISSION CIRCLE	SUITE 203	SANTA ROSA	CA	95409	5369	49	06097	38.457882	-122.674104	Sonoma County
193127	Fee-for-Service	1346324720	1346324720	1	1	DE GUZMAN, LINO J MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	46594	10	Gastroenterology (M.D. only)	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
193131	Fee-for-Service	1568899417	1568899417	1	1	DESERT MARRIAGE AND FAMILY C	6/30/2022	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	OUNSELING INC	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
193186	Fee-for-Service	1609028893	1609028893	1	1	DASHTI, AZADEH MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114046	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
193212	Fee-for-Service	1013481969	1013481969	1	1	DELLEN, ALICIA R CRNA	8/28/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
193235	Fee-for-Service	1881764868	1881764868	1	1	DR. ROSANNE LINDA BOSCH M.D.	9/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1205 S GRANGE AVE	None	SIOUX FALLS	SD	57105	0410	00	None	43.534575	-96.742845	Minnehaha County
193258	Fee-for-Service	1871974071	1871974071	1	1	DOUGHERTY, COLTEN D DPM	7/5/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
193271	Fee-for-Service	1730383878	1730383878	1	1	DALAL, HUSENA H	8/1/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
193284	Fee-for-Service	1881712578	1881712578	1	1	DENIS J YOSHII, DO INC	12/27/2018	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	26750 TOWNE CENTRE DR	SUITE D	FOOTHILL RANCH	CA	92610	2841	30	06059	33.67417453	-117.6625787	Orange County
193321	Fee-for-Service	1023235819	1023235819	1	1	DE LUNA, MIRANDA F MD	1/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	119274	08	Family Practice	0	In state provider	None	27522 ANTONIO PKWY	P3	LADERA RANCH	CA	92694	2166	30	06059	33.56343335	-117.6292292	Orange County
193343	Fee-for-Service	1992751937	1992751937	2	1	DUGGAL, ARUN MD	3/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	42295	08	Family Practice	0	In state provider	None	1401 SPANOS COURT	SUITE 205	MODESTO	CA	95355	2813	50	06099	37.66975543	-120.9724048	Stanislaus County
193373	Fee-for-Service	1922012830	1922012830	1	1	DAVID WARE BRANCH	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5121 S COTTONWOOD ST	None	MURRAY	UT	84107	5701	00	None	40.659588	-111.891798	Salt Lake County
193392	Fee-for-Service	1518083856	1518083856	1	1	DAUER, LEONARD I MD INC	4/11/2017	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	15215 LEFFINGWELL RD	None	WHITTIER	CA	90604	2254	19	06037	33.92827161	-118.0059744	Los Angeles County
193408	Fee-for-Service	1912141367	1912141367	1	1	DASHKOFF, PETER B MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
193417	Fee-for-Service	1346324720	1346324720	1	1	DE GUZMAN, LINO J MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	46594	41	Internal Medicine	0	In state provider	None	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	36	06071	34.1268333	-117.2705634	San Bernardino County
193431	Fee-for-Service	1073730891	1073730891	1	1	DELLINGER, THANH H MD	6/5/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	10333	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
193435	Fee-for-Service	1659876878	1659876878	1	1	DESMOND, BRIAN S MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181648	None	None	0	In state provider	None	2621 10TH	None	BERKELEY	CA	94710	2674	01	06001	37.85811852	-122.2898175	Alameda County
193439	Fee-for-Service	1255358156	1255358156	1	1	DELIO, PHILIP R MD	3/1/1999	2084N0400X	NA	Neurology	026	PHYSICIANS	60966	13	Neurology (M.D. only)	0	In state provider	None	219 NOGALES AVE	STE F	SANTA BARBARA	CA	93105	3848	42	06083	34.43171016	-119.7220176	Santa Barbara County
193455	Fee-for-Service	1326062712	1326062712	1	1	DOSHI, PINAL J MD	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53826	01	General Practice	0	In state provider	None	16510 BLOOMFIELD AVE	None	CERRITOS	CA	90703	2115	19	06037	33.88108335	-118.0639087	Los Angeles County
193598	Fee-for-Service	1215391164	1215391164	1	1	DZIUBA, ADAM J MD	6/4/2022	207L00000X	NA	Other	026	PHYSICIANS	175251	None	None	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
193617	Fee-for-Service	1437213279	1437213279	1	5	DIENTES COMMUNITY DENTAL	7/5/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	100 PIONEER STREET	STE D	SANTA CRUZ	CA	95060	2181	44	06087	36.98787846	-122.0337559	Santa Cruz County
193628	Fee-for-Service	1790149078	1790149078	1	1	DANISH, CHARLES K DO	1/24/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1050 WEST GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
193633	Fee-for-Service	1063463875	1063463875	1	1	DUANE, DAWN C MD	9/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86982	79	Neurology-Child	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
193641	Fee-for-Service	1720079924	1720079924	1	1	DARMAWAN, STEVE MD	4/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85492	None	None	0	In state provider	None	505 E ROMIE LN	ST K	SALINAS	CA	93901	4018	27	06053	36.65998191	-121.6461895	Monterey County
193656	Fee-for-Service	1588202378	1588202378	1	1	DSI APPLE VALLEY HOME	1/20/2021	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS LLC	17125 SILICA DR	STE 100	VICTORVILLE	CA	92395	7715	36	06071	34.47821037	-117.2884179	San Bernardino County
193657	Fee-for-Service	1043312291	1043312291	1	1	DE LUNA VLAHOS, MELANIE	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92363	36	Psychiatry	0	In state provider	H MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
193661	Fee-for-Service	1639582620	1639582620	1	1	DICARO, DANE D DO	10/25/2021	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	18066	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
193688	Fee-for-Service	1174044341	1174044341	1	1	DE BORJA, CELINA FRANCESCA	8/30/2019	2080S0010X	NA	Orthopedic Surgery	026	PHYSICIANS	162846	40	Pediatrics	0	In state provider	MD	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
193730	Fee-for-Service	1174571061	1174571061	1	1	DELIMA, PATRICIA MD	8/17/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76591	40	Pediatrics	0	In state provider	None	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
193731	Fee-for-Service	1093482143	1093482143	1	1	DANNY DUY VU, OD, INC.	8/8/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1540 W FOOTHILL BLVD	None	UPLAND	CA	91786	3653	36	06071	34.10688347	-117.6784002	San Bernardino County
193732	Fee-for-Service	1801859301	1801859301	1	1	DOANE, JERI A	1/31/1996	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	450 N BEDFORD DRIVE	STE 312	BEVERLY HILLS	CA	90210	4307	19	06037	34.06885525	-118.4059408	Los Angeles County
193734	Fee-for-Service	1306160882	1306160882	1	1	DAY, LINDSAY M MD	6/17/2022	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
193743	Fee-for-Service	1326062712	1326062712	1	1	DOSHI, PINAL J MD	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53826	41	Internal Medicine	0	In state provider	None	16510 BLOOMFIELD AVE	None	CERRITOS	CA	90703	2115	19	06037	33.88108335	-118.0639087	Los Angeles County
193754	Fee-for-Service	1154078186	1154078186	1	1	DIRECTO, CHERYL GRACE S	5/15/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
193759	Fee-for-Service	1003424987	1003424987	1	1	DEPENDABLE HOSPICE SERVICES	9/15/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	333 N SANTA ANITA AVE	STE 10	ARCADIA	CA	91006	2839	19	06037	34.14447	-118.031608	Los Angeles County
193778	Fee-for-Service	1366541849	1366541849	1	1	DORSEY-TYLER, KEVIN R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50630	02	General Surgery	0	In state provider	None	2 GOVERNORS LN	STE A	CHICO	CA	95926	1988	04	06007	39.75567003	-121.8588553	Butte County
193849	Fee-for-Service	1710963038	1710963038	1	1	DHILLON, MANPRIT K MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75869	14	Neurological Surgery	0	In state provider	None	44902 10TH ST W	None	LANCASTER	CA	93534	2314	19	06037	34.699158	-118.148051	Los Angeles County
193870	Fee-for-Service	1790851962	1790851962	1	1	DARIUSH GHAFFARI MD	4/3/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	714 LINCOLN ST NE	None	LE MARS	IA	51031	3311	00	None	42.79704846	-96.15637684	Plymouth County
193876	Fee-for-Service	1922658160	1922658160	1	1	DREYER, NAOMI CCC-SLP	7/12/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
193904	Fee-for-Service	1437213279	1437213279	1	5	DIENTES COMMUNITY DENTAL	7/5/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	100 PIONEER STREET	STE D	SANTA CRUZ	CA	95060	2181	44	06087	36.98787846	-122.0337559	Santa Cruz County
193907	Fee-for-Service	1356544407	1356544407	1	1	DHINGSA, JASKARAN S MD	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	109958	01	General Practice	0	In state provider	None	11420 WARNER AVENUE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
193930	Fee-for-Service	1083971881	1083971881	1	14	DIGNITY HEALTH MEDICAL FOUND	7/21/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	-BAKERSFIELD INC.	3838 SAN DIMAS ST	STE A 100	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
194002	Fee-for-Service	1306677612	1306677612	1	1	DURLEY, KRISTIN BIRTH DOULA	4/7/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
194015	Fee-for-Service	1730406901	1730406901	1	1	DISBROW, DAVID E MD	8/2/2019	208C00000X	NA	General Surgery	026	PHYSICIANS	148973	02	General Surgery	0	In state provider	None	6121 N THESTA ST	202	FRESNO	CA	93710	8603	10	06019	36.82493955	-119.783139	Fresno County
194016	Fee-for-Service	1396057477	1396057477	1	1	DANG, PHUC MD	3/12/2020	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	117592	20	Orthopedic Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
194020	Fee-for-Service	1275630568	1275630568	1	1	DUDZIAK, DONNA E MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87866	02	General Surgery	0	In state provider	None	591 N 13TH AVE	STE 6	UPLAND	CA	91786	4968	36	06071	34.10081218	-117.6336095	San Bernardino County
194029	Fee-for-Service	1861523029	1861523029	1	1	DAVIS, ROBERT A MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	23265	07	Dermatology	0	In state provider	1100 TRANCAS STREET	PO BOX 2099	None	NAPA	CA	94558	0689	28	06055	0	0	None
194042	Fee-for-Service	1043282338	1043282338	1	1	DYERSBURG HOSPITAL COMPANY	8/18/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	400 E TICKLE STREET	None	DYERSBURG	TN	38024	3120	00	None	36.04738153	-89.379891	Dyer County
194047	Fee-for-Service	1003424987	1003424987	1	1	DEPENDABLE HOSPICE SERVICES	9/15/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	333 N SANTA ANITA AVE	STE 10	ARCADIA	CA	91006	2839	19	06037	34.14447	-118.031608	Los Angeles County
194106	Fee-for-Service	1518129790	1518129790	1	1	DESISTA, ANNA LEE MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125761	08	Family Practice	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
194111	Fee-for-Service	1154555829	1154555829	1	1	DYKES, JOHN C MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135658	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
194117	Fee-for-Service	1992131734	1992131734	1	1	DIGNITY HEALTH	12/13/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	7300 N 99TH AVENUE	None	GLENDALE	AZ	85305	3003	00	None	33.54200707	-112.2725616	Maricopa County
194121	Fee-for-Service	1922460609	1922460609	1	1	DIXIT, ANJALI A MD	7/2/2021	207LP3000X	NA	Other	026	PHYSICIANS	151999	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
194143	Fee-for-Service	1588818561	1588818561	1	1	DUGAS, MARIBEL M LCSW	1/14/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17418 CHATSWORTH	201B	GRANADA HILLS	CA	91344	7624	19	06037	34.26482277	-118.5138395	Los Angeles County
194159	Fee-for-Service	1376950857	1376950857	1	1	DELATORE, JUSTIN P DO	6/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14654	08	Family Practice	0	In state provider	None	13193 CENTRAL AVE	STE 100	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
194166	Fee-for-Service	1952501926	1952501926	1	1	DONALDSON, NATHAN J DO	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
194178	Fee-for-Service	1114978210	1114978210	1	1	DALY, SHAWN P MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	86524	None	None	0	In state provider	None	121 SOTOYOME STREET	None	SANTA ROSA	CA	95405	4871	49	06097	38.44224	-122.70195	Sonoma County
194208	Fee-for-Service	1841466182	1841466182	1	1	DEMATTIA, LISA N PT	2/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25495 MEDICAL CENTER DR.	SUITE 304	MURRIETA	CA	92562	0000	33	06065	33.55804188	-117.1834064	Riverside County
194283	Fee-for-Service	1700989118	1700989118	1	1	DUTRA, DAVICD L DPM, INC	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	601 COURT ST	STE 103	JACKSON	CA	95642	2163	03	06005	38.35197656	-120.7705907	Amador County
194307	Fee-for-Service	1477759975	1477759975	1	1	DESAI, PRAKASH DO	10/21/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	8918	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
194314	Fee-for-Service	1447604343	1447604343	1	1	DANOVITCH, YAEL MD	3/18/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170050	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
194324	Fee-for-Service	1548680838	1548680838	1	1	DHARANEESWARAN, KIRUBA MD	4/10/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	167738	13	Neurology (M.D. only)	0	In state provider	None	1625 PINE STREET	SUITE 102	REDDING	CA	96001	1018	45	06089	40.58321511	-122.388937	Shasta County
194331	Fee-for-Service	1043282338	1043282338	1	1	DYERSBURG HOSPITAL COMPANY	8/18/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	400 E TICKLE STREET	None	DYERSBURG	TN	38024	3120	00	None	36.04738153	-89.379891	Dyer County
194335	Fee-for-Service	1689752289	1689752289	1	1	DUMMEL, ERIC R MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74337	01	General Practice	0	In state provider	PERMANENTE MEDICAL GROUP	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
194361	Fee-for-Service	1437213279	1437213279	1	1	DIENTES COMMUNITY DENTAL	11/1/2002	122300000X	NA	Dental Provider	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CARE	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	44	06087	36.98837145	-121.9802206	Santa Cruz County
194386	Fee-for-Service	1700803418	1700803418	1	66	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
194398	Fee-for-Service	1295042117	1295042117	1	1	DANIEL LERNER	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3424 KOSSUTH AVE	None	BROOKLYN	NY	10467	2410	00	None	40.880385	-73.8815355	Bronx County
194405	Fee-for-Service	1992131734	1992131734	1	1	DIGNITY HEALTH	12/13/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	7300 N 99TH AVENUE	None	GLENDALE	AZ	85305	3003	00	None	33.54200707	-112.2725616	Maricopa County
194420	Fee-for-Service	1518151794	1518151794	1	1	DELAW TRANSPORTATION INC	4/25/2007	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DELAW TRANSPORTATION INC	148 MAJESTIC AVE	None	SAN FRANCISCO	CA	94112	3022	38	06075	37.7161848	-122.4525592	San Francisco County
194451	Fee-for-Service	1386937977	1386937977	1	10	DIGNITY HEALTH MEDICAL FOUND	4/14/2017	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1700 N ROSE AVE	STE 280	OXNARD	CA	93030	7645	56	06111	34.21746	-119.155545	Ventura County
194454	Fee-for-Service	1952501926	1952501926	1	1	DONALDSON, NATHAN J DO	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
194458	Fee-for-Service	1922502343	1922502343	1	1	DOPP, MATTHEW MD	9/16/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164471	30	Radiology	0	In state provider	None	3883 AIRWAY DR	100	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
194474	Fee-for-Service	1851396576	1851396576	1	3	DESERT VALLEY HOSPITAL	4/6/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
194485	Fee-for-Service	1598278467	1598278467	1	1	DANIEL RANSON, LICENSED CLIN	1/31/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	D CONSULTING, INC.	386 W. LINE ST	None	BISHOP	CA	93514	1100	14	06027	37.36135856	-118.3979892	Inyo County
194486	Fee-for-Service	1518928886	1518928886	1	1	DESAI, ANISH BIPIN MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77785	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
194503	Fee-for-Service	1477709483	1477709483	1	1	DOMINGUEZ, SUSAN D PHD	11/5/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
194504	Fee-for-Service	1376185405	1376185405	1	1	DEW SENIOR HEALTH	12/30/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	201 N HOLLYWOOD WAY	STE 206	BURBANK	CA	91505	3477	19	06037	34.15437619	-118.3404595	Los Angeles County
194595	Fee-for-Service	1477759975	1477759975	1	1	DESAI, PRAKASH DO	10/21/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	8918	13	Neurology (M.D. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
194641	Fee-for-Service	1699279067	1699279067	1	1	DAHODWALA, AMMAR Q MD	10/13/2023	207R00000X	NA	Other	026	PHYSICIANS	166109	None	None	0	In state provider	None	8078 E SANTA ANA CANYON	None	ANAHEIM	CA	92808	1108	30	06059	33.86628	-117.750789	Orange County
194650	Fee-for-Service	1437213279	1437213279	1	1	DIENTES COMMUNITY DENTAL	11/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CARE	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	44	06087	36.98837145	-121.9802206	Santa Cruz County
194672	Fee-for-Service	1700803418	1700803418	1	66	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
194724	Fee-for-Service	1770538720	1770538720	1	1	DEBELEN-WILSON, CHRISTIN	7/7/2008	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	RN	4900 BROADWAY	None	SACRAMENTO	CA	95817	2207	34	06067	38.546091	-121.447305	Sacramento County
194772	Fee-for-Service	1598278467	1598278467	1	1	DANIEL RANSON, LICENSED CLIN	1/31/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	D CONSULTING, INC.	386 W. LINE ST	None	BISHOP	CA	93514	1100	14	06027	37.36135856	-118.3979892	Inyo County
194773	Fee-for-Service	1518928886	1518928886	1	1	DESAI, ANISH BIPIN MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77785	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
194790	Fee-for-Service	1376185405	1376185405	1	1	DEW SENIOR HEALTH	12/30/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	201 N HOLLYWOOD WAY	STE 206	BURBANK	CA	91505	3477	19	06037	34.15437619	-118.3404595	Los Angeles County
194791	Fee-for-Service	1174758585	1174758585	1	1	DUQUE SILVA, ALEXANDRA I MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116268	77	Infectious Disease	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
194800	Fee-for-Service	1619304417	1619304417	1	1	DAHLENBURG, TINA	6/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15235 BURBANK BLVD	STE A4	SHERMAN OAKS	CA	91411	3555	19	06037	34.17211848	-118.465128	Los Angeles County
194810	Fee-for-Service	1841879111	1841879111	1	1	DHALIWAL, JASNINDER MD	8/4/2024	207R00000X	NA	Other	026	PHYSICIANS	191283	41	Internal Medicine	0	In state provider	None	1690 BARTON RD	2ND FLOOR	REDLANDS	CA	92373	4229	36	06071	34.04836346	-117.2125293	San Bernardino County
194826	Fee-for-Service	1922241843	1922241843	1	1	DOCTOR'S MANAGED EMERGENCY M	10/14/2017	2279E0002X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	EDICAL GROUP	150 WEST ROUTE 66	None	GLENDORA	CA	91740	6207	19	06037	34.12866152	-117.86535	Los Angeles County
194876	Fee-for-Service	1740712397	1740712397	1	1	DR ANDREW SUMIDA	11/27/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI ST	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
194878	Fee-for-Service	1790171072	1790171072	1	1	DI FIORE, MICHELLE J MD	5/23/2018	390200000X	NA	Other	026	PHYSICIANS	149040	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
194882	Fee-for-Service	1386937977	1386937977	1	6	DIGNITY HEALTH MEDICAL FOUND	1/9/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	943 WEST 7TH STREET	None	OXNARD	CA	93030	6756	56	06111	34.19517346	-119.189297	Ventura County
194887	Fee-for-Service	1891737219	1891737219	1	1	DYES, MARY KAY MD	1/19/1994	2084N0400X	NA	Neurology	026	PHYSICIANS	43176	79	Neurology-Child	0	In state provider	None	2650 ELM AVE	STE 101	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
194899	Fee-for-Service	1558464057	1558464057	1	1	DONAHUE, CLEMENT MD	10/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	81252	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
194926	Fee-for-Service	1023201522	1023201522	1	1	DISIBIO, GUY L MD	1/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	89904	22	Pathology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
194928	Fee-for-Service	1700482452	1700482452	1	1	DELEON, KATHERINE M NP	1/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	33	06065	33.55740114	-117.2157733	Riverside County
194936	Fee-for-Service	1386937977	1386937977	1	8	DIGNITY HEALTH MEDICAL FOUND	9/1/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1700 N ROSE AVE	STE 220	OXNARD	CA	93030	7640	56	06111	34.21746	-119.155545	Ventura County
194954	Fee-for-Service	1174592646	1174592646	1	1	DEA, MARC D OD	7/1/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39355 CALIFORNIA ST	STE 103	FREMONT	CA	94538	1447	01	06001	37.54733091	-121.9819574	Alameda County
194959	Fee-for-Service	1700803418	1700803418	1	23	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1635 CREEKSIDE DR	STE 100	FOLSOM	CA	95630	3830	34	06067	38.6712	-121.1467005	Sacramento County
194977	Fee-for-Service	1174944029	1174944029	1	1	DALY, EMILY M MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127696	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
194996	Fee-for-Service	1417453432	1417453432	1	1	DEPORRE, DANIEL J MD	4/24/2023	207R00000X	NA	Other	026	PHYSICIANS	185397	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195014	Fee-for-Service	1114365418	1114365418	1	1	DELONG, JONATHAN C MD	6/30/2021	208600000X	NA	General Surgery	026	PHYSICIANS	134525	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195043	Fee-for-Service	1023647138	1023647138	1	1	DASGUPTA, SHRUTI MD	9/16/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	191816	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
195046	Fee-for-Service	1386937977	1386937977	1	15	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
195054	Fee-for-Service	1295394591	1295394591	1	1	DUNN, KEELEY LMFT	1/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
195058	Fee-for-Service	1598278467	1598278467	1	1	DANIEL RANSON, LICENSED CLIN	1/31/2025	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	D CONSULTING, INC.	386 W. LINE ST	None	BISHOP	CA	93514	1100	14	06027	37.36135856	-118.3979892	Inyo County
195069	Fee-for-Service	1427365352	1427365352	1	1	DECKER, PAUL X MD	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125760	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
195077	Fee-for-Service	1649232729	1649232729	1	1	DUONG, THAO T MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	58995	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
195079	Fee-for-Service	1174758585	1174758585	1	1	DUQUE SILVA, ALEXANDRA I MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116268	40	Pediatrics	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
195096	Fee-for-Service	1205984739	1205984739	1	1	DORIO, RAYMOND J MD	10/29/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	29371	01	General Practice	0	In state provider	None	24237 MAIN ST	None	NEWHALL	CA	91321	2907	19	06037	34.37768435	-118.5271562	Los Angeles County
195116	Fee-for-Service	1841433653	1841433653	1	1	DO, LILY H DO	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10665	41	Internal Medicine	0	In state provider	None	17660 LAKEWOOD BLVD	None	BELLFLOWER	CA	90706	6410	19	06037	33.87138705	-118.142548	Los Angeles County
195129	Fee-for-Service	1215961966	1215961966	1	1	DORIAN, ARMAND H MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75918	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
195152	Fee-for-Service	1205463189	1205463189	1	1	DEVERA, JUSTIN MD	3/18/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	185044	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
195176	Fee-for-Service	1891737219	1891737219	1	1	DYES, MARY KAY MD	1/19/1994	2084N0400X	NA	Neurology	026	PHYSICIANS	43176	13	Neurology (M.D. only)	0	In state provider	None	2650 ELM AVE	STE 101	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
195213	Fee-for-Service	1992883540	1992883540	1	1	DESHADAREVIAN, JEAN J MD	7/22/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	33449	34	Urology and Urological Surgery	0	In state provider	None	1125 E 17TH ST	STE N252	SANTA ANA	CA	92701	2273	30	06059	33.76004145	-117.854838	Orange County
195226	Fee-for-Service	1114163805	1114163805	1	1	DICK, GARY F MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	34297	07	Dermatology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
195245	Fee-for-Service	1700803418	1700803418	1	66	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
195246	Fee-for-Service	1700808748	1700808748	1	1	DIABLO CARDIOLOGY	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP INC	1399 YGNACIO VALLEY RD	STE 11	WALNUT CREEK	CA	94598	2879	07	06013	37.91095214	-122.0468144	Contra Costa County
195265	Fee-for-Service	1568698447	1568698447	1	1	DICKEY, MELISSA A RN	2/19/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195290	Fee-for-Service	1184078222	1184078222	1	1	DANDEKAR, GIOVANNI N MD	9/16/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151545	36	Psychiatry	0	In state provider	None	420 BROADWAY STREET	None	REDWOOD CITY	CA	94063	3132	41	06081	37.48517644	-122.2022111	San Mateo County
195313	Fee-for-Service	1083753628	1083753628	1	1	DEMPSEY, MARQUITA S LMFT	2/14/2023	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8273 WHITE OAK AVE	B	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10329677	-117.5642466	San Bernardino County
195335	Fee-for-Service	1386937977	1386937977	1	15	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	168 N BRENT ST	STE 502	VENTURA	CA	93003	2840	56	06111	34.27448266	-119.2572489	Ventura County
195383	Fee-for-Service	1205984739	1205984739	1	1	DORIO, RAYMOND J MD	10/29/2018	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	29371	38	Geriatrics	0	In state provider	None	24237 MAIN ST	None	NEWHALL	CA	91321	2907	19	06037	34.37768435	-118.5271562	Los Angeles County
195407	Fee-for-Service	1477575447	1477575447	1	1	DEV, NIMRET K DO	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9207	08	Family Practice	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
195447	Fee-for-Service	1568881001	1568881001	1	1	DENG, HUIQIONG MD	2/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	154139	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195456	Fee-for-Service	1386937977	1386937977	1	19	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	1700 N ROSE AVE	STE 350	OXNARD	CA	93030	7627	56	06111	34.21746	-119.155545	Ventura County
195501	Fee-for-Service	1336499797	1336499797	1	1	DAYLIGHT HOME HEALTH	12/11/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1155 N CENTRAL AVENUE	SUITE 211	GLENDALE	CA	91202	2534	19	06037	34.16347353	-118.2569192	Los Angeles County
195515	Fee-for-Service	1770152100	1770152100	1	1	DIAZ, STEPHANIE N	5/31/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
195536	Fee-for-Service	1700803418	1700803418	1	66	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
195574	Fee-for-Service	1003286550	1003286550	1	1	DARAZI, MICHEL DO	2/12/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	16092	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
195623	Fee-for-Service	1013962224	1013962224	1	1	DHIMAN, DARSHAN K MD	5/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	43949	41	Internal Medicine	0	In state provider	None	1398 S STATE ST	STE E	SAN JACINTO	CA	92583	4923	33	06065	33.77367	-116.9719155	Riverside County
195632	Fee-for-Service	1952369399	1952369399	1	1	DONOVAN, JAMES W MD	12/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84806	18	Ophthalmology	0	In state provider	None	3325 PALO VERDE AVE	STE 103	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
195727	Fee-for-Service	1912128356	1912128356	1	1	DAVIS, GLEN P	12/9/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	175195	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
195735	Fee-for-Service	1871667576	1871667576	1	1	DUBOSE, JOSEPH J MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94889	89	Surgery-Traumatic	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
195743	Fee-for-Service	1386937977	1386937977	1	19	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	1700 N ROSE AVE	STE 350	OXNARD	CA	93030	7627	56	06111	34.21746	-119.155545	Ventura County
195794	Fee-for-Service	1578944161	1578944161	1	1	DESJARDINS, MARK P LCSW	1/2/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
195824	Fee-for-Service	1700803418	1700803418	1	23	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1635 CREEKSIDE DR	STE 100	FOLSOM	CA	95630	3830	34	06067	38.6712	-121.1467005	Sacramento County
195850	Fee-for-Service	1447456579	1447456579	1	1	DILTZ, MATTHEW V MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88315	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
195864	Fee-for-Service	1417074980	1417074980	1	1	DELEMUS, TATJANA MD	11/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6490 S MCCARRAN BLVD	#B13	RENO	NV	89509	6120	00	None	39.47672552	-119.796471	Washoe County
195893	Fee-for-Service	1932179199	1932179199	1	1	DURKOVICH, DAVID W DO	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9546	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
195939	Fee-for-Service	1275659989	1275659989	1	1	DALRYMPLE, ROBERT D MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
195957	Fee-for-Service	1902167273	1902167273	1	1	DUTTON STILLS, ALLISON	7/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5055 CANYON CREST DR	None	RIVERSIDE	CA	92507	6015	33	06065	33.95862536	-117.3310726	Riverside County
195985	Fee-for-Service	1639359771	1639359771	1	1	DOWNEY BREAST DIAGNOSTIC	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	37287	30	Radiology	0	In state provider	CLINIC INC	8301 FLORENCE AVE	STE 101	DOWNEY	CA	90240	3946	19	06037	33.95129816	-118.125377	Los Angeles County
195998	Fee-for-Service	1609223841	1609223841	1	1	DEBACKER, SILAS J DO	11/25/2021	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
196022	Fee-for-Service	1871667576	1871667576	1	1	DUBOSE, JOSEPH J MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	94889	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
196063	Fee-for-Service	1447338678	1447338678	1	1	DEVINE, SEAN D MD	1/7/1999	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	54300	20	Orthopedic Surgery	0	In state provider	None	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	40	06079	35.29243951	-120.668652	San Luis Obispo County
196098	Fee-for-Service	1316440142	1316440142	1	1	DAVIS, HANK C MD	7/8/2022	207R00000X	NA	Other	026	PHYSICIANS	163732	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
196112	Fee-for-Service	1700803418	1700803418	1	23	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1635 CREEKSIDE DR	STE 100	FOLSOM	CA	95630	3830	34	06067	38.6712	-121.1467005	Sacramento County
196120	Fee-for-Service	1073957239	1073957239	1	1	DAO MEDICAL GROUP INC	1/31/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	9191 WESTMINSTER AVE	SUITE 205	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
196145	Fee-for-Service	1932729068	1932729068	1	1	DIGNITY HOSPICE AND	8/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	14328 VICTORY BLVD	SUITE A	VAN NUYS	CA	91401	1989	19	06037	34.1866137	-118.4454117	Los Angeles County
196167	Fee-for-Service	1003056292	1003056292	2	1	DIRECT PROVIDER OF	11/21/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE SERVICES, INC	9320 BASELINE RD	SUITE B	RANCHO CUCAMONGA	CA	91701	5829	36	06071	34.12156453	-117.6018255	San Bernardino County
196192	Fee-for-Service	1629145586	1629145586	1	1	DUBEY, LON M MD	11/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67333	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
196236	Fee-for-Service	1447361415	1447361415	1	1	DRUCKER, ROBIN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69291	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
196284	Fee-for-Service	1982917274	1982917274	1	1	DAHLMAN, MOLLY R PHD	9/28/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
196295	Fee-for-Service	1922396514	1922396514	1	1	DEDHIA, MONICA S LCSW	1/23/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74476	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
196390	Fee-for-Service	1841726981	1841726981	1	1	DEMEHRI, YASAMAN MD	12/22/2020	207R00000X	NA	Other	026	PHYSICIANS	157294	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
196407	Fee-for-Service	1326502378	1326502378	1	1	DORSETT, ANA RCP	2/5/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
196408	Fee-for-Service	1073957239	1073957239	1	1	DAO MEDICAL GROUP INC	1/31/2014	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9191 WESTMINSTER AVE	SUITE 205	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
196412	Fee-for-Service	1700803418	1700803418	1	66	DIGNITY HEALTH MEDICAL FOUND	9/13/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	67	Endocrinology	0	In state provider	None	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	34	06067	38.679237	-121.298859	Sacramento County
196428	Fee-for-Service	1063558856	1063558856	1	1	DE JESUS, ELAINE M	2/7/2007	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2918 FIFTH AVE	STE 108	SAN DIEGO	CA	92103	5910	37	06073	32.735826	-117.1603565	San Diego County
196433	Fee-for-Service	1932729068	1932729068	1	1	DIGNITY HOSPICE AND	8/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	14328 VICTORY BLVD	SUITE A	VAN NUYS	CA	91401	1989	19	06037	34.1866137	-118.4454117	Los Angeles County
196443	Fee-for-Service	1033159264	1033159264	2	1	DAVITA-RIVERSIDE II, LLC	3/1/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1901 TOWN AND COUNTRY DR	STE 100	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
196477	Fee-for-Service	1720415375	1720415375	1	1	DONATO, AIMEE L PSYD	6/20/2019	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
196480	Fee-for-Service	1629145586	1629145586	1	1	DUBEY, LON M MD	11/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67333	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
196536	Fee-for-Service	1609538040	1609538040	1	1	DIZON, REGINA NP	11/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	473 CARNEGIE DR	STE 200	SAN BERNARDINO	CA	92408	4201	36	06071	34.06796019	-117.2749922	San Bernardino County
196561	Fee-for-Service	1205385408	1205385408	1	1	DAVID D SOHN MD APC	5/1/2017	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	SSIONAL CORPORATION	3663 W. 6TH ST	#106	LOS ANGELES	CA	90020	3047	19	06037	34.06360557	-118.30199	Los Angeles County
196603	Fee-for-Service	1881892628	1881892628	1	1	DE ROULET, TERESA LYNN W MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95044	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
196622	Fee-for-Service	1861634701	1861634701	1	1	DAWSON, DIANA L NP	2/16/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
196638	Fee-for-Service	1205883972	1205883972	1	1	DIVAKARUNI, MONICA S MD	6/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87860	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
196669	Fee-for-Service	1598910267	1598910267	1	1	DIZON, MARIA F MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101526	38	Geriatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
196673	Fee-for-Service	1598126856	1598126856	1	1	DA PAIXAO PASSOS WAIAN, VALD	10/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ERENE	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
196743	Fee-for-Service	1235207747	1235207747	1	1	DOMBROWSKI, ANNA M	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
196752	Fee-for-Service	1013922400	1013922400	1	1	DUFFORD, DONALD B	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3668 STANCE AVE	STE O	SOQUEL	CA	95073	2768	44	06087	36.99353653	-121.9469506	Santa Cruz County
196754	Fee-for-Service	1205399334	1205399334	1	1	DESERT WELLNESS PSYCHIATRY,	8/10/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	None	None	0	In state provider	INC	35800 BOB HOPE	SUITE 210	RANCHO MIRAGE	CA	92270	1707	33	06065	33.790527	-116.4058645	Riverside County
196768	Fee-for-Service	1922330083	1922330083	1	1	DAMMERT CORONADO, PEDRO M MD	8/9/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	176397	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
196831	Fee-for-Service	1437451291	1437451291	1	2	DEVOTED NURSES HOME HEALTH	2/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	15456 VENTURA BLVD	SUITE 203	SHERMAN OAKS	CA	91403	3020	19	06037	34.15453193	-118.4706426	Los Angeles County
196841	Fee-for-Service	1306190467	1306190467	1	1	DJ DIAGNOSTIC SERVICES INC	6/23/2014	335V00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	7345 TOPANGA CANYON BLVD	None	CANOGA PARK	CA	91303	1244	19	06037	34.20414	-118.6059855	Los Angeles County
196858	Fee-for-Service	1083971881	1083971881	1	9	DIGNITY HEALTH MEDICAL FOUND	4/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-BAKERSFIELD	3838 SAN DIMAS ST	B 231	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
196960	Fee-for-Service	1700803418	1700803418	1	6	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	8120 TIMBERLAKE WY	SUITE 102	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
197003	Fee-for-Service	1720395361	1720395361	1	1	DE LEEUW, KELLEY J MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114857	36	Psychiatry	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
197004	Fee-for-Service	1891915252	1891915252	1	1	DOYLE, JUDITH A MD	5/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86529	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
197009	Fee-for-Service	1295503944	1295503944	1	1	DUONG, JANET PT	3/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
197083	Fee-for-Service	1023217320	1023217320	1	1	DONNELLY, CHRISTOPHER T	12/31/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	89487	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
197106	Fee-for-Service	1871598631	1871598631	1	1	DOUGLAS BLANK	2/3/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
197147	Fee-for-Service	1083971881	1083971881	1	9	DIGNITY HEALTH MEDICAL FOUND	12/19/2019	261QM1300X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	-BAKERSFIELD	3838 SAN DIMAS ST	B 231	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
197161	Fee-for-Service	1821175118	1821175118	1	1	DEVARAJ, N R MD INC	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	34201	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3356 W BALL RD	STE 205	ANAHEIM	CA	92804	3728	30	06059	33.81726453	-118.007451	Orange County
197178	Fee-for-Service	1609951888	1609951888	1	1	DHAR, VIJAY MD	2/16/1993	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	51629	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
197179	Fee-for-Service	1386937977	1386937977	1	12	DIGNITY HEALTH MEDICAL FOUND	12/5/2017	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2486 N PONDEROSA DR	SUITE D205	CAMARILLO	CA	93010	2376	56	06111	34.24266768	-119.0228157	Ventura County
197211	Fee-for-Service	1811264807	1811264807	1	1	DOROUDINIA, ABTIN MD	7/1/2024	207U00000X	NA	Other	026	PHYSICIANS	122142	42	Nuclear Medicine	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
197246	Fee-for-Service	1700803418	1700803418	1	6	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	FOUNDATION	8120 TIMBERLAKE WY	SUITE 102	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
197289	Fee-for-Service	1669978862	1669978862	1	1	DONOHOE, BRIAN P MD	3/17/2021	207QS0010X	NA	Adult Primary Care	026	PHYSICIANS	165462	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
197305	Fee-for-Service	1275699332	1275699332	1	1	DOVE, ELAINE J PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	374 N COAST HIGHWAY 101	STE C	ENCINITAS	CA	92024	2542	37	06073	33.05593598	-117.2978358	San Diego County
197317	Fee-for-Service	1972529451	1972529451	1	1	DIABETES STORE INCORPORATED	3/22/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1760 MORIAH WOODS BLVD	SUITE 2	MEMPHIS	TN	38117	7128	00	None	35.08452623	-89.89615808	Shelby County
197318	Fee-for-Service	1538290580	1538290580	1	1	DAVIS, THERESE J LMFT	6/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4411 30TH ST	SUITE 101	SAN DIEGO	CA	92116	4286	37	06073	32.75749632	-117.1301434	San Diego County
197346	Fee-for-Service	1588239149	1588239149	1	1	DHARY, DEEPIKA K MD	8/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192371	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
197347	Fee-for-Service	1386794741	1386794741	2	1	DEVARAJAN, KAMAKSHI MD	12/21/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	55865	40	Pediatrics	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
197353	Fee-for-Service	1437820107	1437820107	1	1	DEAN, JEFFREY A PT	2/10/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
197382	Fee-for-Service	1669411435	1669411435	1	1	DRAGONE, LEONARD L MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65561	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
197389	Fee-for-Service	1316901663	1316901663	1	1	DAVE, GIATRI V MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69760	30	Radiology	0	In state provider	None	7887 N CEDAR AVE	None	FRESNO	CA	93720	2685	10	06019	36.850473	-119.756917	Fresno County
197409	Fee-for-Service	1740368836	1740368836	1	1	DAI, YAN MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71984	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
197420	Fee-for-Service	1285603621	1285603621	1	1	DOUGLAS, JERRY E MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53653	08	Family Practice	0	In state provider	None	15230 LAKESHORE DRIVE	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
197434	Fee-for-Service	1083971881	1083971881	1	9	DIGNITY HEALTH MEDICAL FOUND	4/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	-BAKERSFIELD	3838 SAN DIMAS ST	B 231	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
197438	Fee-for-Service	1558346692	1558346692	1	1	DREXL, ALLAN C OD	1/26/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14124 FOOTHILL BLVD	None	SYLMAR	CA	91342	8049	19	06037	34.31598785	-118.4413895	Los Angeles County
197439	Fee-for-Service	1518936616	1518936616	1	1	DAM, DINH X MD	12/23/2010	207R00000X	NA	Other	026	PHYSICIANS	77320	41	Internal Medicine	0	In state provider	None	200 N JACKSON AVE	STE C	SAN JOSE	CA	95116	1601	43	06085	37.36335224	-121.8481803	Santa Clara County
197453	Fee-for-Service	1821175118	1821175118	1	1	DEVARAJ, N R MD INC	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	34201	41	Internal Medicine	0	In state provider	None	3356 W BALL RD	STE 205	ANAHEIM	CA	92804	3728	30	06059	33.81726453	-118.007451	Orange County
197476	Fee-for-Service	1558009514	1558009514	1	1	DND PHARMACY INC	12/5/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	112 E MAIN STREET	None	CALIPATRIA	CA	92233	0001	13	06025	33.12576053	-115.513821	Imperial County
197491	Fee-for-Service	1942312939	1942312939	1	1	DOS PALOS DRUG INC	11/1/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PIONEER DRUG	1428 CENTER AVE	None	DOS PALOS	CA	93620	2320	24	06047	36.986193	-120.626646	Merced County
197538	Fee-for-Service	1700803418	1700803418	1	6	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	FOUNDATION	8120 TIMBERLAKE WY	SUITE 102	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
197558	Fee-for-Service	1457388720	1457388720	1	2	DICKSON, MATTHEW D MD	3/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	7945	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1628 PALM AVE	None	SAN DIEGO	CA	92154	1027	37	06073	32.58396546	-117.098649	San Diego County
197572	Fee-for-Service	1043501570	1043501570	1	1	DE TRINIDAD, ANA G LMFT	8/2/2021	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
197595	Fee-for-Service	1457412272	1457412272	1	1	DAUM, MELEEN	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
197643	Fee-for-Service	1700142189	1700142189	1	1	DUONG, HENG T MD	4/28/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	128595	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
197650	Fee-for-Service	1689625170	1689625170	1	1	DEBRUHL, NANETTE D MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66392	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
197667	Fee-for-Service	1851393078	1851393078	1	1	DOUGLAS MEHAFFIE M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	145 WALL BLVD	None	GRETNA	LA	70056	0000	00	None	29.88598871	-90.03123488	Jefferson Parish
197678	Fee-for-Service	1316901663	1316901663	1	1	DAVE, GIATRI V MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69760	78	Neoplastic Diseases/Oncology	0	In state provider	None	7887 N CEDAR AVE	None	FRESNO	CA	93720	2685	10	06019	36.850473	-119.756917	Fresno County
197683	Fee-for-Service	1295755080	1295755080	1	1	DANIELS, LORI B MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74503	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
197695	Fee-for-Service	1700911070	1700911070	1	1	DUGARD, MATTHEW A MD	2/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80912	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
197775	Fee-for-Service	1598726143	1598726143	1	1	DAVID EAKIN II	11/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2323 S HARVARD AVE	None	TULSA	OK	74114	3301	00	None	36.12785966	-95.93950506	Tulsa County
197792	Fee-for-Service	1780775007	1780775007	1	1	DAVID, MARIA A MD	12/10/2019	207R00000X	NA	Other	026	PHYSICIANS	162930	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
197823	Fee-for-Service	1700803418	1700803418	1	6	DIGNITY HEALTH MEDICAL FOUND	1/26/2022	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	8120 TIMBERLAKE WY	SUITE 102	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
197844	Fee-for-Service	1033505797	1033505797	1	1	DAVIS PHILLIPS, BENEECE J NP	1/26/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	331 S H ST	None	BAKERSFIELD	CA	93304	3403	15	06029	35.35053984	-119.0213687	Kern County
197903	Fee-for-Service	1942674304	1942674304	1	1	DATE PHARMACY INC	4/1/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39765 DATE STREET	SUITE 101	MURRIETA	CA	92563	2005	33	06065	33.54593179	-117.1538761	Riverside County
197928	Fee-for-Service	1093481780	1093481780	1	1	DINH, NAM H PT	11/19/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
197936	Fee-for-Service	1285211243	1285211243	1	1	DE LA TORRE, SERGIO A MD	4/9/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
197938	Fee-for-Service	1699741645	1699741645	1	1	DELANEY, PATRICK A MD	9/28/2000	2084N0400X	NA	Neurology	026	PHYSICIANS	85892	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
197945	Fee-for-Service	1689192288	1689192288	1	1	DOTTI, ALISON	3/14/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
198033	Fee-for-Service	1942836812	1942836812	1	1	DORNHOFER, KYLE C MD	7/6/2023	207P00000X	NA	Other	026	PHYSICIANS	177990	None	None	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
198046	Fee-for-Service	1538798236	1538798236	1	1	DORNBUSH, SEAN R DO	7/8/2024	390200000X	NA	Other	026	PHYSICIANS	22591	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
198093	Fee-for-Service	1609869767	1609869767	1	1	DILWORTH, HARRISON P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 E 28TH ST	None	MINNEAPOLIS	MN	55407	3723	00	None	44.95428	-93.2614155	Hennepin County
198103	Fee-for-Service	1578618575	1578618575	1	1	DOUGHTY, FRANCES M LMFT	4/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13201 SAN PABLO AVE	310	SAN PABLO	CA	94806	3952	07	06013	37.95165516	-122.3328786	Contra Costa County
198111	Fee-for-Service	1700803418	1700803418	1	6	DIGNITY HEALTH MEDICAL FOUND	2/9/2021	261QM1300X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION	8120 TIMBERLAKE WY	SUITE 102	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
198175	Fee-for-Service	1699777508	1699777508	1	3	DASHIELL, LINDA	3/11/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	230 HOSPITAL DR	STE A	UKIAH	CA	95482	4563	23	06045	39.15171639	-123.2035457	Mendocino County
198219	Fee-for-Service	1801447842	1801447842	1	1	DABE, DARIEN E LMFT	10/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
198225	Fee-for-Service	1699741645	1699741645	1	1	DELANEY, PATRICK A MD	9/28/2000	2084N0400X	NA	Neurology	026	PHYSICIANS	85892	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
198245	Fee-for-Service	1033472931	1033472931	1	1	DARKI, LEILA MD	7/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133280	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PEDRO STREET	SUITE 3000	LOS ANGELES	CA	90033	5310	19	06037	34.03018021	-118.2556983	Los Angeles County
198308	Fee-for-Service	1992120067	1992120067	1	1	DI PIERO, DANIELA M MFT	6/23/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	547 UREN ST	STE D	NEVADA CITY	CA	95959	2334	29	06057	39.26841435	-121.0124412	Nevada County
198426	Fee-for-Service	1194041319	1194041319	1	1	DEEN, HASHIM N MD	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123539	41	Internal Medicine	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
198443	Fee-for-Service	1639334485	1639334485	1	1	DOWHY, ROBERT J CCC-SP	9/15/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	19	06037	34.07361928	-118.3803143	Los Angeles County
198458	Fee-for-Service	1942603295	1942603295	1	1	DRUMMEY, LAUREN C CNP	2/11/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
198478	Fee-for-Service	1548365471	1548365471	1	1	DUENAS, ELIZABETH D MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64893	08	Family Practice	0	In state provider	None	21501 AVALON BLVD	None	CARSON	CA	90745	2222	19	06037	33.833421	-118.2637985	Los Angeles County
198484	Fee-for-Service	1083971881	1083971881	1	11	DIGNITY HEALTH MEDICAL FOUND	6/28/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-BAKERSFIELD	9500 STOCKDALE HWY	STE 103	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
198495	Fee-for-Service	1548422140	1548422140	1	1	DHESI, AMY S MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111610	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
198559	Fee-for-Service	1770541336	1770541336	1	1	DENAM, WILLIAM DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 E BROAD ST	None	MANSFIELD	TX	76063	5899	00	None	32.56919125	-97.09562468	Tarrant County
198576	Fee-for-Service	1750575734	1750575734	1	1	DEABREU-E-SILVA, PAULA C MD	7/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155371	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
198605	Fee-for-Service	1720175110	1720175110	1	1	DALTON, JOHN W JR MD	4/28/1999	207RP1001X	NA	Pulmonology	026	PHYSICIANS	30038	29	Pulmonary Diseases (M.D. only)	0	In state provider	SANTA MONICA HOSPITAL	1260 15TH ST	None	SANTA MONICA	CA	90404	1135	19	06037	34.02648965	-118.4867439	Los Angeles County
198640	Fee-for-Service	1285824540	1285824540	1	1	DAVI, ANJAHNI LCSW	9/29/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	47725	-	NOT APPLICABLE	0	In state provider	None	20094 MISSION BLVD	None	HAYWARD	CA	94541	1237	01	06001	37.68697869	-122.1024518	Alameda County
198663	Fee-for-Service	1386811925	1386811925	1	1	DYE, RICHELIN V PHD	11/19/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3420 KENYON ST	None	SAN DIEGO	CA	92110	5001	37	06073	32.74894593	-117.2139252	San Diego County
198671	Fee-for-Service	1942518469	1942518469	1	1	DAVIS, LAURENA C OT	12/6/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12411 SLAUSON AVE	STE H	WHITTIER	CA	90606	2835	19	06037	33.96028839	-118.0529975	Los Angeles County
198691	Fee-for-Service	1659715712	1659715712	1	1	DUVIELLA, ZAKIYA S LMFT	8/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
198708	Fee-for-Service	1336750991	1336750991	1	1	DORCAS WANJIKU WANJOHI	5/4/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14562 WILLOW LEAF RD	None	MORENO VALLEY	CA	92555	4758	33	06065	33.90924095	-117.1835715	Riverside County
198711	Fee-for-Service	1013908367	1013908367	1	1	DEL NORTE AMBULANCE, INC	4/1/1991	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2600 MOOREHEAD RD	None	CRESCENT CITY	CA	95531	7904	08	06015	41.86584156	-124.1507457	Del Norte County
198725	Fee-for-Service	1699830554	1699830554	1	1	DURANT, BILL	8/31/1989	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1835 S LA CIENEGA BLVD	None	LOS ANGELES	CA	90035	4600	19	06037	34.04410366	-118.3768223	Los Angeles County
198735	Fee-for-Service	1902326267	1902326267	1	1	DOUGHTEN, JOSEPH D MD	2/9/2023	207R00000X	NA	Other	026	PHYSICIANS	171114	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
198758	Fee-for-Service	1164183729	1164183729	1	1	DANIEL, MADONNA OD	2/14/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 N HARBOR BLVD	STE 101	FULLERTON	CA	92835	9283	30	06059	33.88408114	-117.9253959	Orange County
198759	Fee-for-Service	1871164855	1871164855	1	1	DR KIM ANH NGUYEN LLC	7/18/2024	208600000X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	5920 S RAINBOW BLVD	SUITE 5	LAS VEGAS	NV	89118	4209	00	None	36.08098821	-115.2426863	Clark County
198789	Fee-for-Service	1891840955	1891840955	1	1	DUBOSE, ANTHONY R MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	77593	41	Internal Medicine	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
198827	Fee-for-Service	1104194299	1104194299	1	1	DE SANTO, MICHELLE D DO	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	12005	01	General Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
198829	Fee-for-Service	1609800960	1609800960	1	1	DINH, MICHELLE P MD	6/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92662	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
198875	Fee-for-Service	1083818892	1083818892	1	1	DAMANI, NISHA R PT	10/18/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
198904	Fee-for-Service	1679139869	1679139869	1	1	DAIVA MARILYN MITCHELL	4/5/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 BOWER HILL RD	None	PITTSBURGH	PA	15243	1873	00	None	40.37744491	-80.06601413	Allegheny County
198950	Fee-for-Service	1518966506	1518966506	1	1	DUFF, STEVEN B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3555 OLENTANGY RIVER RD	None	COLUMBUS	OH	43214	3912	00	None	40.03214278	-83.03264797	Franklin County
198992	Fee-for-Service	1336750991	1336750991	1	1	DORCAS WANJIKU WANJOHI	5/4/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14562 WILLOW LEAF RD	None	MORENO VALLEY	CA	92555	4758	33	06065	33.90924095	-117.1835715	Riverside County
199084	Fee-for-Service	1003409905	1003409905	1	1	DEMPSEY, SARAH N PT	2/23/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
199106	Fee-for-Service	1275535700	1275535700	1	1	DUGE, WILLIAM D MD	4/30/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	40998	30	Radiology	0	In state provider	None	23961 CALLE DE LA MAGDAL	STE 217	LAGUNA HILLS	CA	92653	3600	30	06059	33.60999658	-117.7126577	Orange County
199120	Fee-for-Service	1336716679	1336716679	1	1	DUCETT, MITCHELL J DO	12/13/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23343	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
199136	Fee-for-Service	1740692466	1740692466	1	1	DIAZ, FRANK C MD	1/14/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	142932	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
199194	Fee-for-Service	1386937977	1386937977	1	18	DIGNITY HEALTH MEDICAL FOUND	6/4/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	400 E SANTA BARBARA ST	SUITE A	SANTA PAULA	CA	93060	2675	56	06111	34.35269772	-119.069955	Ventura County
199198	Fee-for-Service	1649238254	1649238254	1	1	DE LORIMIER, ARTHUR J MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137863	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
199276	Fee-for-Service	1124067731	1124067731	1	1	DEMARCO, VINCENT MD	1/1/1999	207L00000X	NA	Other	026	PHYSICIANS	67540	05	Anesthesiology	0	In state provider	None	CLAY & BUCHANAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
199308	Fee-for-Service	1578018792	1578018792	1	1	DAVID KERBOW	8/27/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60637	1443	00	None	41.788431	-87.60489252	Cook County
199311	Fee-for-Service	1881605038	1881605038	1	1	DEPAULO, PAUL S MD	5/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37155	66	Emergency Medicine (Urgent Care)	0	In state provider	None	869 CHERRY AVE	None	TULARE	CA	93274	0000	54	06107	36.220932	-119.337698	Tulare County
199364	Fee-for-Service	1336210376	1336210376	1	1	DONATH, JEFFREY R MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76984	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
199380	Fee-for-Service	1043415383	1043415383	1	1	DERMENDJIAN, DIANA DO	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9265	08	Family Practice	0	In state provider	None	607 S GLENOAKS BLVD	None	BURBANK	CA	91502	1424	19	06037	34.17950025	-118.3013539	Los Angeles County
199413	Fee-for-Service	1366488603	1366488603	1	1	DURAIRAJ, KALPNA K D MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56015	04	Otology, Laryngology, Rhinology	0	In state provider	None	1505 WILSON TER	STE 270	GLENDALE	CA	91206	4078	19	06037	34.14960934	-118.2313491	Los Angeles County
199431	Fee-for-Service	1225184963	1225184963	1	1	DIGNITY HEALTH	9/30/2001	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	124 S COLLEGE DRIVE	None	SANTA MARIA	CA	93454	5325	42	06083	34.951968	-120.4247835	Santa Barbara County
199495	Fee-for-Service	1467617480	1467617480	1	1	DR. IONEL C RAD M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1550 N 115TH ST	None	SEATTLE	WA	98133	8401	00	None	47.714643	-122.337108	King County
199496	Fee-for-Service	1952796260	1952796260	1	1	DENIWAR, AHMED MD	11/13/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	185844	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
199509	Fee-for-Service	1548793946	1548793946	1	1	DESPUJOS HARFOUCHE, FAIRUZ C	11/7/2019	390200000X	NA	Other	026	PHYSICIANS	157123	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
199529	Fee-for-Service	1386669372	1386669372	1	1	DEARING, MARK MD	8/1/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176431	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
199549	Fee-for-Service	1336533421	1336533421	1	1	DICKERSON, AMANDA K MD	10/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134580	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	95205	3043	33	06065	33.904782	-117.469323	Riverside County
199552	Fee-for-Service	1063475192	1063475192	1	1	DUCLOS, MARTIN A MD	7/11/2019	207R00000X	NA	Other	026	PHYSICIANS	162883	41	Internal Medicine	0	In state provider	None	6601 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
199584	Fee-for-Service	1861680944	1861680944	1	1	DECKER, KERRY A	6/17/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
199711	Fee-for-Service	1083846455	1083846455	1	1	DOYLE, DARIEL A PHD	8/15/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
199735	Fee-for-Service	1811212087	1811212087	1	1	DERALEAU, ERIKA L MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111714	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
199799	Fee-for-Service	1043656697	1043656697	1	1	DALAI, SUDEB MD	3/16/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	134059	77	Infectious Disease	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
199812	Fee-for-Service	1932333267	1932333267	1	1	DAVIS, TEELA A LMFT	6/6/2019	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41760 IVY STREET	SUITE 204	MURRIETA	CA	92562	0000	33	06065	33.55331844	-117.2081759	Riverside County
199822	Fee-for-Service	1780932236	1780932236	1	1	DALE, ALEXANDRIA P LMFT	9/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	35325 DATE PALM DRIVE	STE 122	CATHEDRAL CITY	CA	92234	7002	33	06065	33.79144444	-116.4581341	Riverside County
199850	Fee-for-Service	1447593207	1447593207	1	1	DEMOSS, DANIEL MD	10/4/2018	207RE0101X	NA	Endocrinology	026	PHYSICIANS	132298	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
199880	Fee-for-Service	1710167168	1710167168	1	1	DANIELS, CHARLES S MD	3/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94985	25	Physical Medicine and Rehabilitation	0	In state provider	None	44725 N 10TH ST W	STE 110	LANCASTER	CA	93534	3015	19	06037	34.695693	-118.1480965	Los Angeles County
199897	Fee-for-Service	1649257296	1649257296	1	1	DU, EMMA Z MD	3/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78015	22	Pathology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
199902	Fee-for-Service	1326154147	1326154147	1	1	DAVIS, MARK H MD	10/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	40838	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	ONE HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
199904	Fee-for-Service	1265688311	1265688311	1	1	DAVOUDPOUR, SIMONA DO	2/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	10113	None	None	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
199950	Fee-for-Service	1639633860	1639633860	1	1	DUASO, ANGELO A RCP	1/17/2022	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
199999	Fee-for-Service	1649619792	1649619792	1	2	DAVILA, BELEN	2/2/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	148569	-	NOT APPLICABLE	0	In state provider	None	25 E. THIRD STREET	None	CALEXICO	CA	92231	1889	13	06025	32.66779032	-115.4978211	Imperial County
200041	Fee-for-Service	1124043948	1124043948	1	1	DE MARIA ANTHONY NM	2/4/1974	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	20471	41	Internal Medicine	0	In state provider	UCD PROF SVC GRP	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
200054	Fee-for-Service	1154943041	1154943041	1	1	DIVINE HOSPICE SERVICES INC	1/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3535 CAHUENGA BLVD W	SUITE 204A	LOS ANGELES	CA	90068	1359	19	06037	34.13338191	-118.3569444	Los Angeles County
200055	Fee-for-Service	1407890429	1407890429	1	1	DELAPENA, WENDY L MD	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78894	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
200092	Fee-for-Service	1043389026	1043389026	1	1	DUSTIN, ADAM F	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	317 N EL CAMINO REAL	STE 407	ENCINITAS	CA	92024	2815	37	06073	33.05428107	-117.2615637	San Diego County
200096	Fee-for-Service	1235112962	1235112962	1	1	DODGE, JUSTIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
200100	Fee-for-Service	1174959639	1174959639	1	1	DANG, VAN T	1/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
200123	Fee-for-Service	1124129788	1124129788	1	1	DYM, JEFFREY M MD	8/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93960	None	None	0	In state provider	None	8700 BEVERLY BLVD	RM M335	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
200152	Fee-for-Service	1710525571	1710525571	1	1	DALLAL, NINA CCC-SP	5/1/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
200189	Fee-for-Service	1922162650	1922162650	1	1	DUFFY WATSON, CHRISTINE M PT	5/16/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
200240	Fee-for-Service	1215980560	1215980560	1	1	DHSC LLC	7/22/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	875 EIGHTH ST NE	None	MASSILLON	OH	44646	8503	00	None	40.80628633	-81.51597338	Stark County
200251	Fee-for-Service	1457841165	1457841165	1	1	DUENAS, STEVEN A PT	2/9/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
200299	Fee-for-Service	1538150164	1538150164	1	1	DANIEL LEVITAN MD INC	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	255 E ORANGE GROVE AVE	STE D	BURBANK	CA	91502	1240	19	06037	34.18236815	-118.3089281	Los Angeles County
200330	Fee-for-Service	1124043948	1124043948	1	1	DE MARIA ANTHONY NM	2/4/1974	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	20471	06	Cardiovascular Disease (M.D. only)	0	In state provider	UCD PROF SVC GRP	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
200343	Fee-for-Service	1154943041	1154943041	1	1	DIVINE HOSPICE SERVICES INC	1/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3535 CAHUENGA BLVD W	SUITE 204A	LOS ANGELES	CA	90068	1359	19	06037	34.13338191	-118.3569444	Los Angeles County
200368	Fee-for-Service	1487064564	1487064564	1	1	DAROUIAN, NAVID MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142395	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
200398	Fee-for-Service	1629137781	1629137781	1	1	DIGIORGIO, ANTHONY M DO	4/26/2019	390200000X	NA	Other	026	PHYSICIANS	16854	14	Neurological Surgery	0	In state provider	None	1001 POTRERO AVE	RM 4M39	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
200469	Fee-for-Service	1477052074	1477052074	1	1	DEWOLF, ALISON C CRNA	4/2/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
200501	Fee-for-Service	1730470337	1730470337	1	1	DAMIKOLAS, TIFFANY B MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123666	40	Pediatrics	0	In state provider	None	1201 W LA VETA	None	ORANGE	CA	92868	3835	30	06059	33.78034779	-117.8655767	Orange County
200518	Fee-for-Service	1629147897	1629147897	1	1	DESAI, TINA R MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135453	None	None	0	In state provider	None	300 PASTEUR DRIVE	-	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
200530	Fee-for-Service	1215980560	1215980560	1	1	DHSC LLC	7/22/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	875 EIGHTH ST NE	None	MASSILLON	OH	44646	8503	00	None	40.80628633	-81.51597338	Stark County
200533	Fee-for-Service	1255303905	1255303905	1	1	DUDLEY, LESLIE A MD	2/10/1995	207R00000X	NA	Other	026	PHYSICIANS	59598	41	Internal Medicine	0	In state provider	None	65 N MADISON AVE	STE 505	PASADENA	CA	91101	2048	19	06037	34.14705803	-118.1384317	Los Angeles County
200582	Fee-for-Service	1710039938	1710039938	1	1	DENIANKE, KWAME S MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	96920	07	Dermatology	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
200586	Fee-for-Service	1538150164	1538150164	1	1	DANIEL LEVITAN MD INC	5/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	255 E ORANGE GROVE AVE	STE D	BURBANK	CA	91502	1240	19	06037	34.18236815	-118.3089281	Los Angeles County
200601	Fee-for-Service	1164507356	1164507356	1	1	DATTA, NAND S MD	3/9/1973	208800000X	NA	Other	026	PHYSICIANS	25155	34	Urology and Urological Surgery	0	In state provider	None	3953 BOUTON DR	None	LAKEWOOD	CA	90712	3801	19	06037	33.83998337	-118.1456473	Los Angeles County
200605	Fee-for-Service	1508030651	1508030651	1	1	DEATHERAGE, LINDY S MD	2/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN ST	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
200608	Fee-for-Service	1134152028	1134152028	1	1	DAVIS, LELAND J MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	22940	40	Pediatrics	0	In state provider	None	1200 SONOMA AVE	None	SANTA ROSA	CA	95405	6664	49	06097	38.440854	-122.6985165	Sonoma County
200667	Fee-for-Service	1376998476	1376998476	1	1	DEVINE, WALTER P MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	103422	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200686	Fee-for-Service	1508889445	1508889445	1	1	DELIS, DEAN PHD	1/1/1991	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
200745	Fee-for-Service	1891720520	1891720520	1	1	DENG, JANE C MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92364	41	Internal Medicine	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
200820	Fee-for-Service	1659452720	1659452720	1	1	DUTTA, SANJEEV MD	5/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88168	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
200866	Fee-for-Service	1710039938	1710039938	1	1	DENIANKE, KWAME S MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	96920	22	Pathology (M.D. only)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
200871	Fee-for-Service	1891417275	1891417275	1	1	DEL MAR, MAIANA D PT	6/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
200935	Fee-for-Service	1003400458	1003400458	1	1	DEAN, MATTHEW LMFT	8/16/2024	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	911 21ST ST	208	PASO ROBLES	CA	93446	1722	40	06079	35.63623522	-120.6893646	San Luis Obispo County
200946	Fee-for-Service	1154908655	1154908655	1	1	DAVIDSON, TYLER M DO	8/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23333	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
200953	Fee-for-Service	1417953472	1417953472	1	1	DE ST JEOR, LARRY J MD	1/1/1996	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	25036	01	General Practice	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
200994	Fee-for-Service	1043273469	1043273469	1	1	DEVORE, JAMES C MD	9/20/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32000	08	Family Practice	0	In state provider	None	4750 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.442744	-122.6629485	Sonoma County
201017	Fee-for-Service	1053321612	1053321612	1	1	DUTARET, CLAUDINE G MD	11/30/1995	174400000X	NA	Other	026	PHYSICIANS	80357	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
201024	Fee-for-Service	1891720520	1891720520	1	1	DENG, JANE C MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92364	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MED PLAZA STE 365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
201141	Fee-for-Service	1033353594	1033353594	1	1	DUDA, JENNIFER L MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65649	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
201152	Fee-for-Service	1861754467	1861754467	1	1	DHUGGA, AMARDEEP S MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138089	41	Internal Medicine	0	In state provider	None	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
201191	Fee-for-Service	1790716884	1790716884	1	1	DAVIDSON, JOSEPH MD A	5/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86649	18	Ophthalmology	0	In state provider	None	301 N LAKE AVE	STE 110	PASADENA	CA	91101	5125	19	06037	34.15083203	-118.1324046	Los Angeles County
201216	Fee-for-Service	1932196649	1932196649	1	1	DAVIS, BONNIE J MD	5/24/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159789	None	None	0	In state provider	None	27720 JEFFERSON	SUITE 200	TEMECULA	CA	92590	2610	33	06065	33.51188961	-117.1586219	Riverside County
201234	Fee-for-Service	1487906038	1487906038	1	1	DECKER, ROBERT S LMFT	8/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
201235	Fee-for-Service	1154908655	1154908655	1	1	DAVIDSON, TYLER M DO	8/19/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	23333	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
201244	Fee-for-Service	1790930402	1790930402	1	1	DICHTER, GEORGE MD INC	3/2/2010	207R00000X	NA	Other	026	PHYSICIANS	40039	41	Internal Medicine	0	In state provider	None	2876 SYCAMORE DR	#101	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
201257	Fee-for-Service	1578655858	1578655858	1	1	DESERT MEDICAL GROUP	9/30/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF INDIO INC	255 N EL CIELO ROAD	STE C-308	PALM SPRINGS	CA	92262	6972	33	06065	33.82571219	-116.5106736	Riverside County
201295	Fee-for-Service	1104969815	1104969815	1	1	DUENAS, FRANCISCA I LMFT	11/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	673 S AUBURN ST	A,B,C,D	GRASS VALLEY	CA	95945	7576	29	06057	39.2060146	-121.0613316	Nevada County
201319	Fee-for-Service	1528005378	1528005378	1	1	DAUBERT, GLENN P MD	7/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52359	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
201338	Fee-for-Service	1013987718	1013987718	1	1	DHILLION, SAMJOT S MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149240	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
201409	Fee-for-Service	1679640437	1679640437	1	1	DEROBERTIS, CORRY L CRNA	4/5/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
201430	Fee-for-Service	1033353594	1033353594	1	1	DUDA, JENNIFER L MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65649	68	Hematology	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
201464	Fee-for-Service	1689635328	1689635328	1	1	DUFFY, MICHAEL T MD	12/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	59599	41	Internal Medicine	0	In state provider	None	9400 BRIGHTON WAY	STE 201	BEVERLY HILLS	CA	90210	4709	19	06037	34.07043476	-118.4011952	Los Angeles County
201492	Fee-for-Service	1902959307	1902959307	1	1	DANESHRAD, PAYAM MD	11/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71327	04	Otology, Laryngology, Rhinology	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
201497	Fee-for-Service	1568884922	1568884922	1	1	DERBY-TALBOT, TOBYN CRNA	9/26/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
201578	Fee-for-Service	1821133513	1821133513	1	1	D'ABLAING, DAVID P MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	58172	05	Anesthesiology	0	In state provider	None	601 E MICHELTORENA ST	None	SANTA BARBARA	CA	93103	2216	42	06083	34.43292239	-119.701137	Santa Barbara County
201625	Fee-for-Service	1790125771	1790125771	1	1	DAI, YUE	7/2/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
201714	Fee-for-Service	1780057521	1780057521	1	1	DHHS IHS CAO DESERT SAGE	6/17/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	YOUTH WELLNESS CENTER	39990 FAURE RD	None	HEMET	CA	92544	9408	33	06065	33.54540303	-116.8982524	Riverside County
201719	Fee-for-Service	1033353594	1033353594	1	1	DUDA, JENNIFER L MD	12/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65649	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
201778	Fee-for-Service	1043888274	1043888274	1	1	DANG, VARUN MD	9/11/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
201790	Fee-for-Service	1851554422	1851554422	1	1	DISSTON, ALEXANDER R MD	11/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91797	20	Orthopedic Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
201800	Fee-for-Service	1386153542	1386153542	1	1	DIAKITE, FATIMATA	10/4/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11113 CLEMENTINE WAY	None	LOMA LINDA	CA	92354	6124	36	06071	34.054218	-117.2268344	San Bernardino County
201868	Fee-for-Service	1851914220	1851914220	1	1	DISTEFANO, KIMBERLY A	9/4/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
201978	Fee-for-Service	1477582872	1477582872	1	1	DICKINSON, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3355 RIVERBEND DR	STE 300	SPRINGFIELD	OR	97477	8800	00	None	44.08239413	-123.0281717	Lane County
202002	Fee-for-Service	1780057521	1780057521	1	1	DHHS IHS CAO DESERT SAGE	6/17/2016	3245S0500X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	YOUTH WELLNESS CENTER	39990 FAURE RD	None	HEMET	CA	92544	9408	33	06065	33.54540303	-116.8982524	Riverside County
202020	Fee-for-Service	1386221588	1386221588	1	1	DHALIWAL, GURJAP MD	1/1/2025	208M00000X	NA	Other	026	PHYSICIANS	191738	41	Internal Medicine	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
202056	Fee-for-Service	1467523357	1467523357	1	1	DANG, TRUNG HUEY HUU MD	11/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81675	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
202063	Fee-for-Service	1043888274	1043888274	1	1	DANG, VARUN MD	9/11/2024	207R00000X	NA	Other	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
202067	Fee-for-Service	1396232716	1396232716	1	1	DAVIS, MARILYN D LMFT	8/31/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9033 BASELINE RD	STE A	UPLAND	CA	91730	1214	36	06071	34.12151248	-117.6080805	San Bernardino County
202089	Fee-for-Service	1386153542	1386153542	1	1	DIAKITE, FATIMATA	10/4/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11113 CLEMENTINE WAY	None	LOMA LINDA	CA	92354	6124	36	06071	34.054218	-117.2268344	San Bernardino County
202127	Fee-for-Service	1689214173	1689214173	1	1	DIGNIFIED HOSPICE CARE	9/14/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1700 HAMNER AVE	SUITE 212	NORCO	CA	92860	2963	33	06065	33.90719003	-117.5615198	Riverside County
202133	Fee-for-Service	1225031388	1225031388	1	1	DUNBAR-GALLES, ARATI M MD	7/2/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83942	20	Orthopedic Surgery	0	In state provider	None	2900 WHIPPLE AVE	STE 210	REDWOOD CITY	CA	94062	2843	41	06081	37.4783072	-122.2551089	San Mateo County
202136	Fee-for-Service	1194846345	1194846345	1	1	DONOHOO, JAY H MD	10/16/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	141000	30	Radiology	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
202251	Fee-for-Service	1851311492	1851311492	1	1	DE ROUEN, JOHN E MD	5/24/1993	174400000X	NA	Other	026	PHYSICIANS	76575	05	Anesthesiology	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
202264	Fee-for-Service	1902822968	1902822968	1	1	DI STEFANO, DALE V MD	12/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39611	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
202271	Fee-for-Service	1841200748	1841200748	1	1	DESERT PRIMARY CARE	1/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL ASSOCIATES, INC	1492 N PALM CANYON DR	None	PALM SPRINGS	CA	92262	4412	33	06065	33.84286317	-116.5467443	Riverside County
202278	Fee-for-Service	1053795450	1053795450	1	1	DEAN, JENNA T MD	8/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136885	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
202305	Fee-for-Service	1790309516	1790309516	1	1	DAVIS, BRIANNA LPCC	7/21/2021	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
202308	Fee-for-Service	1558318758	1558318758	1	1	DAKKURI, RAMI A MD	12/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96756	02	General Surgery	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
202375	Fee-for-Service	1871910752	1871910752	1	1	DEVLIN, VINCENT P DO	7/30/2019	207KA0200X	NA	Other	026	PHYSICIANS	16972	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
202416	Fee-for-Service	1689214173	1689214173	1	1	DIGNIFIED HOSPICE CARE	9/14/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1700 HAMNER AVE	SUITE 212	NORCO	CA	92860	2963	33	06065	33.90719003	-117.5615198	Riverside County
202418	Fee-for-Service	1164507836	1164507836	1	1	DO, CHUONG M MD	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81439	08	Family Practice	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
202448	Fee-for-Service	1558730473	1558730473	1	1	DUNKIN, CHARLIE LCSW	1/21/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99307	-	NOT APPLICABLE	0	In state provider	None	1930 MARKET STREET	None	SAN FRANCISCO	CA	94102	6228	38	06075	37.77037155	-122.4255051	San Francisco County
202475	Fee-for-Service	1922183979	1922183979	1	1	DONATIELLO, ROBERT M MD	3/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74988	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
202511	Fee-for-Service	1467584011	1467584011	1	1	DELA CRUZ, TRICIA C LMFT	3/18/2019	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
202513	Fee-for-Service	1568436806	1568436806	1	1	DVA RENAL HEALTHCARE INC	1/1/2001	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	ALAMEDA COUNTY DIALYSIS	10700 MACARTHUR BLVD	BUILDING 7	OAKLAND	CA	94605	5260	01	06001	37.74201242	-122.151048	Alameda County
202530	Fee-for-Service	1649459124	1649459124	1	1	DESAI, KIRIT R MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	38150	41	Internal Medicine	0	In state provider	None	3001 SILLECT AVENUE	STE 100	BAKERSFIELD	CA	93308	6370	15	06029	35.38601911	-119.0400416	Kern County
202537	Fee-for-Service	1295008159	1295008159	1	1	DESERT CYPRESS ELDERCARE INC	6/22/2012	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	0WNER/ADMINISTRATOR	68905 HERMOSILLO RD	None	CATHEDRAL CITY	CA	92234	8815	33	06065	33.83322498	-116.4607124	Riverside County
202546	Fee-for-Service	1790027886	1790027886	1	1	DIRECTO, MICHAEL P MD	3/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134056	41	Internal Medicine	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
202564	Fee-for-Service	1881727634	1881727634	2	1	DRUG CO PHARMACY	10/19/2007	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DRUG CO PHARMACY	307 NORTH ASH ST	None	ESCONDIDO	CA	92027	3015	37	06073	33.12949505	-117.0666157	San Diego County
202589	Fee-for-Service	1912161662	1912161662	1	1	DESAI, CHRISTINA T MD	12/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105606	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
202641	Fee-for-Service	1932333085	1932333085	1	1	DHALIWAL, MANDEEP K MD	7/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131514	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
202662	Fee-for-Service	1386146645	1386146645	1	1	DONALDSON, BRIA	4/11/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
202712	Fee-for-Service	1043839970	1043839970	1	1	DARWISH, ALEX S	7/8/2024	207L00000X	NA	Other	026	PHYSICIANS	178319	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
202715	Fee-for-Service	1891061529	1891061529	1	1	DELEON, JESSICA A MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127928	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
202716	Fee-for-Service	1588996623	1588996623	1	1	DEBAY, MARC J MD	10/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110925	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 204	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
202735	Fee-for-Service	1356617260	1356617260	1	1	DICKMAN, MEGHAN M MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126496	07	Dermatology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202764	Fee-for-Service	1750380390	1750380390	1	1	DOWNEY COMMUNITY CARE	6/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BROOKFIELD HEALTHCARE CT	9300 TELEGRAPH RD	None	DOWNEY	CA	90240	2425	19	06037	33.95704507	-118.1045336	Los Angeles County
202773	Fee-for-Service	1134685936	1134685936	1	1	DOGOM, NATILY	5/26/2022	106E00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12522 MOORPARK ST	106	STUDIO CITY	CA	91604	1355	19	06037	34.15033253	-118.406061	Los Angeles County
202796	Fee-for-Service	1669609178	1669609178	1	1	DOYEN, JEROME R MD	1/13/2023	207L00000X	NA	Other	026	PHYSICIANS	183574	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
202807	Fee-for-Service	1578799193	1578799193	1	1	DELDAR, SALAR MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113516	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	7821	27	06053	36.57482436	-121.8101797	Monterey County
202817	Fee-for-Service	1649459124	1649459124	1	1	DESAI, KIRIT R MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	38150	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3001 SILLECT AVENUE	STE 100	BAKERSFIELD	CA	93308	6370	15	06029	35.38601911	-119.0400416	Kern County
202820	Fee-for-Service	1689156838	1689156838	1	1	DO, VICTOR PT	5/15/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
202860	Fee-for-Service	1255016663	1255016663	1	1	DYER, KATHERINE MD	8/27/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
202865	Fee-for-Service	1669447652	1669447652	1	1	DAVID, CHARLES F DO	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10680	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
202885	Fee-for-Service	1245874080	1245874080	1	1	DUNCAN, ERIN AU	3/31/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
202899	Fee-for-Service	1386746287	1386746287	1	1	DATU,STEPHEN P MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48426	41	Internal Medicine	0	In state provider	None	85 SALE LN	None	RED BLUFF	CA	96080	2949	52	06103	40.18182867	-122.2190167	Tehama County
202903	Fee-for-Service	1447284054	1447284054	1	1	DUONG, HAI-LANG MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90657	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
202944	Fee-for-Service	1467719294	1467719294	1	1	DASHEVSKY, BRITTANY MD	6/27/2017	207R00000X	NA	Other	026	PHYSICIANS	148784	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
202948	Fee-for-Service	1336243385	1336243385	1	1	DARIUSHNIA, ALI R MD	2/12/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64803	08	Family Practice	0	In state provider	None	4910 VAN NUYS BLVD	STE 306	SHERMAN OAKS	CA	91403	1770	19	06037	34.15979697	-118.4486826	Los Angeles County
202985	Fee-for-Service	1023239035	1023239035	1	1	DING, SZE H MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141004	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
202990	Fee-for-Service	1669636775	1669636775	1	1	DARRIGAN, DAVID DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3500 W WHEATLAND RD	None	DALLAS	TX	75237	3460	00	None	32.64745255	-96.8764365	Dallas County
203052	Fee-for-Service	1760700918	1760700918	1	1	DONNELLY, ABIGAIL F W MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131222	07	Dermatology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
203086	Fee-for-Service	1518312230	1518312230	1	1	DEWOLF, SEAN E MD	6/9/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	152077	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
203103	Fee-for-Service	1225856941	1225856941	1	1	DIGESTIVE HEALTH AND NUTRITI	11/2/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	ON, INC.	2151 ROSS AVE	None	EL CENTRO	CA	92243	3806	13	06025	32.78143941	-115.5799149	Imperial County
203104	Fee-for-Service	1649459124	1649459124	1	1	DESAI, KIRIT R MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	38150	01	General Practice	0	In state provider	None	3001 SILLECT AVENUE	STE 100	BAKERSFIELD	CA	93308	6370	15	06029	35.38601911	-119.0400416	Kern County
203105	Fee-for-Service	1922420108	1922420108	1	1	DR TANYA OPTOMETRY	10/27/2014	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	563 N MOUTAIN AVE	None	UPLAND	CA	91786	5016	36	06071	34.100505	-117.6703307	San Bernardino County
203122	Fee-for-Service	1407886385	1407886385	1	1	DES PERES HOSPITAL INC	9/26/2016	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2345 DOUGHERTY FERRY RD	None	ST LOUIS	MO	63122	3313	00	None	38.584206	-90.451755	St. Louis County
203144	Fee-for-Service	1144360793	1144360793	1	1	DWYER, HARROLD J	1/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
203173	Fee-for-Service	1770642811	1770642811	1	1	DUCKLES, LINDSAY K LCSW	5/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
203202	Fee-for-Service	1376535955	1376535955	1	1	DUNN, NORMA G PHD	1/1/1979	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3150 EL CAMINO REAL	STE E	CARLSBAD	CA	92008	2110	37	06073	33.17209501	-117.3227345	San Diego County
203211	Fee-for-Service	1780902015	1780902015	1	1	DONIN, NICHOLAS M MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135232	34	Urology and Urological Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 140	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
203264	Fee-for-Service	1548802028	1548802028	1	1	DR. ANNA WILSON DO PC	7/6/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	117 NEAL ST	A	GRASS VALLEY	CA	95945	5079	29	06057	39.2171083	-121.0630466	Nevada County
203315	Fee-for-Service	1275374894	1275374894	1	1	DR KWUN MAN SIMON YU CHIROPR	10/16/2024	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	ACTIC APC	855 N LARK ELLEN AVE	M	WEST COVINA	CA	91791	1099	19	06037	34.087707	-117.9166385	Los Angeles County
203335	Fee-for-Service	1376831057	1376831057	1	1	DAWN THANH VU, OD, AN OPTOME	11/30/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 W. 1ST ST.	SUITE #1	TUSTIN	CA	92780	2948	30	06059	33.74559054	-117.8317485	Orange County
203410	Fee-for-Service	1407886385	1407886385	1	1	DES PERES HOSPITAL INC	9/26/2016	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2345 DOUGHERTY FERRY RD	None	ST LOUIS	MO	63122	3313	00	None	38.584206	-90.451755	St. Louis County
203451	Fee-for-Service	1679609283	1679609283	1	2	DELOZIER, KELLIE A MD	9/15/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55521	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	116 S PALISADE DR	STE 104	SANTA MARIA	CA	93454	8905	42	06083	34.9523869	-120.4120717	Santa Barbara County
203456	Fee-for-Service	1972574952	1972574952	1	1	DESPOIS, PATRICE L MD	7/21/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49136	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	558 3RD ST W	None	SONOMA	CA	95476	6502	49	06097	38.29133791	-122.4636079	Sonoma County
203465	Fee-for-Service	1982044251	1982044251	1	2	DICKERSON, RACHEL M LMFT	5/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	332 WEST F STREET	SUITE C	OAKDALE	CA	95361	8950	50	06099	37.76456685	-120.8520881	Stanislaus County
203471	Fee-for-Service	1225116866	1225116866	1	1	DUH, MICHAEL J MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74582	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
203539	Fee-for-Service	1598163693	1598163693	1	1	DIAZ, KEVIN A MD	9/29/2023	390200000X	NA	Other	026	PHYSICIANS	153894	None	None	0	In state provider	None	6000 J ST	None	SACRAMENTO	CA	95819	2605	34	06067	38.56329	-121.426353	Sacramento County
203597	Fee-for-Service	1760865794	1760865794	1	1	DEEP WELLNESS CENTER CHILD &	5/10/2021	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY COUNSELING INC.	5815 STODDARD RD.	600	MODESTO	CA	95356	9041	50	06099	37.72324601	-121.0686809	Stanislaus County
203623	Fee-for-Service	1568959120	1568959120	1	1	DAVIS, CHARLES B MD	4/5/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184390	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
203632	Fee-for-Service	1457426496	1457426496	1	1	DEPENDABLE CARE AMBULANC	10/15/2004	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	639 N FAIRFAX AVE	FL 2	LOS ANGELES	CA	90036	1714	19	06037	34.082829	-118.361556	Los Angeles County
203634	Fee-for-Service	1407273865	1407273865	1	1	DEVABHAKTUNI, SAMYUKTHA MD	8/16/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184363	None	None	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
203676	Fee-for-Service	1467828863	1467828863	1	1	DANIEL-MURPHY, EMILY N LCSW	9/23/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
203687	Fee-for-Service	1144421256	1144421256	1	1	DEMBITSKY, ZACHARY Y MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
203707	Fee-for-Service	1689845208	1689845208	1	1	DESALEGN YACOB M.D.	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
203723	Fee-for-Service	1346639945	1346639945	1	1	DEER, JESSICA E	1/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
203745	Fee-for-Service	1972574952	1972574952	1	1	DESPOIS, PATRICE L MD	7/21/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49136	41	Internal Medicine	0	In state provider	None	558 3RD ST W	None	SONOMA	CA	95476	6502	49	06097	38.29133791	-122.4636079	Sonoma County
203746	Fee-for-Service	1538729074	1538729074	1	1	DESAI, DIPALI CNP	10/26/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	801 SANTA FE WAY	None	SHAFTER	CA	93263	3158	15	06029	35.49142021	-119.260004	Kern County
203750	Fee-for-Service	1518905421	1518905421	1	1	DEARTH,CHRISTINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ALBANY MEDICAL COLLEGE	47 NEW SCOTSLAND AVE	None	ALBANY	NY	12208	0000	00	None	42.65281106	-73.77466567	Albany County
203776	Fee-for-Service	1073793626	1073793626	1	1	DE SILVA, PREVIN J MD	1/8/2008	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78776	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
203777	Fee-for-Service	1598961245	1598961245	1	15	DIGNITY HEALTH MEDICAL FOUND	9/4/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	FOUNDATION	1779 DOMINICAN WAY	STE B	SANTA CRUZ	CA	95065	1526	44	06087	36.9902958	-121.9808957	Santa Cruz County
203781	Fee-for-Service	1740675404	1740675404	1	1	DIQUATTRO, WESLEY T CRNA	2/20/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
203812	Fee-for-Service	1326312067	1326312067	1	9	DCHS MEDICAL FOUNDATION	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	455 OCONNOR DR	STE 210	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
203845	Fee-for-Service	1003994914	1003994914	1	1	DOLNICK, BRIAN E DO	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7629	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
203863	Fee-for-Service	1992750053	1992750053	1	1	DESAI, RUPAL N MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	82877	40	Pediatrics	0	In state provider	None	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
203869	Fee-for-Service	1770978579	1770978579	1	1	DHAMI, JASDEEP MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156190	01	General Practice	0	In state provider	None	445 W EATON AVENUE	None	TRACY	CA	95376	3420	39	06077	37.743354	-121.432495	San Joaquin County
203881	Fee-for-Service	1760865794	1760865794	1	1	DEEP WELLNESS CENTER CHILD &	5/10/2021	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY COUNSELING INC.	5815 STODDARD RD.	600	MODESTO	CA	95356	9041	50	06099	37.72324601	-121.0686809	Stanislaus County
203890	Fee-for-Service	1801299482	1801299482	1	1	DELL, CHRISTINA L LMFT	1/21/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2628 VICTOR AVE	SUITE A	REDDING	CA	96002	1454	45	06089	40.56894199	-122.3392301	Shasta County
203894	Fee-for-Service	1558314211	1558314211	1	1	DEBNATH, JAYANTA MD	3/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90166	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
203900	Fee-for-Service	1588877963	1588877963	1	1	DERTINA, DAMON M MD	5/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98936	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
203922	Fee-for-Service	1891702593	1891702593	1	1	DEVINE, DOROTHY H LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1290 CUSHMAN AVE	None	SAN DIEGO	CA	92110	3903	37	06073	32.76961343	-117.1979321	San Diego County
204019	Fee-for-Service	1912002122	1912002122	1	1	DALBY, JANICE	7/15/2019	174400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11838 BERNARDO PLAZA CT	SUITE 110	SAN DIEGO	CA	92128	2413	37	06073	33.02037119	-117.0760729	San Diego County
204055	Fee-for-Service	1477225472	1477225472	1	1	DR GABRIEL CRENSHAW CLINICAL	10/5/2021	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGIST INC	401 WILSHIRE BLVD PH	None	SANTA MONICA	CA	90401	1416	19	06037	34.01935551	-118.4980509	Los Angeles County
204100	Fee-for-Service	1326312067	1326312067	1	9	DCHS MEDICAL FOUNDATION	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	455 OCONNOR DR	STE 210	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
204103	Fee-for-Service	1306811625	1306811625	1	1	DEL JUNCO, TIRSO MD	9/30/1987	208600000X	NA	General Surgery	026	PHYSICIANS	41067	02	General Surgery	0	In state provider	None	14860 ROSCOE BLVD	SUITE 200	PANORAMA CITY	CA	91402	4665	19	06037	34.2214515	-118.4573205	Los Angeles County
204167	Fee-for-Service	1760865794	1760865794	1	1	DEEP WELLNESS CENTER CHILD &	10/28/2022	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY COUNSELING INC.	5815 STODDARD RD.	600	MODESTO	CA	95356	9041	50	06099	37.72324601	-121.0686809	Stanislaus County
204214	Fee-for-Service	1245304856	1245304856	1	1	DANIALYPOUR, NOUROLLAH	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	41114	01	General Practice	0	In state provider	WATT AVE MEDICAL CLINIC	5710 WATT AVE	None	NORTH HIGHLANDS	CA	95660	4752	34	06067	38.670723	-121.3823745	Sacramento County
204219	Fee-for-Service	1922073998	1922073998	1	1	DAVIDSON, JERRY A MD	2/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	33458	01	General Practice	0	In state provider	None	2876 SYCAMORE DR	STE 101	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
204236	Fee-for-Service	1811201924	1811201924	1	1	DE SHAY, BELINDA D NP	8/19/2020	2084P0800X	NA	Psychiatry	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
204254	Fee-for-Service	1710998208	1710998208	2	1	DND PHARMACY INC	12/28/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 MAIN STREET	None	BRAWLEY	CA	92227	2548	13	06025	32.97860253	-115.53138	Imperial County
204273	Fee-for-Service	1659518785	1659518785	1	1	DAVITYAN, SARINE LMFT	9/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 N CENTRAL AVE	SUITE 310	GLENDALE	CA	91202	2937	19	06037	34.16012317	-118.2571026	Los Angeles County
204297	Fee-for-Service	1750446811	1750446811	1	1	DOLAN, REBECCA AU	12/9/2024	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
204303	Fee-for-Service	1295763332	1295763332	1	1	DUNCAN, RAYMOND MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	40903	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
204307	Fee-for-Service	1477518421	1477518421	1	1	DE VITO, ALESSANDRO MD	12/31/1992	207ZP0101X	NA	Other	026	PHYSICIANS	50687	22	Pathology (M.D. only)	0	In state provider	None	17821 PIONEER BLVD	None	ARTESIA	CA	90701	3901	19	06037	33.8691791	-118.0823685	Los Angeles County
204311	Fee-for-Service	1770747834	1770747834	1	1	DEBORAH, ANITA MD	10/20/2020	207R00000X	NA	Other	026	PHYSICIANS	160046	41	Internal Medicine	0	In state provider	None	7415 N CEDAR AVE	102	FRESNO	CA	93720	3834	10	06019	36.8438171	-119.7568857	Fresno County
204404	Fee-for-Service	1255672119	1255672119	1	1	DAYRIT, JENNET	3/5/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3149 JAVA COURT	None	WEST SACRAMENTO	CA	95691	5880	57	06113	38.53940483	-121.5739379	Yolo County
204415	Fee-for-Service	1922276047	1922276047	1	1	DEVERS, DELMAR	3/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
204420	Fee-for-Service	1275796419	1275796419	1	1	DIMMOCK, DAVID P MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146669	01	General Practice	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
204432	Fee-for-Service	1477720829	1477720829	1	1	DAVIS KAROLE	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
204445	Fee-for-Service	1982778593	1982778593	1	1	DENHERDER,DEBRA J MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62986	26	Psychiatry (child)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
204446	Fee-for-Service	1093746182	1093746182	1	1	DEEIK, RAMZI	5/10/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79076	None	None	0	In state provider	None	1100 TRANCAS ST	STE 271	NAPA	CA	94558	2908	28	06055	38.32316569	-122.2981938	Napa County
204449	Fee-for-Service	1891435848	1891435848	1	1	DANG, ARUN DO	10/28/2024	207R00000X	NA	Other	026	PHYSICIANS	21672	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
204456	Fee-for-Service	1104017540	1104017540	1	1	DAVIS, MUNTU R MD	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74787	08	Family Practice	0	In state provider	None	400 CAPISTRANO DRIVE	None	OAKLAND	CA	94603	3520	01	06001	37.72764088	-122.1792477	Alameda County
204506	Fee-for-Service	1922073998	1922073998	1	1	DAVIDSON, JERRY A MD	2/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	33458	08	Family Practice	0	In state provider	None	2876 SYCAMORE DR	STE 101	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
204523	Fee-for-Service	1871500389	1871500389	1	1	DESAI, ANANT J MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72186	45	Nephrology (Renal-Kidney)	0	In state provider	None	16907 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	19	06037	34.25754015	-118.5004161	Los Angeles County
204568	Fee-for-Service	1386668473	1386668473	1	1	DAWES, THOMAS M JR MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69978	01	General Practice	0	In state provider	None	5075 S BRADLEY RD	STE 131	SANTA MARIA	CA	93455	5077	42	06083	34.864155	-120.4187955	Santa Barbara County
204625	Fee-for-Service	1114965605	1114965605	1	1	DUNN, MICHAEL P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	495 N PINAL PKWY	STE 101	FLORENCE	AZ	85232	8870	00	None	33.03630276	-111.3790402	Pinal County
204647	Fee-for-Service	1598180341	1598180341	1	2	DUVDEVANY, NETA MD	7/14/2021	208000000X	NA	Pediatric Primary Care	086	MEDICAL DIRECTORS	137556	-	NOT APPLICABLE	0	In state provider	None	3128 E ANITA STREET	None	STOCKTON	CA	95205	3905	39	06077	37.9719539	-121.2517864	San Joaquin County
204732	Fee-for-Service	1982778593	1982778593	1	1	DENHERDER,DEBRA J MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62986	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
204759	Fee-for-Service	1255486403	1255486403	1	1	DRESSLER, JOE B MD	8/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1200 W MOHAVE STREET	None	PARKER	AZ	85344	6349	00	None	34.13580083	-114.2842352	La Paz County
204804	Fee-for-Service	1689043291	1689043291	1	1	DALAG, LEONARD C MD	6/14/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171850	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
204813	Fee-for-Service	1871500389	1871500389	1	1	DESAI, ANANT J MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72186	41	Internal Medicine	0	In state provider	None	16907 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	19	06037	34.25754015	-118.5004161	Los Angeles County
204820	Fee-for-Service	1811097652	1811097652	4	1	DESERT HILLS RX LLC	11/27/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 W HOBSONWAY	None	BLYTHE	CA	92225	1639	33	06065	33.61039803	-114.5999284	Riverside County
204822	Fee-for-Service	1124513312	1124513312	1	1	DHAYALAN, DHAYANITHI MD	7/13/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	173487	None	None	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
204825	Fee-for-Service	1790851244	1790851244	1	1	DOYLE, KRISTIN M LCSW	2/6/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74688	-	NOT APPLICABLE	0	In state provider	None	242 N VILLA AVE	None	WILLOWS	CA	95988	2641	11	06021	39.52243848	-122.208844	Glenn County
204878	Fee-for-Service	1285801704	1285801704	2	1	DAYTON, JOHN R MD	7/19/2021	207P00000X	NA	Other	026	PHYSICIANS	171586	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
204929	Fee-for-Service	1902950934	1902950934	1	1	DO, CHANH Q DO	6/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9226	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
204959	Fee-for-Service	1093211138	1093211138	1	1	DE VERA, JEROME DO	8/11/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	17593	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
204966	Fee-for-Service	1578836524	1578836524	1	1	DESAI, RISHI MD	10/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	100872	40	Pediatrics	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
204977	Fee-for-Service	1578150223	1578150223	1	1	D & A HOME HEALTH SERVICES	1/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	909 S VICTORY BLVD	None	BURBANK	CA	91502	2430	19	06037	34.16727612	-118.3086844	Los Angeles County
205012	Fee-for-Service	1093864944	1093864944	1	1	DEVELOPMENTAL CLIENT CARE	10/4/1992	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INDUSTRIES INC	24675 BAY AVE	None	MORENO VALLEY	CA	92553	3810	33	06065	33.92087352	-117.231912	Riverside County
205057	Fee-for-Service	1598077869	1598077869	1	1	DONG, PHUC-SON S DO	9/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12891	08	Family Practice	0	In state provider	None	2510 AIRPARK DR	STE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
205114	Fee-for-Service	1245448752	1245448752	1	1	DUBER, ROGER D DO INC AMC	5/1/1999	193400000X	NA	Other	026	PHYSICIANS	4904	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	685 N 13TH AVENUE	#9	UPLAND	CA	91786	4165	36	06071	34.10202219	-117.6339091	San Bernardino County
205116	Fee-for-Service	1831742170	1831742170	1	1	DIAZ, MIGUEL AU	12/13/2024	235Z00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
205118	Fee-for-Service	1316460587	1316460587	1	1	DUARTE, ALMA N MFT	8/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST	STE 308	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
205139	Fee-for-Service	1326613522	1326613522	1	1	DHOLE, ATHARVA K MD	6/24/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
205147	Fee-for-Service	1699717041	1699717041	1	1	DESANDRE, GLENN H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69290	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
205186	Fee-for-Service	1427022797	1427022797	1	1	DVA RENAL HEALTHCARE INC	1/1/2001	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	BENICIA DIALYSIS	560 1ST ST	STE D103	BENICIA	CA	94510	3266	48	06095	38.04864856	-122.1593691	Solano County
205205	Fee-for-Service	1902255367	1902255367	1	1	DE CASTRO-ABEGER, ALEXANDER	9/7/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	171995	None	None	0	In state provider	H MD	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
205214	Fee-for-Service	1346621414	1346621414	1	1	DIVITTORIO, SARAH E MD	5/29/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162916	15	Obstetrics (D.O. only)	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
205242	Fee-for-Service	1427136118	1427136118	1	1	DUGONI, THOMAS MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	81253	02	General Surgery	0	In state provider	None	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
205245	Fee-for-Service	1164689568	1164689568	1	1	DULAN, NILKA M CNM	9/12/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1900 E 4TH STREET	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
205288	Fee-for-Service	1811317183	1811317183	1	1	DARYL MUMFORD	3/23/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6711 N SIERRA VISTA AVE	None	FRESNO	CA	93710	9497	10	06019	36.83427193	-119.7401441	Fresno County
205296	Fee-for-Service	1568540318	1568540318	1	1	DUH, HARRY J MD	9/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78017	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
205312	Fee-for-Service	1740624196	1740624196	1	1	DCRUZ, DANIELLE A MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133990	01	General Practice	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
205349	Fee-for-Service	1326036450	1326036450	1	1	DIHENIA, CHANDA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3619 22ND PL	None	LUBBOCK	TX	79410	1317	00	None	33.57413047	-101.8935855	Lubbock County
205361	Fee-for-Service	1154711836	1154711836	1	1	DEJONG, ELLEN M MD	6/27/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151834	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
205385	Fee-for-Service	1891766226	1891766226	1	1	DARREN BRAUDE MD	3/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
205423	Fee-for-Service	1710451711	1710451711	1	1	DANG, JONATHAN LMFT	12/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4929 WILSHIRE BLVD	SUITE 245	LOS ANGELES	CA	90010	3859	19	06037	34.0621435	-118.3380975	Los Angeles County
205437	Fee-for-Service	1699717041	1699717041	1	1	DESANDRE, GLENN H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69290	01	General Practice	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
205502	Fee-for-Service	1346621414	1346621414	1	1	DIVITTORIO, SARAH E MD	5/29/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	162916	09	Gynecology (D.O. only)	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
205514	Fee-for-Service	1437220258	1437220258	1	1	DESERT VIEW EMERGENCY	4/8/2014	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS A MEDICAL COR	38600 MEDICAL CENTER	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
205518	Fee-for-Service	1285801365	1285801365	1	1	DAVIS, KRISTY L LMFT	1/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
205564	Fee-for-Service	1023394285	1023394285	1	1	DESERT VIEW MEDICAL	12/28/2018	193400000X	NA	Other	026	PHYSICIANS	60508	01	General Practice	0	In state provider	None	205 N FIRST ST	STE A	BLYTHE	CA	92225	1777	33	06065	33.613155	-114.595559	Riverside County
205574	Fee-for-Service	1649243478	1649243478	2	1	DAY KIMBALL HEALTHCARE INC	8/20/2015	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	320 POMFRET ST	None	PUTNAM	CT	06260	1836	00	None	41.90743449	-71.91493972	Northeastern Connecticut Planning Region
205576	Fee-for-Service	1083812309	1083812309	1	1	DAVID,JAN B OT	6/22/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6596	19	06037	34.0981755	-118.295055	Los Angeles County
205601	Fee-for-Service	1740624196	1740624196	1	1	DCRUZ, DANIELLE A MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133990	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
205602	Fee-for-Service	1043897002	1043897002	1	1	DENG, XIAOMENG MD	3/26/2024	207R00000X	NA	Other	026	PHYSICIANS	184089	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
205611	Fee-for-Service	1235413352	1235413352	1	1	DACOSTA, MICHELLE E MD	12/14/2020	207L00000X	NA	Other	026	PHYSICIANS	167589	None	None	0	In state provider	None	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
205612	Fee-for-Service	1003934449	1003934449	1	1	DEY, SUJOYA MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104399	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2 BON AIR ROAD	#100	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
205675	Fee-for-Service	1831160712	1831160712	1	1	DR. DORAN SCHNEIDER	12/24/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
205677	Fee-for-Service	1801879861	1801879861	1	1	DANIEL, MICHELLE M MD	2/26/2021	207P00000X	NA	Other	026	PHYSICIANS	171029	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
205680	Fee-for-Service	1407012198	1407012198	1	1	DUNN, ESTHER L DO	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11424	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
205699	Fee-for-Service	1508266982	1508266982	1	1	DEBOER, SANDRA	9/1/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2405 E WOOD AVE	None	LATON	CA	93242	9728	10	06019	36.42374564	-119.7561779	Fresno County
205717	Fee-for-Service	1053196097	1053196097	1	1	DAILEY-GLENN, DANA	6/17/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
205724	Fee-for-Service	1699717041	1699717041	1	1	DESANDRE, GLENN H MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69290	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
205731	Fee-for-Service	1093874604	1093874604	1	1	DEVOR, WILLIAM N MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	46493	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
205831	Fee-for-Service	1013232537	1013232537	1	1	DAVIS, JEREMY C MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131032	07	Dermatology	0	In state provider	None	200 MED PLAZA	#365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
205862	Fee-for-Service	1649243478	1649243478	2	1	DAY KIMBALL HEALTHCARE INC	8/20/2015	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	320 POMFRET ST	None	PUTNAM	CT	06260	1836	00	None	41.90743449	-71.91493972	Northeastern Connecticut Planning Region
205893	Fee-for-Service	1801970876	1801970876	1	1	DONALD, SHAWN M MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55684	41	Internal Medicine	0	In state provider	None	9260 ALCOSTA BLVD	None	SAN RAMON	CA	94583	4134	07	06013	37.73166348	-121.9267174	Contra Costa County
205898	Fee-for-Service	1003934449	1003934449	1	1	DEY, SUJOYA MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104399	41	Internal Medicine	0	In state provider	None	2 BON AIR ROAD	#100	LARKSPUR	CA	94939	1141	21	06041	37.94364568	-122.5396483	Marin County
205986	Fee-for-Service	1508266982	1508266982	1	1	DEBOER, SANDRA	9/1/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2405 E WOOD AVE	None	LATON	CA	93242	9728	10	06019	36.42374564	-119.7561779	Fresno County
206030	Fee-for-Service	1164616280	1164616280	1	1	DAVIS, JANET M NP	3/21/2018	164W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
206107	Fee-for-Service	1871283309	1871283309	1	1	DEL RIO, LAUREN E CRNA	8/9/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
206126	Fee-for-Service	1255587259	1255587259	1	1	DELEON, LUIS D LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
206140	Fee-for-Service	1588988083	1588988083	1	1	DZUL-CHURCH, VIRGINIA E MD	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119562	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
206148	Fee-for-Service	1831518109	1831518109	1	1	DIMESPINE NEUROSURGERY INC	6/27/2014	193400000X	NA	Other	026	PHYSICIANS	92374	14	Neurological Surgery	0	In state provider	None	175 N JACKSON AVE	STE 203	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
206207	Fee-for-Service	1962465336	1962465336	1	1	DELEON, MARISSA Q MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70357	None	None	0	In state provider	None	223 CHINA GRADE LOOP	None	BAKERSFIELD	CA	93308	1707	15	06029	35.42652761	-119.0186006	Kern County
206233	Fee-for-Service	1093185035	1093185035	1	1	DUBOIS, VICTORIA LCSW	9/24/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
206256	Fee-for-Service	1669881967	1669881967	1	1	DHALIWAL, PUNIT K OD	10/31/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8120 TIMBERLAKE WAY	None	SACRAMENTO	CA	95823	5414	34	06067	38.461023	-121.41414	Sacramento County
206267	Fee-for-Service	1790720688	1790720688	1	1	DUGGER, RONALD F MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	25298	13	Neurology (M.D. only)	0	In state provider	None	545 E CLEVELAND ST	STE B	STOCKTON	CA	95204	5535	39	06077	37.97379447	-121.2893338	San Joaquin County
206294	Fee-for-Service	1033544325	1033544325	2	1	DAMERON MEDICAL GROUP, INC.	12/2/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	525 ACACIA	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
206298	Fee-for-Service	1093894941	1093894941	1	1	DIAL, FREDDIE P MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42356	None	None	0	In state provider	None	3975 JACKSON ST	STE 200	RIVERSIDE	CA	92503	3947	33	06065	33.92729721	-117.4413503	Riverside County
206339	Fee-for-Service	1841376423	1841376423	1	1	DUTKIEWICZ, RADEK M MD	4/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	520 MEDICAL CENTER DR	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
206354	Fee-for-Service	1568465466	1568465466	1	3	DOCTORS ON DUTY MEDICAL GROU	9/27/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	1513 FREMONT BLVD	E1	SEASIDE	CA	93955	4319	27	06053	36.60786927	-121.8463495	Monterey County
206359	Fee-for-Service	1184811556	1184811556	1	1	DE ALBA, DENISE DPM	5/23/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
206431	Fee-for-Service	1639104326	1639104326	1	1	DUNN, MATTHEW D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	78638	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	STE 7416	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
206472	Fee-for-Service	1063458495	1063458495	1	1	DEFELICE, RICHARD D MD	12/31/1981	207RC0200X	NA	Other	026	PHYSICIANS	47183	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3637 MISSION AVE	STE 6	CARMICHAEL	CA	95608	2946	34	06067	38.631564	-121.355874	Sacramento County
206486	Fee-for-Service	1881836047	1881836047	1	1	DAVE, RADHIKA B MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113244	None	None	0	In state provider	None	455 HICKEY BLVD	STE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
206533	Fee-for-Service	1003964966	1003964966	1	1	DREW, DONALD A MD	8/28/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80977	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
206571	Fee-for-Service	1457073215	1457073215	1	1	DEVAI, VIVIAN N OT	10/7/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
206593	Fee-for-Service	1942568639	1942568639	1	1	DEBOW, D'ARTAGNAN MD	9/10/2022	208600000X	NA	General Surgery	026	PHYSICIANS	126744	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
206614	Fee-for-Service	1417638768	1417638768	1	1	DENNIS STOLPNER MD INC	11/16/2023	163WG0000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	6221 WILSHIRE BLVD	SUITE 504	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
206626	Fee-for-Service	1841376423	1841376423	1	1	DUTKIEWICZ, RADEK M MD	4/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	520 MEDICAL CENTER DR	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
206642	Fee-for-Service	1548797301	1548797301	1	1	DAVISON, BLAIRE DO	9/9/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17130	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
206644	Fee-for-Service	1568465466	1568465466	1	3	DOCTORS ON DUTY MEDICAL GROU	9/27/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P, INC	1513 FREMONT BLVD	E1	SEASIDE	CA	93955	4319	27	06053	36.60786927	-121.8463495	Monterey County
206657	Fee-for-Service	1255524930	1255524930	1	1	DRAGHICI, CATALINA MD	4/16/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183338	36	Psychiatry	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
206673	Fee-for-Service	1275911257	1275911257	1	1	DOUGLAS, PATRICE N LMFT	11/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8350 ARCHIBALD AVE	STE 100	RANCHO CUCAMONGA	CA	91730	0660	36	06071	34.10202623	-117.5935082	San Bernardino County
206676	Fee-for-Service	1962915488	1962915488	1	1	DEMAR, SCOTT T CRNA	4/3/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
206684	Fee-for-Service	1225039779	1225039779	1	1	DOBARIA, PRAKASHCHANDRA	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77951	41	Internal Medicine	0	In state provider	None	MARSHALL WAY	None	PLACERVILLE	CA	95667	0000	09	06017	38.72587744	-120.791388	El Dorado County
206791	Fee-for-Service	1427264563	1427264563	1	1	DIAZ, EDESSA O NP	1/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
206792	Fee-for-Service	1013902600	1013902600	1	1	DAVIS, ALVIN W MD	12/2/2022	207L00000X	NA	Other	026	PHYSICIANS	88760	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
206793	Fee-for-Service	1508127523	1508127523	1	1	DOWNEY, MONIKA A PHD	7/14/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
206819	Fee-for-Service	1518033356	1518033356	1	1	DONAHUE, JOSEPH P MD	5/9/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	86163	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206902	Fee-for-Service	1063446763	1063446763	1	1	DEL RIEGO, CHRISTOPHER F	12/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92757	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
206946	Fee-for-Service	1306147152	1306147152	1	1	DENISE RAE MEYERS	1/10/2011	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3326 E CLINTON AVE	None	FRESNO	CA	93703	2455	10	06019	36.77226322	-119.7696122	Fresno County
206966	Fee-for-Service	1366411894	1366411894	1	1	DONG, KEVIN J OD	6/19/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 GREGORY LANE	SUITE 110	PLEASANT HILL	CA	94523	2851	07	06013	37.94798358	-122.073455	Contra Costa County
207042	Fee-for-Service	1265759088	1265759088	1	1	DHILLON, HARPREET S MD INC	10/27/2010	207R00000X	NA	Other	026	PHYSICIANS	71150	41	Internal Medicine	0	In state provider	None	2287 MOWRY AVE	STE F	FREMONT	CA	94538	1622	01	06001	37.55664244	-121.9818434	Alameda County
207076	Fee-for-Service	1538575568	1538575568	1	1	DE MAHY, AMELIE M LAC	5/8/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
207135	Fee-for-Service	1902945629	1902945629	1	1	DO, LUCY H OD	1/30/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
207136	Fee-for-Service	1063420115	1063420115	1	1	DRUMGOLE, TANJULA LMFT	11/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41690 ENTERPRISE CIR N	STE. 226	TEMECULA	CA	92590	5616	33	06065	33.51949343	-117.1693521	Riverside County
207143	Fee-for-Service	1497712871	1497712871	1	1	DELSMAN, MARK J OD	7/1/1997	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	NORTH PARK OPTOMETRY	3068 UNIVERSITY AVE	None	SAN DIEGO	CA	92104	3034	37	06073	32.74852147	-117.128403	San Diego County
207187	Fee-for-Service	1629221346	1629221346	1	1	DEBROT MARCANO, LAURA M MD	4/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134881	40	Pediatrics	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
207188	Fee-for-Service	1639702053	1639702053	1	1	DE ARMAS, JOSE I CRNA	1/25/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
207235	Fee-for-Service	1306147152	1306147152	1	1	DENISE RAE MEYERS	1/10/2011	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3326 E CLINTON AVE	None	FRESNO	CA	93703	2455	10	06019	36.77226322	-119.7696122	Fresno County
207257	Fee-for-Service	1760537187	1760537187	1	1	DUBE, JANE A LCSW	1/11/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
207288	Fee-for-Service	1073543732	1073543732	1	1	DANIEL R HAGENGRUBER MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
207327	Fee-for-Service	1265968945	1265968945	1	1	DAVIS, SETH J MD	10/10/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	191206	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207331	Fee-for-Service	1235332503	1235332503	1	1	DEFELICE, BELINDA S	7/25/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
207359	Fee-for-Service	1558403311	1558403311	1	1	DADRAS, SOHEIL S MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92514	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
207362	Fee-for-Service	1013798875	1013798875	1	1	DAVIS, KYLI R OT	10/16/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25467 MEDICAL CENTER DR	100	MURRIETA	CA	92562	1501	33	06065	33.55711632	-117.1860368	Riverside County
207382	Fee-for-Service	1336349091	1336349091	1	1	DICKERSON, DANIEL L DO	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8291	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
207385	Fee-for-Service	1619085636	1619085636	1	1	DAVID PATRICK H	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
207387	Fee-for-Service	1366735664	1366735664	1	1	DHESI, SHAWNJIT S MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141485	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
207404	Fee-for-Service	1649246059	1649246059	1	1	DESAI, NIRAJ S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4473 PAHEE ST	STE L	LIHUE	HI	96766	2037	00	None	21.97021516	-159.3833984	Kauai County
207428	Fee-for-Service	1972556108	1972556108	1	1	DEBS, ANTHONY D MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71007	None	None	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
207435	Fee-for-Service	1245527167	1245527167	1	1	DIGNEY, BRADLEY W MD	12/19/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1901 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97165921	-121.2895813	San Joaquin County
207456	Fee-for-Service	1346414695	1346414695	1	1	D'MORIAS, LINET R MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	48021	None	None	0	In state provider	None	5670 N FRESNO ST	STE 110	FRESNO	CA	93710	8330	10	06019	36.82062	-119.781292	Fresno County
207539	Fee-for-Service	1457997645	1457997645	1	1	DAVID G SONG MD INC	3/23/2020	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	5365 WALNUT AVENUE	STE A	CHINO	CA	91710	2262	36	06071	34.02626051	-117.6883155	San Bernardino County
207551	Fee-for-Service	1457303398	1457303398	2	1	DAVIS, JADE N OD	5/20/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3451 S DOGWOOD AVE	SUITE 1334	EL CENTRO	CA	92243	7906	13	06025	32.762997	-115.530678	Imperial County
207552	Fee-for-Service	1578821286	1578821286	1	1	DUKES, WILLIAM S MD	9/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126499	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
207580	Fee-for-Service	1073554804	1073554804	1	1	DR LOUIS T COWLEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
207596	Fee-for-Service	1275601478	1275601478	1	1	DOMINGUEZ, GILBERT R MD	6/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75306	None	None	0	In state provider	None	41715 WINCHESTER RD	SUITE 101	TEMECULA	CA	92590	4808	33	06065	33.51843041	-117.1680022	Riverside County
207659	Fee-for-Service	1750396552	1750396552	1	1	DAUGHARTY, TERRANCE M MD	1/1/1997	207L00000X	NA	Other	026	PHYSICIANS	15431	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
207662	Fee-for-Service	1790025385	1790025385	1	1	DATNOW, JULIE S	10/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
207762	Fee-for-Service	1053378828	1053378828	1	1	DUDLEY, PAUL L MD	9/1/1982	193400000X	NA	Other	026	PHYSICIANS	25705	13	Neurology (M.D. only)	0	In state provider	None	2220 LYNN RD	STE 206	THOUSAND OAKS	CA	91360	8007	56	06111	34.20863046	-118.8852156	Ventura County
207764	Fee-for-Service	1790216851	1790216851	1	1	DUTKO, HELEN NP	3/7/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
207785	Fee-for-Service	1982782611	1982782611	1	1	DOAN, THAO X MD	12/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82149	40	Pediatrics	0	In state provider	None	5301 F ST	STE 220	SACRAMENTO	CA	95819	3221	34	06067	38.571354	-121.4368695	Sacramento County
207789	Fee-for-Service	1417357351	1417357351	1	1	DIMARCO, MARISSA OT	3/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7090 MIRATECH DR	None	SAN DIEGO	CA	92121	3109	37	06073	32.89821825	-117.1711874	San Diego County
207801	Fee-for-Service	1407999105	1407999105	1	1	DICKEY, LARRY L MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	43175	08	Family Practice	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
207805	Fee-for-Service	1598961245	1598961245	1	10	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	44	06087	36.962588	-122.0439201	Santa Cruz County
207823	Fee-for-Service	1083109847	1083109847	1	1	DAY, DANA V DPM	6/17/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15366 ELEVENTH STREET	SUITE A	VICTORVILLE	CA	92395	3726	36	06071	34.530156	-117.292539	San Bernardino County
207833	Fee-for-Service	1154809895	1154809895	1	1	DATOR, KEVIN RCP	9/24/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
207950	Fee-for-Service	1831469444	1831469444	1	1	DAVIS, TERI D PHD	5/12/2021	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3756 SANTA ROSALIA STREE	SUITE 420	LOS ANGELES	CA	90008	3606	19	06037	34.00888336	-118.3389334	Los Angeles County
207957	Fee-for-Service	1366480915	1366480915	1	1	DECARVALHO, LORIE T PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1025 N DOUTY	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
207960	Fee-for-Service	1003971920	1003971920	1	1	DIGERONIMO, MARY J	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
207984	Fee-for-Service	1508374430	1508374430	1	1	DR PHARMACY RX INC	6/26/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5733 LAS VIRGENES RD	STE A	CALABASAS	CA	91302	1255	19	06037	34.16110325	-118.7028673	Los Angeles County
207994	Fee-for-Service	1588826697	1588826697	1	1	DIENER, BENJAMIN G MD	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104111	08	Family Practice	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
208011	Fee-for-Service	1134296098	1134296098	1	1	DEVITT, JENNY JMD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50720	78	Neoplastic Diseases/Oncology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
208023	Fee-for-Service	1750325643	1750325643	1	1	DING, LARRY G MD	9/1/1998	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	66008	25	Physical Medicine and Rehabilitation	0	In state provider	None	4444 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4136	33	06065	33.97614344	-117.3797664	Riverside County
208039	Fee-for-Service	1316095359	1316095359	1	1	DRESNIN, AARON D DO	12/11/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8943	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
208062	Fee-for-Service	1720713043	1720713043	1	1	DIODE ART ENGINEERING	3/21/2023	253Z00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9535 BRASHER ST	None	PICO RIVERA	CA	90660	2163	19	06037	34.00156216	-118.073599	Los Angeles County
208123	Fee-for-Service	1578634531	1578634531	1	1	DOES, ALEC V MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72642	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
208129	Fee-for-Service	1043409337	1043409337	1	1	DIESTLER, ADAM W LMFT	5/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1341 W ROBINHOOD DR	SUITE B2	STOCKTON	CA	95207	5517	39	06077	37.99838007	-121.3243901	San Joaquin County
208206	Fee-for-Service	1316193915	1316193915	1	1	DAVE, HIREN M MD	2/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110429	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
208218	Fee-for-Service	1396891735	1396891735	1	1	DO, HUY M MD	2/1/1999	2085N0700X	NA	MRI Provider	026	PHYSICIANS	75470	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
208251	Fee-for-Service	1376157982	1376157982	1	1	DEVOTED HANDS HOSPICE INC	8/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21054 SHERMAN WAY	STE 365	CANOGA PARK	CA	91303	1777	19	06037	34.20094949	-118.592541	Los Angeles County
208287	Fee-for-Service	1396058418	1396058418	1	1	DANAI, HASIB DO	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10976	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
208297	Fee-for-Service	1134296098	1134296098	1	1	DEVITT, JENNY JMD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50720	68	Hematology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
208334	Fee-for-Service	1316962756	1316962756	2	1	DREYER, JERROLD S MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	31161	41	Internal Medicine	0	In state provider	None	4835 VAN NUYS BLVD	SUITE 109	SHERMAN OAKS	CA	91403	2134	19	06037	34.1587068	-118.4487394	Los Angeles County
208359	Fee-for-Service	1639152044	1639152044	1	1	DOUGLAS, JASON F	8/30/2022	208M00000X	NA	Other	026	PHYSICIANS	54005	None	None	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
208360	Fee-for-Service	1497859425	1497859425	1	1	DILES, CHRISTINE G	8/15/1981	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
208369	Fee-for-Service	1124525167	1124525167	1	1	DESURE, ARIELL R MD	4/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173759	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
208382	Fee-for-Service	1255383121	1255383121	1	1	DAVID T WHEELER M.D.	7/9/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2801 N GANTENBEIN AVE	None	PORTLAND	OR	97227	1623	00	None	45.54387841	-122.6696022	Multnomah County
208416	Fee-for-Service	1194356592	1194356592	1	1	DUNGCA, DAVID CNP	3/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208430	Fee-for-Service	1598961245	1598961245	1	1	DIGNITY HEALTH MEDICAL FOUND	6/28/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
208441	Fee-for-Service	1720166374	1720166374	1	1	DORWARD, KAHT MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55197	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	87 SCRIPPS DR	STE 202	SACRAMENTO	CA	95825	6381	34	06067	38.572092	-121.410261	Sacramento County
208457	Fee-for-Service	1649470600	1649470600	1	1	DELGADO, CLAUDIA C	11/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
208511	Fee-for-Service	1639312887	1639312887	1	1	DIAZ, PATRICIA L LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	96740	-	NOT APPLICABLE	0	In state provider	None	1625 WEST OLYMPIC BLVD	SUITE 600	LOS ANGELES	CA	90015	3809	19	06037	34.04957404	-118.2750068	Los Angeles County
208519	Fee-for-Service	1396903944	1396903944	1	1	DARVIN, LAARNI G MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98770	40	Pediatrics	0	In state provider	None	1164 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849621	-117.941612	Orange County
208523	Fee-for-Service	1326049867	1326049867	1	1	DADVAND, FARDIN	6/1/2000	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY 2000	1646 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5604	19	06037	34.05212763	-118.4389495	Los Angeles County
208539	Fee-for-Service	1376157982	1376157982	1	1	DEVOTED HANDS HOSPICE INC	8/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21054 SHERMAN WAY	STE 365	CANOGA PARK	CA	91303	1777	19	06037	34.20094949	-118.592541	Los Angeles County
208549	Fee-for-Service	1316168511	1316168511	1	1	DUNNIGAN, JULIE M LMFT	1/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
208573	Fee-for-Service	1790749984	1790749984	1	1	DHILLON-ACOSTA, RAMINDER K D	2/14/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18847	None	None	0	In state provider	O	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
208585	Fee-for-Service	1134296098	1134296098	1	1	DEVITT, JENNY JMD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50720	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
208603	Fee-for-Service	1881002186	1881002186	1	1	DELGADO, MELISSA LMFT	9/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
208621	Fee-for-Service	1265715882	1265715882	1	1	DELLER, ELIZABETH CCC-SLP	5/18/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4420 MIRALOMA	A	ANAHEIM	CA	92807	1837	30	06059	33.86201793	-117.8200765	Orange County
208624	Fee-for-Service	1861614299	1861614299	1	1	DEC, ERIC MD	2/7/2018	207SG0201X	NA	Other	026	PHYSICIANS	108036	41	Internal Medicine	0	In state provider	None	320 SUPERIOR AVE	SUITE 280	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
208627	Fee-for-Service	1508271263	1508271263	1	1	DORFMAN, DAVID MD INC	7/28/2014	208200000X	NA	General Surgery	026	PHYSICIANS	106340	None	None	0	In state provider	None	4968 BOOTH CIRCLE	STE 105	IRVINE	CA	92604	3366	30	06059	33.68590715	-117.7855253	Orange County
208700	Fee-for-Service	1417417296	1417417296	1	1	DUNCAN, IESHA R LCSW	3/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
208710	Fee-for-Service	1154785673	1154785673	1	1	DIANGKINAY, IBARRA G CNP	7/25/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
208720	Fee-for-Service	1609337674	1609337674	1	1	DALI, SALMA S MD	4/14/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178768	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
208784	Fee-for-Service	1568782647	1568782647	1	1	DICKAN, AUDREY S MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129398	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
208805	Fee-for-Service	1417006305	1417006305	1	1	DO, PHILIP K OD	10/12/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1843 1/2 S LA CIENEGA	None	LOS ANGELES	CA	90035	4603	19	06037	34.04410366	-118.3768223	Los Angeles County
208807	Fee-for-Service	1578298428	1578298428	1	1	DAWSON INDIVIDUAL AND FAMILY	10/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COUNSELING INC	9700 EL CAMINO REAL	301	ATASCADERO	CA	93422	5581	40	06079	35.46523281	-120.647999	San Luis Obispo County
208820	Fee-for-Service	1629194956	1629194956	1	1	DUONG, VICKI P MD	8/16/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	100109	None	None	0	In state provider	None	7260 SOUTHGATE DR	STE D	SACRAMENTO	CA	95823	2609	34	06067	38.493999	-121.438395	Sacramento County
208846	Fee-for-Service	1902848112	1902848112	1	1	DENNY, SUSAN R MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	48379	30	Radiology	0	In state provider	None	3001 COLBY ST	None	BERKELEY	CA	94705	2039	01	06001	37.85496934	-122.2575642	Alameda County
208850	Fee-for-Service	1619162302	1619162302	1	1	DAVE, SULABHA MD INC	1/1/1997	2085R0001X	NA	Other	026	PHYSICIANS	30598	30	Radiology	0	In state provider	RADIATION ONCOLOGY ASSOC	2440 E SOUTH ST	None	LONG BEACH	CA	90805	4426	19	06037	33.86013954	-118.163439	Los Angeles County
208894	Fee-for-Service	1568465466	1568465466	1	9	DOCTORS ON DUTY MEDICAL GROU	9/4/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P, INC	1505 MAIN ST	None	WATSONVILLE	CA	95076	3761	44	06087	36.91747129	-121.7773741	Santa Cruz County
208915	Fee-for-Service	1831247998	1831247998	1	1	DIAMOND, MARK D PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	24980 TERRENO DR	None	TEMECULA	CA	92590	3989	33	06065	33.50309014	-117.2287045	Riverside County
208989	Fee-for-Service	1083986350	1083986350	1	1	DO, NAM H PT	2/25/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
209013	Fee-for-Service	1962814327	1962814327	1	1	DE MARCHIS, EMILIA H MD	5/18/2017	390200000X	NA	Other	026	PHYSICIANS	138207	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
209034	Fee-for-Service	1538618020	1538618020	1	1	DELGADO-ESCALERA, LESLIE M L	1/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
209104	Fee-for-Service	1568533073	1568533073	1	1	DENQ, STEPHEN P MD	4/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65839	41	Internal Medicine	0	In state provider	None	1000 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4709	19	06037	34.084557	-118.123042	Los Angeles County
209114	Fee-for-Service	1790334316	1790334316	1	1	DORSEY, KYLE T PT	11/6/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1626 SWEETWATER	SUITES A & B	NATIONAL CITY	CA	91950	7645	37	06073	32.66147525	-117.0818981	San Diego County
209115	Fee-for-Service	1790855534	1790855534	1	1	DAVID JONES MD	7/6/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
209135	Fee-for-Service	1447226204	1447226204	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SAN JUAN CAPO S DIALYSIS	31736 RANCHO VIEJO RD	STE B&C	SAN JUAN CAPISTRA	CA	92675	2783	30	06059	33.50179731	-117.6536314	Orange County
209136	Fee-for-Service	1619162302	1619162302	1	1	DAVE, SULABHA MD INC	1/1/1997	2085R0001X	NA	Other	026	PHYSICIANS	30598	78	Neoplastic Diseases/Oncology	0	In state provider	RADIATION ONCOLOGY ASSOC	2440 E SOUTH ST	None	LONG BEACH	CA	90805	4426	19	06037	33.86013954	-118.163439	Los Angeles County
209183	Fee-for-Service	1568465466	1568465466	1	9	DOCTORS ON DUTY MEDICAL GROU	9/4/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	1505 MAIN ST	None	WATSONVILLE	CA	95076	3761	44	06087	36.91747129	-121.7773741	Santa Cruz County
209208	Fee-for-Service	1265541270	1265541270	1	1	DOCKWEILER, ROSALIND R	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	47781	40	Pediatrics	0	In state provider	None	317 N EL CAMINO REAL	STE 506	ENCINITAS	CA	92024	2816	37	06073	33.05428107	-117.2615637	San Diego County
209232	Fee-for-Service	1598961245	1598961245	1	25	DIGNITY HEALTH MEDICAL FOUND	6/11/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1066 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	4163	44	06087	36.91746931	-121.7842657	Santa Cruz County
209278	Fee-for-Service	1497251722	1497251722	1	1	DEAN, RYAN E MD	8/7/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	185521	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
209345	Fee-for-Service	1215100623	1215100623	1	1	DECKERT, CHRISTINA N MD	12/31/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	103195	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
209371	Fee-for-Service	1578021325	1578021325	1	1	DELGADO, CARLOS A PT	6/13/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
209393	Fee-for-Service	1578301495	1578301495	1	1	DAZZLE HEALTH P C	1/23/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	18650 MACARTHUR BLVD	SUITE 450	IRVINE	CA	92612	1244	30	06059	33.67724732	-117.8605599	Orange County
209410	Fee-for-Service	1841808946	1841808946	1	1	DELTA HEALTH HOSPICE	8/31/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17037 CHATSWORTH ST	STE 206	GRANADA HILLS	CA	91344	5874	19	06037	34.26483049	-118.50372	Los Angeles County
209451	Fee-for-Service	1629242698	1629242698	1	1	DIGESTIVE ASSOCIATES LLP	1/4/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	1	Border provider	None	2031 MCDANIEL ST	SUITE 140	NORTH LAS VEGAS	NV	89030	6303	00	None	36.19740597	-115.1207123	Clark County
209461	Fee-for-Service	1699120212	1699120212	1	1	DILLON, ALEXANDER B MD	6/17/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168691	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
209471	Fee-for-Service	1568465466	1568465466	1	9	DOCTORS ON DUTY MEDICAL GROU	9/4/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC	1505 MAIN ST	None	WATSONVILLE	CA	95076	3761	44	06087	36.91747129	-121.7773741	Santa Cruz County
209476	Fee-for-Service	1194815910	1194815910	1	1	DUNCAN, KEITH L MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	47683	22	Pathology (M.D. only)	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
209501	Fee-for-Service	1598258386	1598258386	1	1	DODGE, LEVI	10/5/2022	207R00000X	NA	Other	026	PHYSICIANS	19187	None	None	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
209569	Fee-for-Service	1013394030	1013394030	1	1	DESAI, BRINDA MD	6/12/2023	207R00000X	NA	Other	026	PHYSICIANS	168528	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
209633	Fee-for-Service	1275580607	1275580607	1	1	DAGWASE, SATURNINO B PT	11/29/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
209647	Fee-for-Service	1780972638	1780972638	1	1	DY, CHERRIE R T MD	11/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	63725	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
209665	Fee-for-Service	1477736056	1477736056	1	1	DAVID, NOEL C MD INC	9/17/2008	261QP2300X	NA	Other	026	PHYSICIANS	51570	08	Family Practice	0	In state provider	None	250 CHERRY LN	STE 111	MANTECA	CA	95337	4397	39	06077	37.80036522	-121.2310051	San Joaquin County
209674	Fee-for-Service	1285194142	1285194142	1	1	DAM, MAI-ANH MD	9/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181397	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
209687	Fee-for-Service	1598750820	1598750820	1	1	DUNN, JACK D MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	101 CIVIC CENTER LN	None	LK HAVASU CTY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
209699	Fee-for-Service	1841808946	1841808946	1	1	DELTA HEALTH HOSPICE	8/31/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17037 CHATSWORTH ST	STE 206	GRANADA HILLS	CA	91344	5874	19	06037	34.26483049	-118.50372	Los Angeles County
209710	Fee-for-Service	1366516718	1366516718	1	1	DANIELS, DAVID H JR MD	10/18/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	30416	41	Internal Medicine	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
209722	Fee-for-Service	1578959045	1578959045	1	1	DELLA VECCHIA, JASON A DO	7/23/2019	207P00000X	NA	Other	026	PHYSICIANS	17417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
209729	Fee-for-Service	1780941161	1780941161	1	1	DREVNO, DAVID J NP	7/29/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
209778	Fee-for-Service	1750100400	1750100400	1	1	DOULA JUSTINA LLC	10/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
209789	Fee-for-Service	1790063238	1790063238	1	1	DIRECT SUCCESS INC	10/31/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1710 HIGHWAY 34	None	FARMINGDALE	NJ	07727	3906	00	None	40.18848229	-74.11562072	Monmouth County
209800	Fee-for-Service	1760187827	1760187827	1	1	DAVE, KAVINA PT	10/2/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
209851	Fee-for-Service	1023650561	1023650561	1	1	DESHPANDE, APOORVA OT	6/6/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41760 IVY ST	SUITE 101	MURRIETA	CA	92562	9416	33	06065	33.55331844	-117.2081759	Riverside County
209904	Fee-for-Service	1184121204	1184121204	1	1	DENG, BO MD	10/20/2021	207R00000X	NA	Other	026	PHYSICIANS	174235	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
209962	Fee-for-Service	1588717110	1588717110	1	1	DENZ, EDWARD A OD	10/28/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
209964	Fee-for-Service	1538272281	1538272281	2	1	DAYAN, MICHAEL A MD	1/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67375	41	Internal Medicine	0	In state provider	None	350 S OAK AVE	None	OAKDALE	CA	95361	3519	50	06099	37.75764557	-120.8600743	Stanislaus County
209999	Fee-for-Service	1366516718	1366516718	1	1	DANIELS, DAVID H JR MD	10/18/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	30416	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
210007	Fee-for-Service	1912573981	1912573981	1	1	DESCANSO ANESTHESIA GROUP	11/18/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
210029	Fee-for-Service	1629398490	1629398490	1	1	DINOTO, JACQUELINE M L MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111658	40	Pediatrics	0	In state provider	None	30131 TOWN CENTER DR	SUITE 215	LAGUNA NIGUEL	CA	92677	2033	30	06059	33.52530096	-117.7148334	Orange County
210063	Fee-for-Service	1770509838	1770509838	1	1	DUESBERG, SUSANNE U MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66470	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
210079	Fee-for-Service	1801915830	1801915830	1	1	DHANOA, TEGINDER S MD	7/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94646	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
210153	Fee-for-Service	1366817546	1366817546	1	1	DUMAS, JUVANIA S LPCC	12/5/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
210252	Fee-for-Service	1598961245	1598961245	1	8	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	13350 BIG BASIN WAY	None	BOULDER CREEK	CA	95006	9237	44	06087	37.12492123	-122.1245364	Santa Cruz County
210286	Fee-for-Service	1124528112	1124528112	1	1	DICKMAN, PAIGE LMFT	3/24/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26465 CARMEL RANCHO BLVD	6	CARMEL	CA	93923	8747	27	06053	36.53969948	-121.904788	Monterey County
210311	Fee-for-Service	1285782847	1285782847	1	1	DOSS, RAID P MD	12/28/1995	174400000X	NA	Other	026	PHYSICIANS	43098	18	Ophthalmology	0	In state provider	None	1700 CESAR CHAVEZ AVE	# 209	LOS ANGELES	CA	90033	2494	19	06037	34.05101259	-118.217259	Los Angeles County
210318	Fee-for-Service	1174731046	1174731046	1	1	DAUDI, SAYEEMA N MD	2/1/2021	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170620	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
210334	Fee-for-Service	1124386156	1124386156	1	1	DRAGICEVIC, NATASA MD	12/2/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	169361	None	None	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
210338	Fee-for-Service	1730133257	1730133257	1	1	DIOGENES ANESTHESIA MED	2/8/2001	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	GROUP, INC	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
210351	Fee-for-Service	1770509838	1770509838	1	1	DUESBERG, SUSANNE U MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66470	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
210378	Fee-for-Service	1336132224	1336132224	1	2	DOUNG TRAN, JOHN H MD	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86401	40	Pediatrics	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
210390	Fee-for-Service	1568465466	1568465466	1	8	DOCTORS ON DUTY MEDICAL GROU	1/27/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	27	06053	36.61275747	-121.9010674	Monterey County
210467	Fee-for-Service	1679783914	1679783914	1	1	DAVID CHRISTIAN CHAPMAN MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
210489	Fee-for-Service	1265477749	1265477749	1	1	DELKHAH, SHAHIN MD	12/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94156	41	Internal Medicine	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	6403	19	06037	34.16979433	-118.5312303	Los Angeles County
210564	Fee-for-Service	1134741994	1134741994	1	1	DALE, CAROLINE F MD	9/28/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183740	None	None	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
210568	Fee-for-Service	1881668093	1881668093	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	FULLERTON DIALYSIS	238 ORANGEFAIR MALL	None	FULLERTON	CA	92832	3037	30	06059	33.857829	-117.921033	Orange County
210620	Fee-for-Service	1346282704	1346282704	1	1	DENKERS, GLORY	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39 N SAN MATEO DR	STE 5	SAN MATEO	CA	94401	2832	41	06081	37.56748642	-122.327359	San Mateo County
210639	Fee-for-Service	1770509838	1770509838	1	1	DUESBERG, SUSANNE U MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66470	08	Family Practice	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
210641	Fee-for-Service	1871878538	1871878538	1	1	DELLACORT-ERICKSON, LAURA M	8/28/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1255 LIBERTY ST	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
210679	Fee-for-Service	1568465466	1568465466	1	8	DOCTORS ON DUTY MEDICAL GROU	1/27/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	27	06053	36.61275747	-121.9010674	Monterey County
210685	Fee-for-Service	1326073081	1326073081	1	1	DAMSKER, KEITH E MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54755	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
210691	Fee-for-Service	1336660299	1336660299	1	1	DRAGOVIC, KRISTINA MD	10/1/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171793	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
210702	Fee-for-Service	1093989402	1093989402	1	1	DALIZU, ALICE A NP	5/12/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210767	Fee-for-Service	1962862318	1962862318	1	1	DEDRICK, LANE K DO	12/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17592	None	None	0	In state provider	None	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	33	06065	33.52069117	-117.1653103	Riverside County
210773	Fee-for-Service	1174057079	1174057079	1	1	DELGADO, JEANNE R MD	10/7/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169146	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
210777	Fee-for-Service	1265477749	1265477749	1	1	DELKHAH, SHAHIN MD	12/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	94156	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	6403	19	06037	34.16979433	-118.5312303	Los Angeles County
210819	Fee-for-Service	1295837243	1295837243	1	1	DOO, EDWARD C MD	9/1/2002	204F00000X	NA	General Surgery	026	PHYSICIANS	76796	10	Gastroenterology (M.D. only)	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
210823	Fee-for-Service	1831127018	1831127018	1	1	DONAHUE, KELLIE M MD	5/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	56175	08	Family Practice	0	In state provider	None	6215 HIGHWAY 9	None	FELTON	CA	95018	9710	44	06087	37.05147861	-122.0732932	Santa Cruz County
210838	Fee-for-Service	1679916407	1679916407	1	1	DAO, DIEP N DO	5/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13600	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
210863	Fee-for-Service	1861579468	1861579468	1	3	D&E HOMES	4/19/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10317 DIANE AVE	None	BUENA PARK	CA	90620	4411	30	06059	33.81242584	-118.0223935	Orange County
210864	Fee-for-Service	1750484085	1750484085	1	1	DESTINY HOME HEALTH	6/17/2004	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY, INC	12370 PERRIS BLVD	None	MORENO VALLEY	CA	92557	7423	33	06065	33.941196	-117.2263605	Riverside County
210928	Fee-for-Service	1578587309	1578587309	1	1	DUFFIN,MICHAEL D MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	63443	01	General Practice	0	In state provider	None	880 S ATLANTIC BLVD	STE 101	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
210931	Fee-for-Service	1184970618	1184970618	1	1	DIETZ, TINA PHD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
210967	Fee-for-Service	1568465466	1568465466	1	8	DOCTORS ON DUTY MEDICAL GROU	1/27/2020	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P, INC	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	27	06053	36.61275747	-121.9010674	Monterey County
211056	Fee-for-Service	1538164066	1538164066	1	1	DAVID C NELSON	3/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1205 S GRANGE AVE	STE 510	SIOUX FALLS	SD	57105	0410	00	None	43.534575	-96.742845	Minnehaha County
211091	Fee-for-Service	1134231715	1134231715	1	1	DUNKELBERGER, LAURA J MFT	11/19/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 ALHAMBRA BLVD	SUITE 1	SACRAMENTO	CA	95816	4432	34	06067	38.574657	-121.464162	Sacramento County
211127	Fee-for-Service	1295935377	1295935377	1	1	DIMARTINO, JORGE MD	1/14/2008	2080P0207X	NA	Hematology	026	PHYSICIANS	80354	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
211181	Fee-for-Service	1972064004	1972064004	1	1	DIVINE HELP MEDICAL GROUP IN	2/7/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	C	1500 S CENTRAL AVE	320	GLENDALE	CA	91204	2530	19	06037	34.12736888	-118.257777	Los Angeles County
211183	Fee-for-Service	1578641379	1578641379	1	1	DAVIS, RAYMOND L MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70761	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
211191	Fee-for-Service	1184044216	1184044216	1	1	DE LOS SANTOS, ROCIO A MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150245	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
211214	Fee-for-Service	1477009827	1477009827	1	1	DEL CAMPO, GUADALUPE B LMFT	9/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
211223	Fee-for-Service	1073648945	1073648945	1	1	DAUGHARTY-FOWLER, SUSAN	2/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COEUR D'ALENE	ID	83814	0000	00	None	47.69465937	-116.7917936	Kootenai County
211226	Fee-for-Service	1386106102	1386106102	1	1	DABIJA, DOMINIQUE I MD	9/9/2022	207P00000X	NA	Other	026	PHYSICIANS	176997	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
211246	Fee-for-Service	1972505675	1972505675	1	2	DUNAGAN, CLARENCE M MD	11/1/2022	207PE0004X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
211248	Fee-for-Service	1245461771	1245461771	1	1	DOLAN, THOMAS W	7/1/1996	222Z00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	623 N MAIN STREET	None	ORANGE	CA	92868	1103	30	06059	33.79716	-117.866533	Orange County
211256	Fee-for-Service	1659518884	1659518884	1	1	DETTERICH, JON A MD	1/14/2009	207PP0204X	NA	Other	026	PHYSICIANS	89834	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
211428	Fee-for-Service	1104803527	1104803527	1	1	DAVID G MCNEIR	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2 CARE CIR	None	AMARILLO	TX	79124	2118	00	None	35.18934848	-101.928204	Potter County
211431	Fee-for-Service	1134137409	1134137409	1	1	DAVID, MARIE-CLAUD L MD	2/28/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38760	40	Pediatrics	0	In state provider	None	2615 I ST	None	SACRAMENTO	CA	95816	4395	34	06067	38.575656	-121.470867	Sacramento County
211509	Fee-for-Service	1538511191	1538511191	1	2	DAREEN KHALAF MD INC	7/6/2020	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	215 N ALLEN AVE	None	PASADENA	CA	91106	1601	19	06037	34.149798	-118.113208	Los Angeles County
211522	Fee-for-Service	1770682874	1770682874	1	1	DELLINGER, OSCAR D MD	5/16/2023	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	169230	None	None	0	In state provider	None	2501 W BURBANK BLVD	STE 206	BURBANK	CA	91505	2347	19	06037	34.17861961	-118.3385265	Los Angeles County
211540	Fee-for-Service	1992083844	1992083844	1	1	DHAH, SATINDERPAL S DO	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14053	25	Physical Medicine and Rehabilitation	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
211552	Fee-for-Service	1538476288	1538476288	1	1	DLAKA, SANDRA M NP	10/8/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
211577	Fee-for-Service	1619078904	1619078904	1	1	DRAEGER, JAY T MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	53023	41	Internal Medicine	0	In state provider	STE 1300-A	1600 CREEKSIDE DR	None	FOLSOM	CA	95630	3444	34	06067	38.669994	-121.147488	Sacramento County
211631	Fee-for-Service	1548399736	1548399736	1	1	DOCTORS MEDICAL CENTER	11/1/2007	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	OF MODESTO-PSYCH UNIT	1501 CLAUS RD	None	MODESTO	CA	95355	9711	50	06099	37.66541403	-120.9213226	Stanislaus County
211638	Fee-for-Service	1487688941	1487688941	1	1	DANIEL, LAMBERT N MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	46387	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
211692	Fee-for-Service	1558461327	1558461327	1	1	DEVEIKIS, AUDRA MD	1/1/1995	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	40896	77	Infectious Disease	0	In state provider	None	2880 ATLANTIC AVE	STE 260	LONG BEACH	CA	90806	1716	19	06037	33.809382	-118.185001	Los Angeles County
211708	Fee-for-Service	1609846955	1609846955	1	1	DE VIRGILIO, CHRISTIAN M	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62525	02	General Surgery	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
211755	Fee-for-Service	1578067609	1578067609	1	1	DESAI, SEEMA S MD	7/6/2020	390200000X	NA	Other	026	PHYSICIANS	164680	02	General Surgery	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
211767	Fee-for-Service	1598010316	1598010316	1	1	DR. MARK DETWILLER M.D.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
211840	Fee-for-Service	1427474998	1427474998	1	1	D'SOUZA, KARINA MD	9/29/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	166474	68	Hematology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
211976	Fee-for-Service	1265704894	1265704894	1	1	DUNNING, KATHLEEN V PHD	9/27/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15500 W SAND ST	STE 4	VICTORVILLE	CA	92392	2906	36	06071	34.51317572	-117.3255013	San Bernardino County
211979	Fee-for-Service	1558461327	1558461327	1	1	DEVEIKIS, AUDRA MD	1/1/1995	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	40896	40	Pediatrics	0	In state provider	None	2880 ATLANTIC AVE	STE 260	LONG BEACH	CA	90806	1716	19	06037	33.809382	-118.185001	Los Angeles County
211996	Fee-for-Service	1609846955	1609846955	1	1	DE VIRGILIO, CHRISTIAN M	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62525	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
212016	Fee-for-Service	1215514963	1215514963	1	1	DR. ESCALONA BARRAGAN AND AS	9/6/2024	103TC1900X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SOCIATES THERAPY SERVICE	27451 TOURNEY ROAD	SUITE 120	VALENCIA	CA	91355	6304	19	06037	34.42210981	-118.5795785	Los Angeles County
212042	Fee-for-Service	1518159698	1518159698	1	1	DYREYES, JONATHAN Q MD	10/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93977	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
212050	Fee-for-Service	1700594728	1700594728	1	1	DAIF, ZOUHAIR NP	1/23/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
212119	Fee-for-Service	1225236433	1225236433	1	1	DELATORRE, ADRIAN L MD	3/31/1985	207P00000X	NA	Other	026	PHYSICIANS	54333	66	Emergency Medicine (Urgent Care)	0	In state provider	None	620 E ST	None	WASCO	CA	93280	1918	15	06029	35.59516169	-119.3350256	Kern County
212129	Fee-for-Service	1417007873	1417007873	1	1	DU, JEAN DAJIAN CA	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	PROHEALTH ACPTR CTR	1926 28TH ST	None	SACRAMENTO	CA	95816	7312	34	06067	38.56311	-121.4741835	Sacramento County
212130	Fee-for-Service	1427474998	1427474998	1	1	D'SOUZA, KARINA MD	9/29/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	166474	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
212143	Fee-for-Service	1730129859	1730129859	1	1	DR. ABRAMSON, SIMEON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	MEDICAL CENTER OF AURORA	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
212165	Fee-for-Service	1962476606	1962476606	1	1	DVA RENAL HEALTHCARE INC	1/1/2000	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	SADDLEBACK DIALYSIS	23141 PLAZA POINTE DR	None	LAGUNA HILLS	CA	92653	1425	30	06059	33.6264604	-117.7227609	Orange County
212177	Fee-for-Service	1689392045	1689392045	1	1	D'ANTONIO, ASHLEY	6/3/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18419 US HIGHWAY 18	STE 6	APPLE VALLEY	CA	92307	2333	36	06071	34.53946944	-117.2621779	San Bernardino County
212199	Fee-for-Service	1427671882	1427671882	1	1	DHHS IHS CAO SACRED OAKS HEA	1/10/2022	3245S0500X	NA	Other	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	0	In state provider	None	33100 COUNTY ROAD 31	None	DAVIS	CA	95616	9523	57	06113	38.562426	-121.893282	Yolo County
212204	Fee-for-Service	1154407534	1154407534	2	1	DILLION, KEITH O MD	5/8/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75356	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1510 E MAIN ST	STE 104	SANTA MARIA	CA	93454	4826	42	06083	34.95282793	-120.4100798	Santa Barbara County
212246	Fee-for-Service	1881684363	1881684363	1	1	DONTHINENI, RAKESH MD	10/15/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	55666	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
212252	Fee-for-Service	1699796557	1699796557	1	1	DUBELMAN, ALEXANDER M MD	1/5/1995	207L00000X	NA	Other	026	PHYSICIANS	29686	05	Anesthesiology	0	In state provider	None	955 BLANCO CIR	STE A	SALINAS	CA	93901	4452	27	06053	36.65564507	-121.6367659	Monterey County
212253	Fee-for-Service	1306814918	1306814918	1	3	DELTA PATHOLOGY ASSOC	8/4/2009	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	525 W ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
212261	Fee-for-Service	1669892006	1669892006	1	1	DELCID, LESLIE B LMFT	8/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
212302	Fee-for-Service	1215514963	1215514963	1	1	DR. ESCALONA BARRAGAN AND AS	8/2/2024	103TC1900X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SOCIATES THERAPY SERVICE	27451 TOURNEY ROAD	SUITE 120	VALENCIA	CA	91355	6304	19	06037	34.42210981	-118.5795785	Los Angeles County
212329	Fee-for-Service	1043390958	1043390958	1	1	DELANGE, MICHAEL D MD	8/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70358	08	Family Practice	0	In state provider	None	20126 STANTON AVENUE	SUITE 201	CASTRO VALLEY	CA	94546	5270	01	06001	37.69722866	-122.090936	Alameda County
212339	Fee-for-Service	1720578875	1720578875	1	1	DILWALI, SONAM MD	4/21/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	167292	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
212428	Fee-for-Service	1215704424	1215704424	1	1	DISCOVER ME US MARRIAGE AND	1/26/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY THERAPY PROF. COR	2001 SALVIO ST	STE. 28	CONCORD	CA	94520	2495	07	06013	37.97709583	-122.0355651	Contra Costa County
212435	Fee-for-Service	1114671799	1114671799	1	1	DAT WILLIAM NGUYEN MD INC	9/16/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	229	LA MESA	CA	91942	3026	37	06073	32.77978322	-117.0094766	San Diego County
212460	Fee-for-Service	1629117643	1629117643	1	1	DILAURO, STEVEN C MD	4/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104332	41	Internal Medicine	0	In state provider	None	354 SANTA FE DRIVE	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
212464	Fee-for-Service	1649651027	1649651027	1	1	DATTA MITRA, ANANYA MD	5/28/2020	390200000X	NA	Other	026	PHYSICIANS	150441	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
212470	Fee-for-Service	1568465466	1568465466	1	5	DOCTORS ON DUTY MEDICAL GROU	10/9/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P, INC	1212 S MAIN ST	None	SALINAS	CA	93901	2260	27	06053	36.65759539	-121.6594973	Monterey County
212480	Fee-for-Service	1417005489	1417005489	1	1	DIFRONZO, YOLANDA B DO	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7413	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
212486	Fee-for-Service	1427671882	1427671882	1	1	DHHS IHS CAO SACRED OAKS HEA	1/10/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	33100 COUNTY ROAD 31	None	DAVIS	CA	95616	9523	57	06113	38.562426	-121.893282	Yolo County
212499	Fee-for-Service	1245655588	1245655588	1	1	DIAZ, RAY G CO	2/26/2014	174400000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	4479 STONERIDGE DR	STE A	PLEASANTON	CA	94588	8448	01	06001	37.68796252	-121.8761775	Alameda County
212523	Fee-for-Service	1851461768	1851461768	1	1	DAGCUTA, CHARITA L MD	7/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	35501	36	Psychiatry	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
212532	Fee-for-Service	1487719340	1487719340	1	1	DUZMAL, DAVID W OD	5/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
212539	Fee-for-Service	1346531563	1346531563	1	1	DRU, CHRISTOPHER MD	12/17/2023	208800000X	NA	Other	026	PHYSICIANS	125559	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
212555	Fee-for-Service	1992294508	1992294508	1	1	DICKEY, WILLIAM W LMFT	4/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
212565	Fee-for-Service	1104367135	1104367135	1	1	DAVIS-BATES, THERESA NP	11/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
212577	Fee-for-Service	1245232578	1245232578	2	1	DICHMANN, ROBERT A MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54341	78	Neoplastic Diseases/Oncology	0	In state provider	None	1325 E CHURCH ST	STE 301	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
212590	Fee-for-Service	1861555781	1861555781	1	1	DICKSTEIN, SHERYL S	12/11/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70321	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
212636	Fee-for-Service	1679522288	1679522288	1	2	DR MATTHEW SAFAPOUR DPM INC	3/21/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	7325 MEDICAL CENTER DRIV	307	WEST HILLS	CA	91307	1975	19	06037	34.20369349	-118.629837	Los Angeles County
212641	Fee-for-Service	1982133096	1982133096	1	1	DAWES, JHANELLE MD	8/1/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162960	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
212666	Fee-for-Service	1124015235	1124015235	1	1	DECKEY,JEFFREY E MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	83859	20	Orthopedic Surgery	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
212766	Fee-for-Service	1417005489	1417005489	1	1	DIFRONZO, YOLANDA B DO	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7413	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
212769	Fee-for-Service	1568465466	1568465466	1	5	DOCTORS ON DUTY MEDICAL GROU	10/9/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	1212 S MAIN ST	None	SALINAS	CA	93901	2260	27	06053	36.65759539	-121.6594973	Monterey County
212804	Fee-for-Service	1376530444	1376530444	1	1	DOUGLAS MACINERNEY MD	7/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
212807	Fee-for-Service	1205154549	1205154549	1	1	DURANT, ANDREA MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109803	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
212866	Fee-for-Service	1245232578	1245232578	2	1	DICHMANN, ROBERT A MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54341	68	Hematology	0	In state provider	None	1325 E CHURCH ST	STE 301	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
212897	Fee-for-Service	1194196972	1194196972	1	2	D&T TRANSPORTATION LLC	9/21/2021	347C00000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	820 W. 22ND STREET	A	MERCED	CA	95340	1385	24	06047	37.30827345	-120.4855806	Merced County
212907	Fee-for-Service	1558611863	1558611863	1	1	DANESHMAND, HOOTAN M D	1/15/2019	193400000X	NA	Other	026	PHYSICIANS	73325	24	Plastic Surgery	0	In state provider	INCORPORATED	27462 PORTOLA PKWY	STE 100	FOOTHILL RANCH	CA	92610	2838	30	06059	33.670692	-117.6558795	Orange County
212910	Fee-for-Service	1952426462	1952426462	1	1	DUDL, ROBERT R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29849	67	Endocrinology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
212943	Fee-for-Service	1811252182	1811252182	1	1	DAPAAH-SIAKWAN, FREDRICK MD	7/23/2018	390200000X	NA	Other	026	PHYSICIANS	152930	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
212959	Fee-for-Service	1881369197	1881369197	1	1	DAYSMAN PHARMACY LLC	2/2/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3760 MOWRY AVE	None	FREMONT	CA	94538	1428	01	06001	37.55024254	-121.9869844	Alameda County
212984	Fee-for-Service	1780744995	1780744995	1	1	DELAERE, KEITH J LCSW	3/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
213019	Fee-for-Service	1790718997	1790718997	1	1	DUBOIS, BEN MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86722	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
213066	Fee-for-Service	1295819944	1295819944	1	1	DUPREE, ROBERT W JR OD	8/27/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	255 E WEBER AVE	None	STOCKTON	CA	95202	2706	39	06077	37.95422434	-121.2877163	San Joaquin County
213069	Fee-for-Service	1497839211	1497839211	1	1	D & Y GOFF MD A MEDICAL	5/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	73947	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	5965 SEVERIN DRIVE	None	LA MESA	CA	91942	3806	37	06073	32.78709552	-116.9990329	San Diego County
213138	Fee-for-Service	1649472374	1649472374	1	1	DEOL, PARMINDER S MD	10/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98630	30	Radiology	0	In state provider	None	6305 COYLE AVENUE	None	CARMICHAEL	CA	95608	0438	34	06067	38.668248	-121.3181415	Sacramento County
213194	Fee-for-Service	1578040218	1578040218	1	1	DAHLGREN, AMELIA E OT	2/26/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
213197	Fee-for-Service	1952426462	1952426462	1	1	DUDL, ROBERT R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29849	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
213221	Fee-for-Service	1073569026	1073569026	1	1	DURSTEIN-DECKER, CHERYL MD	9/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55590	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 WEST E ST	None	TEHACHAPI	CA	93561	1607	15	06029	35.13009994	-118.4488237	Kern County
213307	Fee-for-Service	1790718997	1790718997	1	1	DUBOIS, BEN MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86722	20	Orthopedic Surgery	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
213337	Fee-for-Service	1598961245	1598961245	1	28	DIGNITY HEALTH MEDICAL FOUND	2/4/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	- DOMINICAN, INC	4700 SOQUEL DR	None	SOQUEL	CA	95073	2427	44	06087	36.98815433	-121.9571695	Santa Cruz County
213354	Fee-for-Service	1669589537	1669589537	1	1	DADWAL, SANJEET	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71102	77	Infectious Disease	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
213381	Fee-for-Service	1104981042	1104981042	1	1	DAVYDOVA, YELENA OD	7/14/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1071 BROADWAY	None	EL CAJON	CA	92021	4804	37	06073	32.8076427	-116.9450865	San Diego County
213473	Fee-for-Service	1376590778	1376590778	1	1	DONALD S. HOWARD M.D.	5/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
213484	Fee-for-Service	1740625656	1740625656	1	1	DOCTOR, MICHAEL B MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
213500	Fee-for-Service	1669782124	1669782124	1	2	DE NIRO, JENNIFER E MD	6/1/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	115886	18	Ophthalmology	0	In state provider	None	491 30TH ST	STE 201	OAKLAND	CA	94609	3235	01	06001	37.81935528	-122.2667902	Alameda County
213511	Fee-for-Service	1578940722	1578940722	1	1	DURBANO, TESSA R LCSW	9/21/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1304	30	06059	33.5230101	-117.6683028	Orange County
213544	Fee-for-Service	1881633287	1881633287	1	1	DANIEL S DUNKELMAN, MD	3/12/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	CEDARS TOWERS SURGICAL	8631 W 3RD ST	STE 235E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
213577	Fee-for-Service	1386689453	1386689453	1	1	DIEGO, LORAINE V MD INC	1/1/2001	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	67445	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2405 W 8TH ST	STE 105	LOS ANGELES	CA	90057	5016	19	06037	34.05634309	-118.2810868	Los Angeles County
213642	Fee-for-Service	1699262394	1699262394	1	1	DALLALZADEH, LIANE O MD	4/20/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	163676	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
213657	Fee-for-Service	1215985932	1215985932	1	1	DOMUSH, CHRISTOPHER M MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86887	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
213681	Fee-for-Service	1073795456	1073795456	1	1	DOTY, AMANDA K LMFT	4/27/2020	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
213686	Fee-for-Service	1326264128	1326264128	1	1	DEAN, ARIF	5/25/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
213704	Fee-for-Service	1326312067	1326312067	1	7	DCHS MEDICAL FOUNDATION	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1800 SULLIVAN AVE	STE 504	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
213717	Fee-for-Service	1306814918	1306814918	1	1	DELTA PATHOLOGY ASSOC	4/25/1998	207ZP0102X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	3133 W MARCH LANE	STE 1040	STOCKTON	CA	95219	2360	39	06077	37.98412533	-121.3519903	San Joaquin County
213719	Fee-for-Service	1265440101	1265440101	1	1	DITMARS, MICHAEL L MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80207	02	General Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
213720	Fee-for-Service	1134540719	1134540719	1	1	DO, TAM D MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	133815	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
213754	Fee-for-Service	1053325761	1053325761	1	1	DOSHI, DIPTI MD	5/5/2019	207RR0500X	NA	Other	026	PHYSICIANS	79465	None	None	0	In state provider	None	17100 NORWALK BLVD	STE 101	CERRITOS	CA	90703	2750	19	06037	33.87557796	-118.0725386	Los Angeles County
213804	Fee-for-Service	1366408841	1366408841	1	1	DONEGAN, ELIZABETH A	11/1/1995	207L00000X	NA	Other	026	PHYSICIANS	32890	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
213811	Fee-for-Service	1447224126	1447224126	1	1	DALILI-SHOAIE, VALENTINA R	11/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103357	41	Internal Medicine	0	In state provider	MD	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
213898	Fee-for-Service	1326008723	1326008723	1	1	DICKINSON, KIM MD	8/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	61530	22	Pathology (M.D. only)	0	In state provider	None	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
213945	Fee-for-Service	1215985932	1215985932	1	1	DOMUSH, CHRISTOPHER M MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86887	15	Obstetrics (D.O. only)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
213950	Fee-for-Service	1295762326	1295762326	1	1	DACULA, BENJAMIN D MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54857	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
213968	Fee-for-Service	1295994655	1295994655	1	1	DE LA CRUZ, ANA L MD	1/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122539	22	Pathology (M.D. only)	0	In state provider	None	726 4TH STREET	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
213973	Fee-for-Service	1477589851	1477589851	1	1	DINOME, MAGGIE L MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	62419	02	General Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 214	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
213986	Fee-for-Service	1073739033	1073739033	1	1	DELANEY, ELIZABETH A MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	68896	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 120	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
213993	Fee-for-Service	1326312067	1326312067	1	7	DCHS MEDICAL FOUNDATION	1/17/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1800 SULLIVAN AVE	STE 504	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
214030	Fee-for-Service	1164532990	1164532990	1	1	DANIELSON, MICHAEL C MD	2/16/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	31003	05	Anesthesiology	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
214059	Fee-for-Service	1861579468	1861579468	1	2	D&E HOMES	9/2/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6590 SAN FRANCISCO DR	None	BUENA PARK	CA	90620	3747	30	06059	33.83473397	-118.0180396	Orange County
214075	Fee-for-Service	1972237964	1972237964	1	1	DONALDSON, HEATHER NP	9/22/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1563	34	06067	38.546091	-121.447305	Sacramento County
214173	Fee-for-Service	1235378563	1235378563	1	1	DUTTA, ANKHI MD	8/10/2022	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
214189	Fee-for-Service	1053534123	1053534123	1	1	DUDLEY, KRISTIN T	4/19/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
214206	Fee-for-Service	1225550023	1225550023	1	1	DINELLA, LAUREN G CRNA	8/11/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
214311	Fee-for-Service	1790997716	1790997716	1	1	DO, HONG MD A PROFESSIONAL	5/20/1985	174400000X	NA	Other	026	PHYSICIANS	41726	07	Dermatology	0	In state provider	CORPORATION	1692 TULLY RD	STE 9	SAN JOSE	CA	95122	2550	43	06085	37.3212391	-121.8273245	Santa Clara County
214360	Fee-for-Service	1407854391	1407854391	1	1	DEPENDABLE MEDICAL EQUIP	9/1/1994	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12547 SHERMAN WAY	#1	NORTH HOLLYWOOD	CA	91605	7101	19	06037	34.2012285	-118.4069475	Los Angeles County
214365	Fee-for-Service	1144646704	1144646704	1	2	DA SILVA BHATIA, BRIANNA A M	1/11/2022	207R00000X	NA	Other	026	PHYSICIANS	170034	None	None	0	In state provider	D	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
214380	Fee-for-Service	1598400665	1598400665	1	1	DOSE MANAGEMENT CA CORPORATI	8/20/2024	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	ON	3620 BIRCH STREET	SUITE 210	NEWPORT BEACH	CA	92660	2624	30	06059	33.66216626	-117.8722496	Orange County
214427	Fee-for-Service	1336148766	1336148766	1	1	DIESTELHORST, JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1851	00	None	48.77211992	-122.473101	Whatcom County
214451	Fee-for-Service	1639326630	1639326630	1	1	DAMRON, AMANDA L	8/29/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1800 28TH STREET	None	SACRAMENTO	CA	95816	7310	34	06067	38.564892	-121.4734095	Sacramento County
214467	Fee-for-Service	1285745943	1285745943	1	1	DESAI, SUNDEEP H MD	8/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86924	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
214499	Fee-for-Service	1043527104	1043527104	1	1	DENG, YU HANG LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	38	06075	37.78096742	-122.4322568	San Francisco County
214507	Fee-for-Service	1982053609	1982053609	1	1	DELEON, RANDALL MD	8/31/2020	390200000X	NA	Other	026	PHYSICIANS	151070	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
214520	Fee-for-Service	1336349091	1336349091	1	2	DICKERSON, DANIEL L DO	8/15/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	8291	-	NOT APPLICABLE	0	In state provider	None	11901 SANTA MONICA BLVD	SUITE 204	LOS ANGELES	CA	90025	2706	19	06037	34.042059	-118.4607765	Los Angeles County
214560	Fee-for-Service	1982773388	1982773388	1	1	DURHAM UNIFIED SCHOOL	2/9/2000	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	9420 PUTNEY DR	None	DURHAM	CA	95938	9426	04	06007	39.64688179	-121.8032976	Butte County
214596	Fee-for-Service	1417013038	1417013038	1	1	DOBSON, DEANNA CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
214616	Fee-for-Service	1356190417	1356190417	1	1	DCA INVEST LLC	6/11/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7826 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4034	30	06059	33.75918737	-117.9924986	Orange County
214630	Fee-for-Service	1952416802	1952416802	1	1	DIAZ,ALBERTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	METROHEALTH MEDICAL CTR	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1998	00	None	41.46242416	-81.69888235	Cuyahoga County
214632	Fee-for-Service	1174167191	1174167191	1	1	DOORWAY FAMILY THERAPY INC	12/6/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	298 GRAND AVE	STE 100	OAKLAND	CA	94610	4797	01	06001	37.80909278	-122.2574153	Alameda County
214639	Fee-for-Service	1336137850	1336137850	1	1	DESAI, KAMLESH MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81397	08	Family Practice	0	In state provider	None	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	54	06107	36.05128153	-119.0422344	Tulare County
214641	Fee-for-Service	1588934202	1588934202	1	1	DREYFUS, MADELEINE C LCSW	11/14/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
214650	Fee-for-Service	1801357439	1801357439	1	1	DITTMAR, MICHAEL MD	5/31/2022	207R00000X	NA	Other	026	PHYSICIANS	178438	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
214660	Fee-for-Service	1649426248	1649426248	1	1	DESILVA, CECIL T MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108815	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
214662	Fee-for-Service	1750814570	1750814570	1	1	DOGAN, OZGE C MD	6/4/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166546	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
214693	Fee-for-Service	1164919908	1164919908	1	1	DHILLON, HARSUKH NIDHAN S MD	9/17/2021	208M00000X	NA	Other	026	PHYSICIANS	173570	None	None	0	In state provider	None	9500 STOCKDALE HWY	STE 203	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
214722	Fee-for-Service	1689666307	1689666307	1	1	DECONCINI, DINO T MD	4/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84439	34	Urology and Urological Surgery	0	In state provider	None	8631 W THIRD STREET	STE 715E	LOS ANGELES	CA	90048	5911	19	06037	34.07361928	-118.3803143	Los Angeles County
214759	Fee-for-Service	1619064037	1619064037	1	1	DOMANSKI, MAREK MD	2/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109878	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	#103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
214865	Fee-for-Service	1922505924	1922505924	1	1	DWORKIN, MICHAEL MD	9/1/2023	2085R0001X	NA	Other	026	PHYSICIANS	166759	None	None	0	In state provider	None	1575 SOQUEL DR	None	SANTA CRUZ	CA	95065	1700	44	06087	36.98861921	-121.9831127	Santa Cruz County
214889	Fee-for-Service	1639259732	1639259732	1	1	DE ALBA, ISRAEL MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78698	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
214911	Fee-for-Service	1154417244	1154417244	1	1	DIAZ, LUIS R DC	2/4/2004	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	811 E MASON STREET	None	SANTA BARBARA	CA	93103	3314	42	06083	34.42191044	-119.6808976	Santa Barbara County
214912	Fee-for-Service	1437134855	1437134855	1	3	DEMARTINI, DAVID R MD	10/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	39000	18	Ophthalmology	0	In state provider	None	1421 OAKDALE RD	STE 2	MODESTO	CA	95355	3359	50	06099	37.664802	-120.9576055	Stanislaus County
214920	Fee-for-Service	1265565774	1265565774	1	1	DANTAS, ZOETANIA N MD	3/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	56305	15	Obstetrics (D.O. only)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
214921	Fee-for-Service	1174167191	1174167191	1	1	DOORWAY FAMILY THERAPY INC	12/6/2024	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	298 GRAND AVE	STE 100	OAKLAND	CA	94610	4797	01	06001	37.80909278	-122.2574153	Alameda County
214971	Fee-for-Service	1942983473	1942983473	1	1	DR CARNEIRO WOUND MEDICINE C	12/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	ORP	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
215005	Fee-for-Service	1578646998	1578646998	1	1	DUIR, KIMBERLY MD	6/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	57232	01	General Practice	0	In state provider	None	400 29TH ST	STE 108	OAKLAND	CA	94609	3522	01	06001	37.81784861	-122.2652263	Alameda County
215017	Fee-for-Service	1427539998	1427539998	1	1	DYNASTY VALLEY, LLC	7/31/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	121 DORSEY DRIVE	None	GRASS VALLEY	CA	95945	5201	29	06057	39.22978911	-121.0438433	Nevada County
215029	Fee-for-Service	1851325518	1851325518	1	1	DIACONESCU, DRAGOS MD	5/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128632	None	None	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
215069	Fee-for-Service	1982888228	1982888228	1	1	DE GRADO, JUSTIN J MD	6/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131145	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
215119	Fee-for-Service	1669497038	1669497038	1	1	DOMINICK, JUSTIN E MD	8/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75156	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
215126	Fee-for-Service	1487194734	1487194734	1	1	DORF, DENNIS M DO	12/28/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18412	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
215208	Fee-for-Service	1174167191	1174167191	1	1	DOORWAY FAMILY THERAPY INC	4/9/2025	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	298 GRAND AVE	STE 100	OAKLAND	CA	94610	4797	01	06001	37.80909278	-122.2574153	Alameda County
215325	Fee-for-Service	1972985190	1972985190	1	1	DAVIS, DANIELLE S MD DO	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	156356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
215334	Fee-for-Service	1659429454	1659429454	1	1	DOGRA, BALBIR K MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	42294	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
215340	Fee-for-Service	1538119623	1538119623	1	1	DING, LIN MD	3/14/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61803	05	Anesthesiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
215386	Fee-for-Service	1396713103	1396713103	1	1	DESJARDINS, ANDREW P MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	75058	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
215406	Fee-for-Service	1689600165	1689600165	1	1	DAVID EVANGELISTA	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
215446	Fee-for-Service	1497013122	1497013122	1	1	DIAZ, AARON M	2/23/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93590	-	NOT APPLICABLE	0	In state provider	None	2650 E FOOTHILL BLVD	SUITE 100 & 200	PASADENA	CA	91107	3439	19	06037	34.14982934	-118.0957459	Los Angeles County
215453	Fee-for-Service	1780759431	1780759431	1	1	DELA PAZ, LENNIE R MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	31351	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	610 EUCLID AVE	STE 303	NATIONAL CITY	CA	91950	2953	37	06073	32.68419388	-117.0829524	San Diego County
215474	Fee-for-Service	1215223136	1215223136	1	1	DAO, TAM V MD	9/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127845	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
215508	Fee-for-Service	1790730869	1790730869	1	1	DONOVAN, ROBERT MD	1/31/1985	207P00000X	NA	Other	026	PHYSICIANS	50023	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
215514	Fee-for-Service	1558361683	1558361683	1	1	DAVID A HUELSMAN	5/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	375 DIXMYTH AVE	None	CINCINNATI	OH	45220	2475	00	None	39.14076839	-84.52169161	Hamilton County
215534	Fee-for-Service	1295222768	1295222768	1	1	DARVISHAN, ROUZBEH MD	7/22/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164770	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
215563	Fee-for-Service	1497914550	1497914550	1	1	DONANGELO, INES MD	10/20/2011	207RE0101X	NA	Endocrinology	026	PHYSICIANS	109619	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
215571	Fee-for-Service	1598961245	1598961245	1	18	DIGNITY HEALTH MEDICAL FOUND	7/1/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	FOUNDATION	1595 SOQUEL DR	STE 350	SANTA CRUZ	CA	95065	1723	44	06087	36.98879599	-121.9826354	Santa Cruz County
215579	Fee-for-Service	1598717613	1598717613	1	1	DEL NORTE MEDICAL IMAGIN	7/7/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	G, INC	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
215609	Fee-for-Service	1336320688	1336320688	1	1	DEPERIO, MIGUEL G JR MD	4/3/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43710	01	General Practice	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
215635	Fee-for-Service	1306109053	1306109053	1	1	DATTA, VIVEK MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141261	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
215662	Fee-for-Service	1407823925	1407823925	1	1	DE JONGH, LUIS F MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105786	41	Internal Medicine	0	In state provider	None	1437 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	5015	19	06037	34.01175497	-118.159261	Los Angeles County
215672	Fee-for-Service	1851534465	1851534465	1	1	DEL PILAR, ALBERTO S MD	3/25/2020	207QA0505X	NA	Adult Primary Care	026	PHYSICIANS	166310	08	Family Practice	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
215708	Fee-for-Service	1457849671	1457849671	1	1	DHARMARAJAN, HARISH MD	4/16/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
215726	Fee-for-Service	1912933953	1912933953	1	1	DOORNIK, ALBERT B MD	6/27/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63161	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
215740	Fee-for-Service	1124687645	1124687645	1	1	DUAN, SARAH DO	2/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20071	None	None	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
215745	Fee-for-Service	1942425079	1942425079	1	1	DAVIS, BARBARA J DO	7/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9925	41	Internal Medicine	0	In state provider	None	15 MAREBLU	None	ALISO VIEJO	CA	92656	3015	30	06059	33.5729913	-117.703431	Orange County
215749	Fee-for-Service	1093863961	1093863961	1	1	DINH, LONG THAI MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80158	41	Internal Medicine	0	In state provider	None	25 S RAYMOND AVE	STE 201	ALHAMBRA	CA	91801	7146	19	06037	34.09042452	-118.1450725	Los Angeles County
215779	Fee-for-Service	1326134859	1326134859	1	1	DALL'ERA, MARC A MD	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95571	34	Urology and Urological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
215818	Fee-for-Service	1124893482	1124893482	1	1	DESTINY BEHAVIORAL HEALTH	4/3/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	2250 CAMINO RAMON	None	SAN RAMON	CA	94583	1353	07	06013	37.776366	-121.9698225	Contra Costa County
215850	Fee-for-Service	1497914550	1497914550	1	1	DONANGELO, INES MD	10/20/2011	207RE0101X	NA	Endocrinology	026	PHYSICIANS	109619	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
215859	Fee-for-Service	1598961245	1598961245	1	18	DIGNITY HEALTH MEDICAL FOUND	7/1/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	FOUNDATION	1595 SOQUEL DR	STE 350	SANTA CRUZ	CA	95065	1723	44	06087	36.98879599	-121.9826354	Santa Cruz County
215892	Fee-for-Service	1336320688	1336320688	1	1	DEPERIO, MIGUEL G JR MD	4/3/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43710	41	Internal Medicine	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
215907	Fee-for-Service	1255591608	1255591608	2	1	DEVEN COX	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
215949	Fee-for-Service	1083669592	1083669592	1	1	DICKINSON, LAWRENCE D MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	84805	14	Neurological Surgery	0	In state provider	None	20055 LAKE CHABOT RD	STE 110	CASTRO VALLEY	CA	94546	5332	01	06001	37.69836512	-122.0873587	Alameda County
215980	Fee-for-Service	1871859504	1871859504	1	1	DEWAN, ROHIT R DO	4/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13849	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
216057	Fee-for-Service	1417660978	1417660978	1	1	DUSK HEALTHCARE INC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2725 E BROADWAY	None	LONG BEACH	CA	90803	5431	19	06037	33.76576615	-118.1600882	Los Angeles County
216083	Fee-for-Service	1538647953	1538647953	1	1	DUNN, OUN S RCP	10/26/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
216149	Fee-for-Service	1386103109	1386103109	1	1	DENG, LILY Y MD	8/8/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	178651	None	None	0	In state provider	None	2652 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3041	43	06085	37.35228637	-121.9754073	Santa Clara County
216183	Fee-for-Service	1770767311	1770767311	1	1	DUDOVITZ, REBECCA N MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100268	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
216184	Fee-for-Service	1578007514	1578007514	1	1	DE CRAIG RANCH, LLC	6/3/2021	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	NICAN NORTH LAS VEGAS CA	1550 W CRAIG RD	None	LAS VEGAS	NV	89044	0224	00	None	36.2395135	-115.162875	Clark County
216243	Fee-for-Service	1801112339	1801112339	1	1	DUBEY,ANJU	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	451 CLARKSON AVENUE	None	BROOKLYN	NY	11203	2054	00	None	40.656258	-73.9446165	Kings County
216261	Fee-for-Service	1467560565	1467560565	1	1	DR. HEMANG MAHENDRA GANDHI M	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20701 N SCOTTSDALE RD	STE 107-601	SCOTTSDALE	AZ	85255	6413	00	None	33.6750627	-111.9253307	Maricopa County
216271	Fee-for-Service	1215982756	1215982756	1	1	DUONG, ANH T MD	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	78152	10	Gastroenterology (M.D. only)	0	In state provider	None	35900 BOB HOPE DR	275	RANCHO MIRAGE	CA	92270	1767	33	06065	33.790311	-116.405864	Riverside County
216273	Fee-for-Service	1033175658	1033175658	1	1	DUONG, KIEN-AN MD	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94108	40	Pediatrics	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
216296	Fee-for-Service	1336125236	1336125236	1	1	DWAYNE'S FRIENDLY PHRMCY	6/1/1996	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SABRINA ENTERPRISES	644 W LINE ST	None	BISHOP	CA	93514	3315	14	06027	37.36134772	-118.4010159	Inyo County
216304	Fee-for-Service	1952833691	1952833691	1	1	DEMAIO, RICHARD L MD	6/21/2021	207L00000X	NA	Other	026	PHYSICIANS	158950	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
216322	Fee-for-Service	1639314701	1639314701	1	1	D'ANGELO, RASHIN	2/29/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
216403	Fee-for-Service	1780863340	1780863340	1	1	DALY, MEGAN E MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100798	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
216422	Fee-for-Service	1821120197	1821120197	1	1	DIBLASI, DANIEL A LMFT	12/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
216466	Fee-for-Service	1578007514	1578007514	1	1	DE CRAIG RANCH, LLC	6/28/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	NICAN NORTH LAS VEGAS CA	1550 W CRAIG RD	None	LAS VEGAS	NV	89044	0224	00	None	36.2395135	-115.162875	Clark County
216484	Fee-for-Service	1932616638	1932616638	1	1	DEL CASTILLO, ANDREA LMFT	10/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
216536	Fee-for-Service	1730993874	1730993874	1	1	DIALLO, BRUSHIRA H	3/12/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
216562	Fee-for-Service	1033175658	1033175658	1	1	DUONG, KIEN-AN MD	10/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	94108	41	Internal Medicine	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
216597	Fee-for-Service	1336386416	1336386416	1	1	DONTHINENI, RAKESH MD INC	3/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55666	20	Orthopedic Surgery	0	In state provider	None	5700 TELEGRAPH AVENUE	SUITE 100	OAKLAND	CA	94609	1710	01	06001	37.84323585	-122.2614659	Alameda County
216599	Fee-for-Service	1144612813	1144612813	1	1	DEKKER, ANNETTE M MD	7/22/2020	207P00000X	NA	Other	026	PHYSICIANS	169132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
216631	Fee-for-Service	1366829186	1366829186	1	1	DINH, ANDREW T MD	7/21/2020	207L00000X	NA	Other	026	PHYSICIANS	161236	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216650	Fee-for-Service	1417042334	1417042334	1	1	DEMASELLIS, GINA M MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
216674	Fee-for-Service	1598961245	1598961245	1	30	DIGNITY HEALTH MEDICAL FOUND	4/28/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-DOMINICAN	1595 SOQUEL DR	210	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
216746	Fee-for-Service	1861502189	1861502189	1	1	DELIMA, CHRISTOPHER J LCSW	7/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
216773	Fee-for-Service	1619141751	1619141751	1	1	DANDAPANI, SAVITA V MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110779	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
216775	Fee-for-Service	1144239500	1144239500	1	1	DAVID WADDELL	11/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	624 HOSPITAL DR	None	MOUNTAIN HOME	AR	72653	2955	00	None	36.342738	-92.3962095	Baxter County
216808	Fee-for-Service	1629132592	1629132592	1	1	DRAKE, EDWARD S DO	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5769	08	Family Practice	0	In state provider	None	420 W CENTRAL AVE	STE A	BREA	CA	92821	3001	30	06059	33.93194888	-117.9029987	Orange County
216837	Fee-for-Service	1467942540	1467942540	1	1	DE NIEAR, MATTHEW A MD	11/27/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	166649	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
216864	Fee-for-Service	1073705208	1073705208	1	1	DUBOWITZ, NADINE MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98723	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216867	Fee-for-Service	1285624320	1285624320	1	1	DAVIS, LOUISE C MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42406	18	Ophthalmology	0	In state provider	None	9100 WILSHIRE BLVD	STE 852W	BEVERLY HILLS	CA	90212	3411	19	06037	34.06703047	-118.390212	Los Angeles County
216872	Fee-for-Service	1578974069	1578974069	1	1	DEVANABANDA, ARVIND REDDY M	7/10/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	171266	None	None	0	In state provider	D	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
216876	Fee-for-Service	1316982507	1316982507	1	1	DORADO, RUSSELL D MD	12/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87541	05	Anesthesiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
216916	Fee-for-Service	1639105489	1639105489	1	1	DANNENBERG, BERNARD W MD	8/14/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49855	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216917	Fee-for-Service	1043664881	1043664881	1	1	DUBE, PRIYANKA DO	3/25/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18671	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
216921	Fee-for-Service	1942283825	1942283825	1	1	DAVID, SEAN P MD	12/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101334	08	Family Practice	0	In state provider	None	300 PASTEUR DRIVE	MC5500	PALO ALTO	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
216924	Fee-for-Service	1598943615	1598943615	1	1	DHALL, SANJAY S MD	11/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102531	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216982	Fee-for-Service	1154520930	1154520930	1	1	DAFTARI, BABAK MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98628	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
217026	Fee-for-Service	1962782896	1962782896	1	1	DAVE, PALAK A MD	4/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118057	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
217034	Fee-for-Service	1811068885	1811068885	1	1	DER-SARKISSIAN, JACK K	12/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60009	08	Family Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
217039	Fee-for-Service	1962508366	1962508366	1	1	DIRKS, BRET A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	850 W IRONWOOD DR	STE 300	COEUR D ALENE	ID	83814	4903	00	None	47.69429085	-116.7957548	Kootenai County
217062	Fee-for-Service	1619141751	1619141751	1	1	DANDAPANI, SAVITA V MD	6/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110779	30	Radiology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
217126	Fee-for-Service	1821134040	1821134040	1	2	DIGNITY HEALTH	4/7/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4555 EL CAMINO REAL	UNIT A	ATASCADERO	CA	93422	2700	40	06079	35.49733794	-120.6812704	San Luis Obispo County
217167	Fee-for-Service	1932373529	1932373529	1	1	DICKENS, AARON J MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124199	20	Orthopedic Surgery	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
217196	Fee-for-Service	1811534811	1811534811	1	1	DESERT BLOOM RECOVERY LLC	1/7/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	14286 CALIFORNIA AVE	SUITE 102	VICTORVILLE	CA	92392	2911	36	06071	34.5103347	-117.3286484	San Bernardino County
217203	Fee-for-Service	1639105489	1639105489	1	1	DANNENBERG, BERNARD W MD	8/14/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49855	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
217209	Fee-for-Service	1750466298	1750466298	1	1	DESAI, ASHA K MD	2/8/2015	207K00000X	NA	Other	026	PHYSICIANS	39587	None	None	0	In state provider	None	3581 PALMER DR	STE 203	SHINGLE SPRINGS	CA	95682	8237	09	06017	38.66109103	-120.9649544	El Dorado County
217210	Fee-for-Service	1609326289	1609326289	1	1	DO, DIEN NP	2/18/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
217264	Fee-for-Service	1871667022	1871667022	1	1	DEIDRICK, BRENDA R	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
217272	Fee-for-Service	1053321273	1053321273	1	1	DANICHICH, MICHELE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2827 FORT MISSOULA RD	None	MISSOULA	MT	59804	0000	00	None	46.847151	-114.0480405	Missoula County
217274	Fee-for-Service	1821443375	1821443375	1	1	DOU, EDA MD	6/21/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172104	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
217291	Fee-for-Service	1649402785	1649402785	1	1	DEVRIES, IDDO E CCC-SLP	10/31/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	410 E MERCED AVE	STE. D	WEST COVINA	CA	91790	5058	19	06037	34.05493113	-117.9381152	Los Angeles County
217296	Fee-for-Service	1548462534	1548462534	1	1	DAVIO, MICHAEL B MD	8/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88165	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
217320	Fee-for-Service	1558589812	1558589812	1	1	DACARE, INC	9/10/1997	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	DAYOUT ADULT DAY HEALTH	616 MAIN STREET	None	BRAWLEY	CA	92227	0000	13	06025	32.97860254	-115.531704	Imperial County
217345	Fee-for-Service	1386825164	1386825164	1	1	DE LA SIERRA, ANA L MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94155	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
217365	Fee-for-Service	1104697499	1104697499	1	1	DEEPLY ROOTED FAMILY COUNSEL	8/23/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ING	5740 N PALM AVE	STE 101	FRESNO	CA	93704	1800	10	06019	36.82151326	-119.8082243	Fresno County
217376	Fee-for-Service	1912439027	1912439027	1	1	DUONG, JENNIFER T MD	8/9/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	186920	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
217394	Fee-for-Service	1174902548	1174902548	1	1	DREGER, NICHOLAS J MD	11/1/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	149388	None	None	0	In state provider	None	11234 ANDERSON ST	SUITE 6200	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
217413	Fee-for-Service	1821134040	1821134040	1	2	DIGNITY HEALTH	4/7/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4555 EL CAMINO REAL	UNIT A	ATASCADERO	CA	93422	2700	40	06079	35.49733794	-120.6812704	San Luis Obispo County
217495	Fee-for-Service	1649732827	1649732827	1	1	DANG, KIM N MD	6/2/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177149	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
217535	Fee-for-Service	1912038126	1912038126	1	1	DURAND, LORI C LCSW	11/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
217538	Fee-for-Service	1023428414	1023428414	1	1	DIDINGER, TRACEY C MD	7/21/2023	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	135500	None	None	0	In state provider	None	16311 VENTURA BLVD	SUITE #1150	ENCINO	CA	91436	4386	19	06037	34.15706864	-118.4885978	Los Angeles County
217545	Fee-for-Service	1801112669	1801112669	1	1	DROKER, BRIAN S MD	10/5/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	119924	None	None	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
217716	Fee-for-Service	1548311145	1548311145	1	1	DMS IMAGING INC	7/8/2008	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	18000 STUDEBAKER RD	STE 700	CERRITOS	CA	90703	2684	19	06037	33.86863289	-118.0988933	Los Angeles County
217735	Fee-for-Service	1699222851	1699222851	1	1	DR KAZARIAN PROFESSIONAL	4/6/2018	261QU0200X	NA	Other	026	PHYSICIANS	104760	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL CORP	8337 LAUREL CANYON BLVD	None	SUN VALLEY	CA	91352	3809	19	06037	34.22306683	-118.3964783	Los Angeles County
217781	Fee-for-Service	1932150836	1932150836	1	1	DESAI, KIRTIKUMAR G MD	8/20/1994	207L00000X	NA	Other	026	PHYSICIANS	65930	05	Anesthesiology	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
217795	Fee-for-Service	1477567923	1477567923	1	1	DEACON, JOHN M MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66064	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18TH AVE, HWY 13	None	CLEARLAKE	CA	95422	0000	17	06033	38.93598084	-122.6107567	Lake County
217796	Fee-for-Service	1669419693	1669419693	1	1	DAVIDSON,JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N CURTIS RD	None	BOISE	ID	83706	0000	00	None	43.61455048	-116.256231	Ada County
217799	Fee-for-Service	1437473121	1437473121	1	1	DABISH, CYNTHIA RITA MD	8/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106568	05	Anesthesiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
217802	Fee-for-Service	1669682811	1669682811	1	1	DUDLEY, BENJAMIN C MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136154	34	Urology and Urological Surgery	0	In state provider	None	770 MASON STREET	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
217867	Fee-for-Service	1962412056	1962412056	1	1	DOROSTKAR, PARVIN MD	5/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
217960	Fee-for-Service	1457821522	1457821522	1	1	DAVIS, JORDAN LMFT	9/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
217976	Fee-for-Service	1295734721	1295734721	1	1	DEL JUNCO, ROBERT MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40272	84	Surgery-Head and Neck	0	In state provider	None	302 W LA VETA AVE	STE 201	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
218000	Fee-for-Service	1528032505	1528032505	1	1	DVA HEALTHCARE RENAL INC	7/1/1991	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	HANFORD DIALYSIS	402 W 8TH ST	None	HANFORD	CA	93230	4536	16	06031	36.32693051	-119.6509889	Kings County
218073	Fee-for-Service	1639752553	1639752553	1	2	DISPATCHHEALTH-CA, PC	8/4/2023	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
218081	Fee-for-Service	1942516786	1942516786	1	1	DEIBLER, LINDSAY B PHD	12/3/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1110 E CHAPMAN AVE	STE 201	ORANGE	CA	92866	2139	30	06059	33.78781993	-117.8418094	Orange County
218175	Fee-for-Service	1548266505	1548266505	1	1	DOMINGUEZ, CARLOS C MD	10/21/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32934	01	General Practice	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
218264	Fee-for-Service	1851351209	1851351209	1	1	DALTON, KATHLEEN PT	6/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
218267	Fee-for-Service	1295734721	1295734721	1	1	DEL JUNCO, ROBERT MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40272	04	Otology, Laryngology, Rhinology	0	In state provider	None	302 W LA VETA AVE	STE 201	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
218273	Fee-for-Service	1598961245	1598961245	1	5	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	-DOMINICAN	1595 SOQUEL DR	STE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
218306	Fee-for-Service	1528002839	1528002839	1	1	DEVGAN-KACKER, SONIA MD	10/27/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	67070	None	None	0	In state provider	None	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
218351	Fee-for-Service	1134854094	1134854094	1	1	DEERMER, COLEEN LCSW	9/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
218360	Fee-for-Service	1639752553	1639752553	1	2	DISPATCHHEALTH-CA, PC	8/4/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
218361	Fee-for-Service	1952793200	1952793200	1	1	DIGNITY TRANSPORTATION	6/19/2018	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICE INC	1751 E ROUTE 66	None	GLENDORA	CA	91741	3361	19	06037	34.12915038	-117.8318887	Los Angeles County
218397	Fee-for-Service	1669596839	1669596839	1	2	DOUGLAS O CHARTERS &	1/1/1979	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	KENNETH L HIEB	3749 S MOONEY BLVD	None	VISALIA	CA	93277	8000	54	06107	36.296091	-119.31498	Tulare County
218407	Fee-for-Service	1114959657	1114959657	1	1	DRABANT, BRADLEE G MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
218420	Fee-for-Service	1427026145	1427026145	1	1	DURAZO, ANTONIO JR MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	48642	08	Family Practice	0	In state provider	OROSI URGENT CARE CTR	41696 ROAD 128	None	OROSI	CA	93647	2059	54	06107	36.54685753	-119.2869082	Tulare County
218444	Fee-for-Service	1255536520	1255536520	1	1	DELA CRUZ, FRANCISCO C	4/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
218520	Fee-for-Service	1598758245	1598758245	1	1	DHIMAN, JAY K MD	10/17/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69368	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
218554	Fee-for-Service	1295734721	1295734721	1	1	DEL JUNCO, ROBERT MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	40272	66	Emergency Medicine (Urgent Care)	0	In state provider	None	302 W LA VETA AVE	STE 201	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
218565	Fee-for-Service	1104882539	1104882539	1	1	DELORENZI, RAYMOND J MD	12/12/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	183342	None	None	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
218591	Fee-for-Service	1063447241	1063447241	1	1	DANIEL-UNDERWOOD, LYNDA	10/31/1991	207P00000X	NA	Other	026	PHYSICIANS	74543	None	None	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
218615	Fee-for-Service	1598961245	1598961245	1	23	DIGNITY HEALTH MEDICAL FOUND	10/17/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1505 SOQUEL DR	STE 1	SANTA CRUZ	CA	95065	1716	44	06087	36.98803429	-121.9848045	Santa Cruz County
218634	Fee-for-Service	1528099611	1528099611	1	1	DEMORE, DELPHINE J PYSD	2/19/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	18345 VENTURA BLVD	SUITE 300	TARZANA	CA	91356	4232	19	06037	34.16738049	-118.5325057	Los Angeles County
218685	Fee-for-Service	1093922635	1093922635	1	1	DRAGOMAN, ASHLEY L MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99866	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
218700	Fee-for-Service	1114959657	1114959657	1	1	DRABANT, BRADLEE G MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
218707	Fee-for-Service	1427026145	1427026145	1	1	DURAZO, ANTONIO JR MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	48642	41	Internal Medicine	0	In state provider	OROSI URGENT CARE CTR	41696 ROAD 128	None	OROSI	CA	93647	2059	54	06107	36.54685753	-119.2869082	Tulare County
218721	Fee-for-Service	1225064454	1225064454	1	1	DHILLON, BALRAJ S MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	110 E NORTH ST	None	TAFT	CA	93268	3606	15	06029	35.13933309	-119.4508927	Kern County
218734	Fee-for-Service	1629053939	1629053939	1	1	D'ANDRE, STACY D MD	1/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85051	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
218750	Fee-for-Service	1841343548	1841343548	1	1	DI FRANCO, MATTHEW J MD	10/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	58994	40	Pediatrics	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
218777	Fee-for-Service	1154401701	1154401701	1	1	DARIAN, GARO BAYRAK MD	12/1/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42268	41	Internal Medicine	0	In state provider	#101	2595 E WASHINGTON BLVD	None	PASADENA	CA	91107	1409	19	06037	34.16917051	-118.096893	Los Angeles County
218781	Fee-for-Service	1750199105	1750199105	1	1	DANIEL, SHANIQA CNP	2/27/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
218817	Fee-for-Service	1609801711	1609801711	1	1	DONTA, THEODORE S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF IOWA HOSP & CLNS	200 HAWKINS DR	None	IOWA CITY	IA	52242	0000	00	None	41.659929	-91.548099	Johnson County
218861	Fee-for-Service	1114258944	1114258944	1	1	DERDERYAN, EDMOND V MD	11/15/2010	207R00000X	NA	Other	026	PHYSICIANS	110089	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092468	-117.2977236	San Bernardino County
218882	Fee-for-Service	1144380338	1144380338	1	1	DALAL, SAPNA K MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86718	08	Family Practice	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
218903	Fee-for-Service	1992061717	1992061717	1	1	DELALOYE, SIBYLLE F MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137207	36	Psychiatry	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
218921	Fee-for-Service	1275701286	1275701286	1	1	DODGE, KELLY L MD	10/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
218963	Fee-for-Service	1609372523	1609372523	1	1	DESAI, AKASH MD	8/22/2022	390200000X	NA	Other	026	PHYSICIANS	176775	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
218994	Fee-for-Service	1649415308	1649415308	1	1	DREW C HUNTER,MD	5/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5555 W THUNDERBIRD RD	None	GLENDALE	AZ	85306	4622	00	None	33.609294	-112.1797485	Maricopa County
219014	Fee-for-Service	1912369414	1912369414	1	1	DREAM ANESTHESIA A	3/28/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	PROFESSIONAL MEDICAL COR	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
219023	Fee-for-Service	1629053939	1629053939	1	1	D'ANDRE, STACY D MD	1/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85051	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
219097	Fee-for-Service	1801974084	1801974084	1	1	DEFOREST, IMELDA V MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	51405	40	Pediatrics	0	In state provider	None	1700 N ROSE AVE	STE 210	OXNARD	CA	93030	7369	56	06111	34.21746	-119.155545	Ventura County
219114	Fee-for-Service	1578537494	1578537494	1	1	DEBLOIS, THOMAS E MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73409	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
219132	Fee-for-Service	1053534768	1053534768	1	1	DYER, TAMMY C LCSW	6/20/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4600 BROADWAY	STE 1100	SACRAMENTO	CA	95820	1527	34	06067	38.546127	-121.452669	Sacramento County
219197	Fee-for-Service	1487949343	1487949343	1	1	DANG, QUYNH Q	11/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128820	None	None	0	In state provider	None	555 TACHEVAH DRIVE	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
219219	Fee-for-Service	1669011599	1669011599	1	1	DE LEON, NADIA LMFT	12/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
219250	Fee-for-Service	1548223571	1548223571	1	1	DOMANCHUK, PAUL M 0D	1/31/1988	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	616 H ST	None	EUREKA	CA	95501	1026	12	06023	40.80110083	-124.163559	Humboldt County
219256	Fee-for-Service	1619097789	1619097789	1	1	DE LA TORRE, ANA R LMFT	9/28/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2777 JEFFERSON ST	SUITE 200C	CARLSBAD	CA	92008	1743	37	06073	33.16370246	-117.3476018	San Diego County
219258	Fee-for-Service	1194800755	1194800755	1	1	DAS, RUPALI	10/31/1990	207R00000X	NA	Other	026	PHYSICIANS	65098	None	None	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
219264	Fee-for-Service	1720010119	1720010119	1	1	DIEGO, ALICE T MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60216	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
219310	Fee-for-Service	1750010195	1750010195	1	1	DANMAR VILLAS LLC	7/14/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	960 NORTH MARTEL AVE	None	LOS ANGELES	CA	90046	6608	19	06037	34.08876	-118.351091	Los Angeles County
219314	Fee-for-Service	1104215920	1104215920	1	1	DESERT CARE ENTERPRISES LLC	12/14/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	555 S SUNRISE WAY	SUITE 213	PALM SPRINGS	CA	92264	7869	33	06065	33.814971	-116.528247	Riverside County
219347	Fee-for-Service	1467569707	1467569707	1	1	DUNN, JAMES T MD	12/31/1992	2086S0127X	NA	General Surgery	026	PHYSICIANS	40257	02	General Surgery	0	In state provider	None	317 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4355	42	06083	34.42967671	-119.7228362	Santa Barbara County
219391	Fee-for-Service	1073665360	1073665360	1	5	DIGNITY HEALTH	5/16/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1700 NORTH ROSE AVENUE	SUITE 300	OXNARD	CA	93030	7626	56	06111	34.21746	-119.155545	Ventura County
219394	Fee-for-Service	1487007373	1487007373	1	1	DAVIS, ASHLEY D CCC-SLP	6/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
219402	Fee-for-Service	1578537494	1578537494	1	1	DEBLOIS, THOMAS E MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73409	26	Psychiatry (child)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
219410	Fee-for-Service	1538723622	1538723622	1	1	DAO, PATRICK H NP	6/23/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
219438	Fee-for-Service	1952550808	1952550808	1	1	DORSETT, KIMBERLY A PHD	7/31/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
219450	Fee-for-Service	1437150562	1437150562	1	1	DOUGHTY, FLOYD A MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72804	18	Ophthalmology	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
219452	Fee-for-Service	1831341007	1831341007	1	1	DICAMILLO, PAUL	11/30/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
219553	Fee-for-Service	1720010119	1720010119	1	1	DIEGO, ALICE T MD	6/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60216	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
219605	Fee-for-Service	1104215920	1104215920	1	1	DESERT CARE ENTERPRISES LLC	12/14/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	555 S SUNRISE WAY	SUITE 213	PALM SPRINGS	CA	92264	7869	33	06065	33.814971	-116.528247	Riverside County
219643	Fee-for-Service	1366579542	1366579542	1	1	DENNING, BRUCE L DC	12/31/1984	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	160 S J ST	None	TULARE	CA	93274	4025	54	06107	36.20669193	-119.3470962	Tulare County
219680	Fee-for-Service	1053359323	1053359323	1	1	DAPAR, RHYS V MD	10/31/1991	207P00000X	NA	Other	026	PHYSICIANS	72749	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
219719	Fee-for-Service	1720545288	1720545288	1	1	DENBAUGH, MADELON A	9/17/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	31515 RANCHO PUEBLO RD	SUITE 101	TEMECULA	CA	92592	0000	33	06065	33.47922478	-117.1107757	Riverside County
219775	Fee-for-Service	1871551341	1871551341	1	1	DRASIN, GEORGE F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 DIVISION ST	None	OREGON CITY	OR	97045	0000	00	None	45.35630784	-122.5883649	Clackamas County
219780	Fee-for-Service	1396712683	1396712683	1	2	DAVID, CHARLES MD	2/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	44877	01	General Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3130	36	06071	34.04805253	-117.249534	San Bernardino County
219831	Fee-for-Service	1942421334	1942421334	1	1	DAVID Y KAHN M.D.	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10503 W THUNDERBIRD BLVD	STE 366	SUN CITY	AZ	85351	2721	00	None	33.604578	-112.285998	Maricopa County
219835	Fee-for-Service	1992076517	1992076517	1	1	DHOOT, SONIA B MD	9/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	122297	18	Ophthalmology	0	In state provider	None	9041 MAGNOLIA AVE	SUITE 207	RIVERSIDE	CA	92503	3956	33	06065	33.92541585	-117.4378266	Riverside County
219859	Fee-for-Service	1174719850	1174719850	1	1	DIEHN, MAXIMILIAN MD	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92153	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
219862	Fee-for-Service	1437211588	1437211588	1	1	DHARMAJI, REKHA S MD	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93234	41	Internal Medicine	0	In state provider	None	2500 GRANT ROAD	None	MOUNTIAN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
219881	Fee-for-Service	1255864385	1255864385	1	1	DEJONG, COLETTE MD	7/17/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160945	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
219926	Fee-for-Service	1346363744	1346363744	1	1	DOUGLAS P MORGAN DO	8/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
219949	Fee-for-Service	1275995862	1275995862	1	1	DAGDAG, ARIANA M MD	6/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	151998	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
219957	Fee-for-Service	1598961245	1598961245	1	13	DIGNITY HEALTH MEDICAL FOUND	9/19/2013	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1595 SOQUEL DRIVE	STE 110	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
219964	Fee-for-Service	1912999269	1912999269	1	1	DOONER, BARBARA CRNA	3/29/2023	367500000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
220065	Fee-for-Service	1821617713	1821617713	1	1	DHAMI, ALYSHA MD	12/10/2024	390200000X	NA	Other	026	PHYSICIANS	188587	30	Radiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
220112	Fee-for-Service	1588770069	1588770069	1	1	DHESI RAJPREET S MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50255	25	Physical Medicine and Rehabilitation	0	In state provider	None	481 PLUMAS BLVD	STE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
220119	Fee-for-Service	1366457764	1366457764	1	1	DOLPHIN HEALTH, INC	6/8/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	DOLPHIN HEALTH	7400 MACARTHUR BLVD	STE A	OAKLAND	CA	94605	2939	01	06001	37.7687873	-122.1714554	Alameda County
220147	Fee-for-Service	1174719850	1174719850	1	1	DIEHN, MAXIMILIAN MD	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92153	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220160	Fee-for-Service	1558649699	1558649699	1	1	DUAN, MARYANNE L LMFT	6/30/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12821 NEWPORT AVE	None	TUSTIN	CA	92780	2711	30	06059	33.75101941	-117.8093474	Orange County
220168	Fee-for-Service	1255864385	1255864385	1	1	DEJONG, COLETTE MD	7/17/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160945	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220177	Fee-for-Service	1871903534	1871903534	1	1	DURSTENFELD, MATTHEW S MD	6/27/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154168	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
220179	Fee-for-Service	1053545376	1053545376	1	1	DO, THOMAS B MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107618	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
220193	Fee-for-Service	1598961245	1598961245	1	11	DIGNITY HEALTH MEDICAL FOUND	6/15/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	9515 SOQUEL DR	STE 100	APTOS	CA	95003	4135	44	06087	36.9753751	-121.8848219	Santa Cruz County
220199	Fee-for-Service	1770016826	1770016826	1	1	DUBIN, TARYN L MD	5/12/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158751	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
220306	Fee-for-Service	1811239163	1811239163	1	1	DHILLON, GAGANDEEP S MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146633	36	Psychiatry	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
220313	Fee-for-Service	1598997678	1598997678	1	1	DAVIS, KATHRYN M PHD	8/9/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1454 E 2ND ST	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
220354	Fee-for-Service	1063754737	1063754737	1	1	DEEPAALEYA MEDICAL INC	10/29/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	61977	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9333 BASELINE RD	SUITE 160	RANCHO CUCAMONGA	CA	91730	1350	36	06071	34.12150849	-117.601407	San Bernardino County
220467	Fee-for-Service	1053545376	1053545376	1	1	DO, THOMAS B MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107618	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
220511	Fee-for-Service	1104233063	1104233063	1	1	DELGADO, CAITLIN E	5/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
220529	Fee-for-Service	1578593778	1578593778	1	1	DA SILVA, FERNANDA N MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	65096	08	Family Practice	0	In state provider	None	7248 S LAND PARK DR	STE 205	SACRAMENTO	CA	95831	3661	34	06067	38.494602	-121.513743	Sacramento County
220545	Fee-for-Service	1598961245	1598961245	1	26	DIGNITY HEALTH MEDICAL FOUND	4/22/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-DOMINICAN INC	1595 SOQUEL DR	STE 230	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
220618	Fee-for-Service	1720473085	1720473085	1	1	DAVID MCELROY	2/28/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
220620	Fee-for-Service	1497140537	1497140537	1	1	DIEP, ROBERT T MD	9/1/2021	207RH0000X	NA	Hematology	026	PHYSICIANS	172103	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220626	Fee-for-Service	1639244049	1639244049	1	1	DINH, CHINH T MD	10/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65428	08	Family Practice	0	In state provider	KNOTT-BALL ANAHEIM MED	3414 W BALL RD	STE F	ANAHEIM	CA	92804	3726	30	06059	33.81723326	-118.0087815	Orange County
220648	Fee-for-Service	1457812398	1457812398	1	1	DONZELLI, GRACE F MD	9/26/2024	207L00000X	NA	Other	026	PHYSICIANS	185508	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
220649	Fee-for-Service	1174259113	1174259113	1	1	DOS SANTOS, ZEHRA LCSW	8/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2210 COTTAGE LN	None	SANTA MARIA	CA	93455	1367	42	06083	34.91929894	-120.4222606	Santa Barbara County
220661	Fee-for-Service	1346789245	1346789245	1	1	DONOHOE, CHRISTINE LCSW	2/20/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1700 SOSCOL AVE	30	NAPA	CA	94559	1351	28	06055	38.305854	-122.2850235	Napa County
220662	Fee-for-Service	1063754737	1063754737	1	1	DEEPAALEYA MEDICAL INC	10/29/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	61977	41	Internal Medicine	0	In state provider	None	9333 BASELINE RD	SUITE 160	RANCHO CUCAMONGA	CA	91730	1350	36	06071	34.12150849	-117.601407	San Bernardino County
220767	Fee-for-Service	1841687878	1841687878	1	1	DADOYAN BEHAVIORAL MEDICAL G	9/25/2023	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	ROUP INC	4955 VAN NUYS BLVD	STE 301	SHERMAN OAKS	CA	91403	1815	19	06037	34.160805	-118.4487295	Los Angeles County
220771	Fee-for-Service	1790036671	1790036671	1	1	DELTA DRUGS II, INC.	11/1/2012	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	437 FERNANDO CT	None	GLENDALE	CA	91204	2723	19	06037	34.12841123	-118.2612779	Los Angeles County
220773	Fee-for-Service	1043456106	1043456106	1	7	DIGNITY HEALTH MEDICAL FOUND	3/14/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	280 SIERRA COLLEGE DR	STE 115	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
220820	Fee-for-Service	1275058869	1275058869	1	1	DRESSEL, DONALD V LCSW	2/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10 ARGENT ALY	APT 5	SAN FRANCISCO	CA	94131	1831	38	06075	37.75278053	-122.4431775	San Francisco County
220854	Fee-for-Service	1992818645	1992818645	1	1	DESERT AIR AMBULANCE INC	2/3/2005	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	140 N BROADWAY	None	BLYTHE	CA	92225	1608	33	06065	33.61119568	-114.5967733	Riverside County
220868	Fee-for-Service	1235751819	1235751819	1	1	DESWAL, ANANYA PT	5/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1617 ST MARKS PLAZA	B	STOCKTON	CA	95207	6423	39	06077	37.98864819	-121.3268062	San Joaquin County
220886	Fee-for-Service	1265414833	1265414833	1	1	DE OLIVEIRA, ELIZABETH R	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50168	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	50 BELLEFONTAINE ST	STE 405	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
220892	Fee-for-Service	1396764080	1396764080	1	1	DECATUR GENERAL HOSPITAL	8/29/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1201 7TH ST SE	None	DECATUR	AL	35601	3337	00	None	34.5911209	-86.97267883	Morgan County
220901	Fee-for-Service	1417976077	1417976077	1	1	DR CHRISTINE EBBERS	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NORAN NEUROLOGICAL	800 E 28TH STREET	None	MINNEAPOLIS	MN	55407	3799	00	None	44.95428	-93.2614155	Hennepin County
220944	Fee-for-Service	1497425045	1497425045	1	1	DAME, MADALYN CCC-SLP	12/5/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
220985	Fee-for-Service	1013156033	1013156033	1	1	DAY, ARTHUR LMFT	2/25/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1531 CORPORATE WAY	None	SACRAMENTO	CA	95831	3888	34	06067	38.492352	-121.520178	Sacramento County
220994	Fee-for-Service	1073040614	1073040614	1	1	DIAZ VOSS VARELA, DAVID A MD	3/22/2021	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
220997	Fee-for-Service	1437213279	1437213279	1	2	DIENTES COMMUNITY DENTAL	2/5/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	302 RIVERSIDE AVE	None	SANTA CRUZ	CA	95060	5524	44	06087	36.96633715	-122.018297	Santa Cruz County
221047	Fee-for-Service	1316133051	1316133051	1	1	DHAYA N. KUTNIKAR M.D	7/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1805 LAMY LN	None	MONROE	LA	71201	3739	00	None	32.53302463	-92.09337256	Ouachita Parish
221055	Fee-for-Service	1841687878	1841687878	1	1	DADOYAN BEHAVIORAL MEDICAL G	9/25/2023	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ROUP INC	4955 VAN NUYS BLVD	STE 301	SHERMAN OAKS	CA	91403	1815	19	06037	34.160805	-118.4487295	Los Angeles County
221063	Fee-for-Service	1467553586	1467553586	1	1	DEEDWANIA, PRAKASH C MD	4/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	34886	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2210 E ILLINOIS AVE	STE 508	FRESNO	CA	93701	2184	10	06019	36.74500687	-119.7846885	Fresno County
221086	Fee-for-Service	1821318106	1821318106	1	1	DE LUNA, REGINA I MD	5/11/2018	207ZP0102X	NA	Other	026	PHYSICIANS	53597	None	None	0	In state provider	None	18300 HIGHWAY 18	None	APPLEY VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
221098	Fee-for-Service	1740962026	1740962026	1	1	DELGADO, MARVIN NP	12/11/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1625 PINE STREET	SUITE 102	REDDING	CA	96001	1018	45	06089	40.58321511	-122.388937	Shasta County
221144	Fee-for-Service	1932526860	1932526860	1	1	DICKEY, BENJAMIN W MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149307	01	General Practice	0	In state provider	None	2323 BERTHARDS DR	None	SANTA ROSA	CA	95405	8500	49	06097	38.427075	-122.6666655	Sonoma County
221167	Fee-for-Service	1790217511	1790217511	1	1	DYMOND, CHELSEA A MD	7/2/2021	207P00000X	NA	Other	026	PHYSICIANS	172420	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
221175	Fee-for-Service	1235200379	1235200379	1	1	DELAUBERT, CLAUDE LMFT	8/22/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6355 TELEGRAPH AVE	STE 309	OAKLAND	CA	94609	1375	01	06001	37.84958903	-122.2606403	Alameda County
221181	Fee-for-Service	1396764080	1396764080	1	1	DECATUR GENERAL HOSPITAL	8/29/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1201 7TH ST SE	None	DECATUR	AL	35601	3337	00	None	34.5911209	-86.97267883	Morgan County
221182	Fee-for-Service	1760756860	1760756860	1	2	DR. JAMIE A. LIPELES, A PROF	3/8/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11602 HAWTHORNE BLVD	STE A	HAWTHORNE	CA	90250	3832	19	06037	33.928776	-118.3524545	Los Angeles County
221187	Fee-for-Service	1538546650	1538546650	1	1	DONNELLY, TRACY L CRNA	1/19/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
221198	Fee-for-Service	1770994873	1770994873	1	1	DYNAMIC REHAB PHYSICAL THERA	10/14/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1935 W AVENUE L	None	LANCASTER	CA	93534	8827	19	06037	34.66045164	-118.1643147	Los Angeles County
221217	Fee-for-Service	1811991862	1811991862	1	1	DANTON STERLING DUNGY, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2121 W CHANDLER BLVD	STE 110	CHANDLER	AZ	85224	6576	00	None	33.305499	-111.879099	Maricopa County
221230	Fee-for-Service	1922359074	1922359074	1	1	DILLON, MAUREEN M LCSW	12/7/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
221238	Fee-for-Service	1184652505	1184652505	1	1	DAVIS, DALE L MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	58039	05	Anesthesiology	0	In state provider	None	688 SHADY PL	None	DIAMOND BAR	CA	91765	4608	19	06037	34.01530968	-117.7935065	Los Angeles County
221282	Fee-for-Service	1952389546	1952389546	1	1	DORSEY, DANIEL M MD	1/31/1989	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	57868	30	Radiology	0	In state provider	UCD PROF BILLING GROUP	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
221285	Fee-for-Service	1437213279	1437213279	1	2	DIENTES COMMUNITY DENTAL	2/5/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	302 RIVERSIDE AVE	None	SANTA CRUZ	CA	95060	5524	44	06087	36.96633715	-122.018297	Santa Cruz County
221475	Fee-for-Service	1720039696	1720039696	1	1	DELLARIPA, JOHN A JR CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
221480	Fee-for-Service	1023132289	1023132289	1	1	DAUER ZOLOMEK, WENDY MD	4/11/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	59129	40	Pediatrics	0	In state provider	None	15215 LEFFINGWELL RD	None	WHITTIER	CA	90604	2254	19	06037	33.92827161	-118.0059744	Los Angeles County
221488	Fee-for-Service	1003103482	1003103482	1	2	DREBY, TIMOTHY C LMFT	1/28/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	638 WEBSTER ST	210C	OAKLAND	CA	93607	0000	01	06001	37.79837796	-122.2718843	Alameda County
221516	Fee-for-Service	1174610273	1174610273	1	2	DE PAIVA, HELDER MD	1/22/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	149852	None	None	0	In state provider	None	50 N LA CIENEGA BLVD	SUITE 204	LOS ANGELES	CA	90211	2227	19	06037	34.06689439	-118.3762514	Los Angeles
221540	Fee-for-Service	1407117062	1407117062	1	1	DIESTO, KARLA LMFT	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
221556	Fee-for-Service	1700841582	1700841582	1	1	DAMASCO-GUTIERREZ, DAISY	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66993	08	Family Practice	0	In state provider	None	386 E H ST	STE 210	CHULA VISTA	CA	91910	7487	37	06073	32.63995805	-117.0482026	San Diego County
221611	Fee-for-Service	1336147560	1336147560	1	1	DOYLE, JAMES T MD	11/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	880 RYLAND ST	None	RENO	NV	89502	1603	00	None	39.52378631	-119.8009873	Washoe County
221656	Fee-for-Service	1528472057	1528472057	1	1	DE LEON, HEIDI S LCSW	1/26/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
221678	Fee-for-Service	1093134777	1093134777	1	1	DANIELS, FELICIA C MD	12/14/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
221679	Fee-for-Service	1356094676	1356094676	1	1	DERMATOLOGY SPA MED INC	6/5/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	120 N MILLER ST	STE C	SANTA MARIA	CA	93454	4557	42	06083	34.95397114	-120.4314387	Santa Barbara County
221697	Fee-for-Service	1821188996	1821188996	1	1	DOVICH, JESSE A MD	8/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89430	18	Ophthalmology	0	In state provider	None	555 N 13TH AVE	STE K	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
221724	Fee-for-Service	1114422730	1114422730	1	1	DAO, LISA MD	8/17/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	165753	None	None	0	In state provider	None	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
221739	Fee-for-Service	1295153393	1295153393	1	1	DELONE, NOAH MD	12/1/2023	207P00000X	NA	Other	026	PHYSICIANS	191593	None	None	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
221855	Fee-for-Service	1972513919	1972513919	1	1	DREISBACH, PHILIP B MD	11/16/2001	207RH0003X	NA	Oncology	026	PHYSICIANS	19293	68	Hematology	0	In state provider	DESERT HEMAT/ONCOL MED	39800 BOB HOPE DR	STE C	RANCHO MIRAGE	CA	92270	3920	33	06065	33.759432	-116.408062	Riverside County
221867	Fee-for-Service	1861092744	1861092744	1	1	DELUXE HOSPICE CARE	8/28/2024	251G00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4119 W BURBANK BLVD	STE 167	BURBANK	CA	91505	2122	19	06037	34.1730175	-118.3553514	Los Angeles County
221930	Fee-for-Service	1194502542	1194502542	1	1	DOBESH, ALEXANDRA PT	12/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	289 W. HUNTINGTON DR.	STE 103	ARCADIA	CA	91007	3492	19	06037	34.13549119	-118.0419175	Los Angeles County
221943	Fee-for-Service	1861466948	1861466948	1	1	DANISH, DAVID C DO	8/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8288	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1794	44	06087	36.98863619	-121.9830754	Santa Cruz County
221982	Fee-for-Service	1255512836	1255512836	1	1	DURIEZ, SOPHIE F MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81912	26	Psychiatry (child)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
221986	Fee-for-Service	1194152652	1194152652	1	1	D'BRAUNSTEIN, JILL CCC-SLP	10/25/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3002 DOW AVE	314	TUSTIN	CA	92780	7234	30	06059	33.70954889	-117.8043627	Orange County
221999	Fee-for-Service	1003823329	1003823329	1	1	DANIEL F PAULY	2/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2640	00	None	39.08455286	-94.57578107	Jackson County
222125	Fee-for-Service	1831311984	1831311984	1	1	DATE, AMIT MD	11/23/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	177918	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
222147	Fee-for-Service	1609810886	1609810886	1	1	DODHIAWALA, BHUPENDRA T MD	10/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106406	05	Anesthesiology	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
222191	Fee-for-Service	1518998814	1518998814	2	1	DHILLON-ASHLEY, TINA J MD	12/28/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	77950	None	None	0	In state provider	MD	1945 FINE AVE	STE 100	FRESNO	CA	93727	1528	10	06019	36.76832721	-119.7290143	Fresno County
222197	Fee-for-Service	1568849743	1568849743	1	1	DIAO, WEI MD	6/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144291	08	Family Practice	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
222224	Fee-for-Service	1629042148	1629042148	1	1	DVA RENAL HEALTHCARE INC	11/6/1985	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8501 BRIMHALL RD	STE 500	BAKERSFIELD	CA	93312	2258	15	06029	35.36876784	-119.0971029	Kern County
222259	Fee-for-Service	1073644290	1073644290	1	1	DELMONT, LAURA L LMFT	11/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6546 DENSMORE AVE	None	LAKE BALBOA	CA	91406	6024	19	06037	34.18981728	-118.477203	Los Angeles County
222263	Fee-for-Service	1538276050	1538276050	1	1	DELOSREYES, M CYNTHIA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	923 S AUBURN ST	None	KENNEWICK	WA	99336	5662	00	None	46.19903243	-119.1184382	Benton County
222267	Fee-for-Service	1063866747	1063866747	1	1	DAILEY, MARK DO	7/10/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16017	36	Psychiatry	0	In state provider	None	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	15	06029	35.3540847	-119.0536548	Kern County
222270	Fee-for-Service	1255512836	1255512836	1	1	DURIEZ, SOPHIE F MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81912	36	Psychiatry	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
222281	Fee-for-Service	1558332585	1558332585	1	1	DUPONT, JAKOB MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106038	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
222285	Fee-for-Service	1174241103	1174241103	1	1	DEL REAL, EVELYN OD	9/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
222317	Fee-for-Service	1356850218	1356850218	1	1	DINKIN, SARA A	11/15/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
222349	Fee-for-Service	1982233169	1982233169	1	1	DVORAK, MARGARET E LCSW	7/2/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
222396	Fee-for-Service	1699272732	1699272732	1	1	DOW, ROBERT MD	9/25/2023	390200000X	NA	Other	026	PHYSICIANS	185636	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
222409	Fee-for-Service	1598961245	1598961245	1	24	DIGNITY HEALTH MEDICAL FOUND	9/18/2018	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	105 POST OFFICE DR	STE F	APTOS	CA	95003	3953	44	06087	36.97663787	-121.9004052	Santa Cruz County
222414	Fee-for-Service	1861125163	1861125163	1	1	DANIELLE GIACONA DO INC	8/21/2023	2086S0122X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	699 W TEFFT ST	STE A	NIPOMO	CA	93444	9288	40	06079	35.03414619	-120.4894206	San Luis Obispo County
222455	Fee-for-Service	1689686263	1689686263	1	1	DORIA, CHRISTOPHER V MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82205	None	None	0	In state provider	None	2415 W VINE ST	STE 100	LODI	CA	95242	3731	39	06077	38.1228953	-121.3052826	San Joaquin County
222466	Fee-for-Service	1053380055	1053380055	1	1	DARWISH, AHMED M MD	2/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92824	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
222557	Fee-for-Service	1255339818	1255339818	1	1	DAWSON, WILLIAM N JR MD	2/8/2015	207T00000X	NA	General Surgery	026	PHYSICIANS	-	14	Neurological Surgery	1	Border provider	None	85 KIRMAN AVE	None	RENO	NV	89502	1339	00	None	39.52624763	-119.7984127	Washoe County
222568	Fee-for-Service	1558332585	1558332585	1	1	DUPONT, JAKOB MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106038	41	Internal Medicine	0	In state provider	None	725 WELCH	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
222623	Fee-for-Service	1598129629	1598129629	1	1	DO, STEVEN C DO	7/17/2019	390200000X	NA	Other	026	PHYSICIANS	16318	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
222684	Fee-for-Service	1023214491	1023214491	1	1	DHANIREDDY, SONI R MD	4/3/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	50 KIRMAN AVE	STE 201	RENO	NV	89502	1175	00	None	39.52637074	-119.7983511	Washoe County
222700	Fee-for-Service	1124462486	1124462486	1	1	DEMISSE, RAHEL MD	12/30/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	135179	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
222724	Fee-for-Service	1134276777	1134276777	1	1	DODD, ROBERT MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69623	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
222739	Fee-for-Service	1700987153	1700987153	1	1	DEANE, LESLIE A MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92635	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
222763	Fee-for-Service	1417421397	1417421397	1	1	DE LEON, TRISHA J RCP	9/23/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
222844	Fee-for-Service	1649798489	1649798489	1	1	DE LA ROSA, ALYSON R LCSW	5/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
222845	Fee-for-Service	1255339818	1255339818	1	1	DAWSON, WILLIAM N JR MD	2/8/2015	207T00000X	NA	General Surgery	026	PHYSICIANS	-	87	Unknown	1	Border provider	None	85 KIRMAN AVE	None	RENO	NV	89502	1339	00	None	39.52624763	-119.7984127	Washoe County
222847	Fee-for-Service	1386698280	1386698280	1	1	DEBOARD, RYAN H MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115412	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE 208	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
222855	Fee-for-Service	1720552599	1720552599	1	1	DR CONNIE CHOI FAMILY	7/17/2018	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY INC	30600 DYER STREET	None	UNION CITY	CA	94587	1717	01	06001	37.60494405	-122.0688532	Alameda County
222896	Fee-for-Service	1881766194	1881766194	1	1	DONALD, JOHN W	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
222920	Fee-for-Service	1801594759	1801594759	1	1	DR VICTOR FAYAD PC	5/11/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	710 S BROOKHURST ST	STE J	ANAHEIM	CA	92804	4321	30	06059	33.822027	-117.958914	Orange County
222946	Fee-for-Service	1871592113	1871592113	1	1	DUKE UNIV HLTH SYS INC	4/1/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3643 NORTH ROXBORO RD	None	DURHAM	NC	27704	2702	00	None	36.03766765	-78.89744327	Durham County
222950	Fee-for-Service	1578640751	1578640751	1	1	DENNIS, SEAN M LCSW	12/19/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
222967	Fee-for-Service	1851472898	1851472898	1	1	DEFOE, DEIDRE M MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137819	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
222993	Fee-for-Service	1174131767	1174131767	1	1	DR. WILSON PHU, O.D. INC.	10/26/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3345 ROSECRANS STREET	STE B	SAN DIEGO	CA	92110	4225	37	06073	32.74779742	-117.2076448	San Diego County
223046	Fee-for-Service	1669670998	1669670998	1	1	DABESTANI, ARDESHIR A MD	6/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115573	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	SAN DIEGO	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego
223071	Fee-for-Service	1477085793	1477085793	1	1	DESANTO CLINICS INC	10/17/2017	207RA0401X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3151 AIRWAY AVE.	SUITE M1	COSTA MESA	CA	92626	4626	30	06059	33.67783408	-117.8720921	Orange County
223231	Fee-for-Service	1154345239	1154345239	1	1	DUMARS, MICHAEL C MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50616	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
223235	Fee-for-Service	1871592113	1871592113	1	1	DUKE UNIV HLTH SYS INC	4/1/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	3643 NORTH ROXBORO RD	None	DURHAM	NC	27704	2702	00	None	36.03766765	-78.89744327	Durham County
223237	Fee-for-Service	1720017148	1720017148	1	2	DOAN, VIEN DO	2/10/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	5276	08	Family Practice	0	In state provider	None	4343 MARKET ST	None	RIVERSIDE	CA	92501	3500	33	06065	33.97734857	-117.3791849	Riverside County
223280	Fee-for-Service	1871760223	1871760223	1	1	DOMINGUEZ, JULIE R MD	10/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110781	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
223286	Fee-for-Service	1861898694	1861898694	1	1	DEATON, ROBERT J JR CRNA	12/5/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
223310	Fee-for-Service	1144755661	1144755661	1	1	DETERMAN, MEGAN MD	9/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
223332	Fee-for-Service	1073800066	1073800066	1	1	DEDAVETS, ALEC MD	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128769	41	Internal Medicine	0	In state provider	None	1900 DRESDEN DRIVE	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
223341	Fee-for-Service	1487624094	1487624094	2	1	DENMARK, STEVEN M MD	11/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	37660	02	General Surgery	0	In state provider	None	258 SAN JOSE STREET	SUITE A	SALINAS	CA	93901	3934	27	06053	36.65808239	-121.6456689	Monterey County
223366	Fee-for-Service	1598961245	1598961245	1	7	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	528 CAPITOLA AVE	None	CAPITOLA	CA	95010	2750	44	06087	36.97685082	-121.9534096	Santa Cruz County
223378	Fee-for-Service	1245074863	1245074863	1	1	DU, NATHALIE LMFT	12/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
223391	Fee-for-Service	1154768695	1154768695	1	1	DIXON, MICHAEL A LCSW	10/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	42	06083	34.65803329	-120.4576446	Santa Barbara County
223440	Fee-for-Service	1053687046	1053687046	1	1	DOUAIHER, JEFFREY MD	9/20/2020	208C00000X	NA	General Surgery	026	PHYSICIANS	155661	02	General Surgery	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
223463	Fee-for-Service	1164573234	1164573234	1	1	DOSHI, AMOL N MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66904	None	None	0	In state provider	None	16870 W BERNARDO DR	None	SAN DIEGO	CA	92127	1677	37	06073	33.01956754	-117.0809122	San Diego County
223469	Fee-for-Service	1003045733	1003045733	1	1	DUCUT, ERICK G MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139530	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
223498	Fee-for-Service	1326312067	1326312067	1	4	DCHS MEDICAL FOUNDATION	6/2/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	966 S WESTERN AVE	SUITE 204	LOS ANGELES	CA	90006	1015	19	06037	34.053777	-118.3090505	Los Angeles County
223521	Fee-for-Service	1639638968	1639638968	1	1	DOAN, ANGELA Q NP	2/8/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
223562	Fee-for-Service	1427091016	1427091016	1	1	DEMARTINI, WILLIAM J MD	11/27/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27905	30	Radiology	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
223564	Fee-for-Service	1255837175	1255837175	1	1	DUONG, TRUC VI H MD	8/12/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164129	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
223596	Fee-for-Service	1144755661	1144755661	1	1	DETERMAN, MEGAN MD	9/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
223612	Fee-for-Service	1326494436	1326494436	1	1	DOI, DANIEL	11/17/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
223621	Fee-for-Service	1912166786	1912166786	1	1	DELISSER, KEMESHA L MD	8/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116122	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94035	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
223670	Fee-for-Service	1700841939	1700841939	1	2	DR LUQUE OD A PROFESSIONAL	9/19/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORPORATION	26471 CARL BOYER DR	None	SANTA CLARITA	CA	91350	2996	19	06037	34.41445746	-118.5047459	Los Angeles County
223682	Fee-for-Service	1023176351	1023176351	1	1	DONNELLY, BARBARA J MD	4/30/1983	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	46791	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
223736	Fee-for-Service	1982044251	1982044251	1	1	DICKERSON, RACHEL M LMFT	6/1/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104308	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
223738	Fee-for-Service	1710050612	1710050612	1	1	DERMAN, BRUCE I	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	23011 OXNARD ST	None	WOODLAND HILLS	CA	91367	3232	19	06037	34.17918488	-118.627939	Los Angeles County
223807	Fee-for-Service	1649749268	1649749268	1	1	DUA, ELIZABETH CCC-SLP	5/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
223837	Fee-for-Service	1902870330	1902870330	1	1	DVA RENAL HEALTHCARE INC	10/31/2003	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	COLLEGE DIALYSIS	6035 UNIVERSITY AVE	None	SAN DIEGO	CA	92115	5810	37	06073	32.75219072	-117.0662889	San Diego County
223867	Fee-for-Service	1275302739	1275302739	1	1	DORADO PHARMACY INC	1/29/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13678 VAN NUYS BLVD	None	PACOIMA	CA	91331	3616	19	06037	34.25957089	-118.4310033	Los Angeles County
223880	Fee-for-Service	1083770622	1083770622	1	1	DEYAN, ALEXANDER MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67568	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	360 SAN MIGUEL DR	STE 508	NEWPORT BEACH	CA	92660	7831	30	06059	33.61321911	-117.8722084	Orange County
223884	Fee-for-Service	1144755661	1144755661	1	1	DETERMAN, MEGAN MD	9/9/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
223923	Fee-for-Service	1144653890	1144653890	1	1	DEL ROSARIO, AMANDA S MD	7/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126932	40	Pediatrics	0	In state provider	None	747 52ND STREET	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
223933	Fee-for-Service	1558391052	1558391052	1	1	DINH, VICTOR H MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50555	08	Family Practice	0	In state provider	None	10495 BOLSA AVE	STE 106	WESTMINSTER	CA	92683	6762	30	06059	33.74509077	-117.9464853	Orange County
223947	Fee-for-Service	1932382736	1932382736	2	2	DR. KHANH BUI, O.D., P.C.	2/11/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1013 E CAPITOL EXPY	None	SAN JOSE	CA	95121	2415	43	06085	37.29895883	-121.8236374	Santa Clara County
223956	Fee-for-Service	1467030692	1467030692	1	1	DOYAN, SARINA	10/25/2024	207R00000X	NA	Other	026	PHYSICIANS	191984	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
223958	Fee-for-Service	1740493873	1740493873	1	1	DE LEON, CARLO	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	SUITE 390	PLEASANTON	CA	94588	2831	01	06001	37.69247085	-121.9301884	Alameda County
224019	Fee-for-Service	1235672403	1235672403	1	1	DIGNITY HEALTH	8/16/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	20833 LONG BRANCH DR	None	COTTONWOOD	CA	96022	8701	45	06089	40.39391709	-122.2799142	Shasta County
224132	Fee-for-Service	1316040512	1316040512	1	1	DAROFF, ROBERT B MD	2/20/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	50253	None	None	0	In state provider	None	14 ROSLYN CT	None	OAKLAND	CA	94618	1945	01	06001	37.85211469	-122.2453979	Alameda County
224220	Fee-for-Service	1942233671	1942233671	1	1	D'SA, PEARL P MD	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93532	41	Internal Medicine	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
224257	Fee-for-Service	1942310891	1942310891	1	1	DOMINIC, WILLIAM J MD	6/30/1991	208600000X	NA	General Surgery	026	PHYSICIANS	60346	24	Plastic Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
224259	Fee-for-Service	1164045803	1164045803	1	1	DESERT HORIZON RESIDENTIAL	9/24/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE	15952 CONDOR ROAD	None	VICTORVILLE	CA	92394	1315	36	06071	34.54070642	-117.3229716	San Bernardino County
224260	Fee-for-Service	1689260028	1689260028	1	1	DIRECT HOME CARE	5/19/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	936 WEST AVENUE J4	UNIT 201	LANCASTER	CA	93534	4246	19	06037	34.68575448	-118.146933	Los Angeles County
224284	Fee-for-Service	1003617945	1003617945	1	1	DIVINE BIRTHWORK OF HEART LL	3/24/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
224304	Fee-for-Service	1235672403	1235672403	1	1	DIGNITY HEALTH	8/16/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	20833 LONG BRANCH DR	None	COTTONWOOD	CA	96022	8701	45	06089	40.39391709	-122.2799142	Shasta County
224325	Fee-for-Service	1184868465	1184868465	1	1	DAMICO, BETH M MD	8/1/2021	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
224381	Fee-for-Service	1750379970	1750379970	1	1	DURANCEAU, CHRISTINE MD	9/30/1982	207P00000X	NA	Other	026	PHYSICIANS	48641	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3100 S SUSANA RD	None	COMPTON	CA	90221	5418	19	06037	33.87386619	-118.2070981	Los Angeles County
224382	Fee-for-Service	1962534875	1962534875	1	1	DAVALOS, EDUARDO LCSW	3/31/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
224427	Fee-for-Service	1376703009	1376703009	1	1	DAVE, SHAIVAL H MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111114	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
224450	Fee-for-Service	1124335534	1124335534	1	1	DAVID, AIMEE K PSYD	7/20/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
224459	Fee-for-Service	1386743128	1386743128	1	1	DROSTEN, RALPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N. MEDICAL DRIVE	None	SALT LAKE CITY	UT	84132	0100	00	None	40.77197161	-111.8352608	Salt Lake County
224472	Fee-for-Service	1336291145	1336291145	1	1	DEEN, LEWIS S MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50520	36	Psychiatry	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
224488	Fee-for-Service	1619320330	1619320330	1	1	DIAZ-GARCIA, GLADYS	12/27/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVENUE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
224554	Fee-for-Service	1295122398	1295122398	1	1	DANIAL, CHRISTINA M MD	8/5/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	143746	07	Dermatology	0	In state provider	None	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	01	06001	37.70553949	-121.872609	Alameda County
224588	Fee-for-Service	1720479298	1720479298	1	1	DONG, LINA CRNA	11/7/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
224596	Fee-for-Service	1982974382	1982974382	1	1	DURANTE, LEA S NP	7/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1141 PEAR TREE LANE	None	NAPA	CA	94558	6485	28	06055	38.32125908	-122.2921523	Napa County
224604	Fee-for-Service	1285614636	1285614636	1	1	DING, JAMES C MD	7/1/1995	207R00000X	NA	Other	026	PHYSICIANS	72916	77	Infectious Disease	0	In state provider	None	3275 SKYPARK DR	None	TORRANCE	CA	90505	5027	19	06037	33.80825394	-118.343391	Los Angeles County
224619	Fee-for-Service	1184882037	1184882037	1	1	DIMITRIU, ALEX MD	10/11/2010	390200000X	NA	Other	026	PHYSICIANS	108409	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
224631	Fee-for-Service	1184604217	1184604217	1	1	DACEY, MICHAEL J MD	7/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81790	07	Dermatology	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
224662	Fee-for-Service	1083882922	1083882922	1	1	DIZON, RINO C H DO	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11168	08	Family Practice	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
224663	Fee-for-Service	1588805121	1588805121	1	1	DE WALT, CAROL N MD	8/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	95208	None	None	0	In state provider	None	10833 LE CONTE AVE	12-311 MDCC	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
224728	Fee-for-Service	1881115988	1881115988	1	1	DAXINI, ANISHA MD	2/18/2021	207R00000X	NA	Other	026	PHYSICIANS	170629	None	None	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
224813	Fee-for-Service	1902936149	1902936149	1	1	DICKLER, NEAL S MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	27788	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
224858	Fee-for-Service	1023323870	1023323870	1	1	DEWAR MEDICAL GROUP INC	1/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	33700	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	SUITE 124	SAN BERNARDINO	CA	92404	3854	36	06071	34.1358627	-117.2757898	San Bernardino County
224893	Fee-for-Service	1285614636	1285614636	1	1	DING, JAMES C MD	7/1/1995	207R00000X	NA	Other	026	PHYSICIANS	72916	41	Internal Medicine	0	In state provider	None	3275 SKYPARK DR	None	TORRANCE	CA	90505	5027	19	06037	33.80825394	-118.343391	Los Angeles County
224951	Fee-for-Service	1083882922	1083882922	1	1	DIZON, RINO C H DO	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11168	01	General Practice	0	In state provider	None	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
224963	Fee-for-Service	1831113901	1831113901	1	1	DO, LUONG T MD	3/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90656	40	Pediatrics	0	In state provider	None	193 E ORANGE GROVE BLVD	None	PASADENA	CA	91103	3487	19	06037	34.15787172	-118.1462979	Los Angeles County
225000	Fee-for-Service	1902801764	1902801764	1	1	DARIN, JOHN J MD	11/21/2007	207W00000X	NA	Ophthalmology	026	PHYSICIANS	29520	18	Ophthalmology	0	In state provider	None	1250 LA VENTA RD	STE 208	WESTLAKE VILLAGE	CA	91361	3763	56	06111	34.14827603	-118.8227637	Ventura County
225008	Fee-for-Service	1629412259	1629412259	1	1	DEHESA, LUIS A MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142134	07	Dermatology	0	In state provider	None	2335 E KASHIAN LANE	SUITE 410	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
225029	Fee-for-Service	1205531993	1205531993	1	1	DUONG, OANH OD	7/22/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
225031	Fee-for-Service	1720285984	1720285984	1	1	DELGADO, KATHLEEN C	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
225047	Fee-for-Service	1770819088	1770819088	1	1	DONOVAN, ANNE L MD	5/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114527	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
225096	Fee-for-Service	1922662410	1922662410	1	1	DHILLON, GURPREET S MD	1/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180887	None	None	0	In state provider	None	374 W OLIVE AVE	STE B	MERCED	CA	95348	3137	24	06047	37.31914092	-120.4749911	Merced County
225098	Fee-for-Service	1538303276	1538303276	1	1	DAVIS, JONATHAN D MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107197	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
225154	Fee-for-Service	1336373836	1336373836	1	1	DIXON, MEREDITH C MD	12/12/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	178312	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
225175	Fee-for-Service	1063430106	1063430106	1	1	DAVIDSON, KERRY LYNN MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68562	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
225215	Fee-for-Service	1437786878	1437786878	1	1	DE GUIA, GECELLE L MD	10/4/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21161	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
225314	Fee-for-Service	1861626491	1861626491	1	1	DEL RIO, ANDREW E	8/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	19239 GOLDEN VALLEY RD	None	SANTA CLARITA	CA	91387	1472	19	06037	34.3922042	-118.4672521	Los Angeles County
225365	Fee-for-Service	1861864720	1861864720	1	1	D & L PHARMACY INC	12/28/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2630 SAN GABRIEL BLVD	STE 106	ROSEMEAD	CA	91770	5204	19	06037	34.059978	-118.0905515	Los Angeles County
225377	Fee-for-Service	1124653167	1124653167	1	1	DOCTORS CHOICE PALLIATIVE	9/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE CARE INC	14112 VICTORY BLVD	SUITE 101	VAN NUYS	CA	91401	6563	19	06037	34.18662949	-118.44054	Los Angeles County
225405	Fee-for-Service	1598961245	1598961245	1	27	DIGNITY HEALTH MEDICAL FOUND	1/29/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	-DOMINICAN INC	223 MOUNT HERMON RD	STE A	SCOTTS VALLEY	CA	95066	4086	44	06087	37.04468857	-122.02669	Santa Cruz County
225411	Fee-for-Service	1598027005	1598027005	1	1	DIDEHVAR, SOROSCH MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141506	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
225432	Fee-for-Service	1760061741	1760061741	1	1	DALAL, SUHANI	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	21153	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
225485	Fee-for-Service	1598961245	1598961245	1	16	DIGNITY HEALTH MEDICAL FOUND	2/12/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1820 41ST AVE	SUITE C	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
225488	Fee-for-Service	1407323025	1407323025	1	1	DUNCAN, SHIRLEY NP	10/11/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1330 N INDIAN CANYON DR	STE F	PALM SPRINGS	CA	92262	4880	33	06065	33.84144	-116.5455715	Riverside County
225489	Fee-for-Service	1861835076	1861835076	1	1	DELFANTI, RACHEL L MD	8/1/2019	390200000X	NA	Other	026	PHYSICIANS	134179	30	Radiology	0	In state provider	None	300 LOMBARD ST	None	THOUSAND OAKS	CA	91360	5808	56	06111	34.17792105	-118.8709907	Ventura County
225601	Fee-for-Service	1376766808	1376766808	1	1	DESERT URGENT CARE MED	5/31/1995	207PH0002X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INDIO EMERG MED GRP	74990 COUNTRY CLUB DR	STE 310	PALM DESERT	CA	92260	1991	33	06065	33.75813764	-116.356689	Riverside County
225630	Fee-for-Service	1821145640	1821145640	2	1	DR PAUL M SCHUMACHER MD	4/27/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
225665	Fee-for-Service	1124653167	1124653167	1	1	DOCTORS CHOICE PALLIATIVE	9/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE CARE INC	14112 VICTORY BLVD	SUITE 101	VAN NUYS	CA	91401	6563	19	06037	34.18662949	-118.44054	Los Angeles County
225714	Fee-for-Service	1245596477	1245596477	1	1	DOUK, BORAMEE MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123977	41	Internal Medicine	0	In state provider	None	2417 CENTRAL AVENUE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
225715	Fee-for-Service	1770650780	1770650780	1	1	DESAI, ABHINANDAN A MD	12/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	39346	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
225743	Fee-for-Service	1104192301	1104192301	1	1	DEJESUS, GARRETT L MD	6/12/2017	390200000X	NA	Other	026	PHYSICIANS	130608	30	Radiology	0	In state provider	None	1001 POTRERO AVE	ROOM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
225768	Fee-for-Service	1437723285	1437723285	1	2	DESERT INSIGHT FAMILY THERAP	5/23/2023	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
225785	Fee-for-Service	1043296403	1043296403	1	1	DAVID M DANSIE	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 N MARIO CAPECCHI DR	None	SALT LAKE CTY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
225795	Fee-for-Service	1467526079	1467526079	1	1	DOSTER, SARA K MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84757	13	Neurology (M.D. only)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
225816	Fee-for-Service	1396316329	1396316329	1	1	DIGESTIVE AND LIVER CENTER C	11/9/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	11100 WARNER AVE	STE 252	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
225914	Fee-for-Service	1710271242	1710271242	1	1	DONGXIA FENG, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	None	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
225935	Fee-for-Service	1760716260	1760716260	1	1	DRULLINGER, KYLE A MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113202	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
225978	Fee-for-Service	1891176954	1891176954	1	1	DOWLATSHAHI, KAYVON MD	5/1/2020	207ZP0102X	NA	Other	026	PHYSICIANS	167279	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
226026	Fee-for-Service	1588271878	1588271878	1	1	DAHMS, RANDI PT	9/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2895 LOMA VISTA ROAD	SUITE H	VENTURA	CA	93003	1542	56	06111	34.27543868	-119.2574459	Ventura County
226045	Fee-for-Service	1629418710	1629418710	1	1	DAVIS, REDD E LCSW	10/12/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
226054	Fee-for-Service	1437723285	1437723285	1	2	DESERT INSIGHT FAMILY THERAP	10/14/2023	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
226078	Fee-for-Service	1346328424	1346328424	1	1	DILLARD, TODD W MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45257	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5600 STONERIDGE MALL RD	None	PLEASANTON	CA	94588	2820	01	06001	37.6921981	-121.9276072	Alameda County
226173	Fee-for-Service	1164401832	1164401832	1	1	DIAS, DAVID A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7301 ROGERS AVE	None	FORT SMITH	AR	72903	4100	00	None	35.35551	-94.35276	Sebastian County
226189	Fee-for-Service	1821432378	1821432378	1	1	DE GUZMAN, EARL ANDREW B MD	11/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132370	None	None	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
226207	Fee-for-Service	1114128386	1114128386	1	1	DEPEREZ, ROSEMARY NP	5/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
226208	Fee-for-Service	1588777569	1588777569	1	1	DR. MICHELLE LEE MAYFIELD JO	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1720 UNIVERSITY DR S	None	FARGO	ND	58103	4940	00	None	46.853136	-96.797421	Cass County
226221	Fee-for-Service	1144800566	1144800566	1	1	DDD WORLD OF ANGELS HOME	9/28/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	14545 FRIAR ST	STE 354	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
226236	Fee-for-Service	1821577107	1821577107	1	1	DIXON, ANGELA LCSW	5/2/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
226290	Fee-for-Service	1588781967	1588781967	1	1	DIXON, LATASHA LMFT	4/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	600 N MOUNTAIN AVE	STE B 106	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
226318	Fee-for-Service	1013338078	1013338078	1	1	DIAMOND, VANESSA PT	2/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 41ST AVE	SUITE H	CAPITOLA	CA	95010	3900	44	06087	36.969003	-121.964871	Santa Cruz County
226342	Fee-for-Service	1437723285	1437723285	1	2	DESERT INSIGHT FAMILY THERAP	5/23/2023	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
226378	Fee-for-Service	1558357145	1558357145	1	1	DENNIS CHINN OD INC	1/1/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5151 N PALM AVE	STE 530	FRESNO	CA	93704	2208	10	06019	36.81119879	-119.808555	Fresno County
226427	Fee-for-Service	1295201762	1295201762	1	1	DEVOTION HOME HEALTH INC	5/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	STE 205	SUN VALLEY	CA	91352	5089	19	06037	34.2016328	-118.3703012	Los Angeles County
226458	Fee-for-Service	1134142854	1134142854	1	1	DELGADO, JULIA J MD	5/30/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60415	40	Pediatrics	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
226463	Fee-for-Service	1093154387	1093154387	1	1	DE LUNA, PATRICIA A W MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150487	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
226508	Fee-for-Service	1942838271	1942838271	1	1	DADE, MAGGIE M DO	3/10/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21307	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
226513	Fee-for-Service	1558463653	1558463653	1	1	DAVIS, STEVEN W MD	12/3/2021	2085R0001X	NA	Other	026	PHYSICIANS	82145	None	None	0	In state provider	None	9730 SUMMERS RIDGE RD	None	SAN DIEGO	CA	92121	3101	37	06073	32.89408843	-117.1706972	San Diego County
226529	Fee-for-Service	1730164708	1730164708	1	1	DELLOTA, KRISS L. MD	5/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
226530	Fee-for-Service	1629121504	1629121504	1	1	DAVIS, HOWELL E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2201 S CLEAR CREEK RD	None	KILLEEN	TX	76549	4110	00	None	31.1131436	-97.79969605	Bell County
226541	Fee-for-Service	1154361558	1154361558	1	1	DYSART, JEFFREY H MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36992	01	General Practice	0	In state provider	None	3303 RUFFIN RD	STE F	SAN DIEGO	CA	92123	4087	37	06073	32.80206941	-117.1288355	San Diego County
226544	Fee-for-Service	1205170651	1205170651	1	1	DE FERNANDEZ, VERONICA P	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	51025	-	NOT APPLICABLE	0	In state provider	LMFT	2035 E BALL ROAD	STE 100A, 100P	ANAHEIM	CA	92806	5158	30	06059	33.81812448	-117.8880075	Orange County
226629	Fee-for-Service	1114651411	1114651411	1	1	DUPLECHAN III, LAWRENCE PT	10/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
226683	Fee-for-Service	1467500470	1467500470	1	1	DE LEON-LIWAG, MARIA	12/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89974	40	Pediatrics	0	In state provider	MARRISA A MD	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
226709	Fee-for-Service	1588650162	1588650162	1	1	DUTRA, TIMOTHY G DPM	11/10/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	0000	01	06001	37.8237837	-122.2590026	Alameda County
226774	Fee-for-Service	1578662631	1578662631	1	1	DIMOV, IVAILO D MD	10/2/2008	207L00000X	NA	Other	026	PHYSICIANS	76262	05	Anesthesiology	0	In state provider	None	450 GREENFIELD AVE	None	HANFORD	CA	93230	3513	16	06031	36.328968	-119.6582195	Kings County
226776	Fee-for-Service	1649390527	1649390527	1	1	DOOLEY, MICHAEL ALLEN DC	11/1/2002	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	TAYLOR CHIROPRACTIC	215 NEEDHAM ST	None	MODESTO	CA	95354	1111	50	06099	37.64575792	-120.9958014	Stanislaus County
226799	Fee-for-Service	1053501767	1053501767	1	1	DELUCA JR., LAWRENCE A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
226800	Fee-for-Service	1093154809	1093154809	1	1	DISTERHOFT, JUDITH O MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143366	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
226829	Fee-for-Service	1154361558	1154361558	1	1	DYSART, JEFFREY H MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36992	08	Family Practice	0	In state provider	None	3303 RUFFIN RD	STE F	SAN DIEGO	CA	92123	4087	37	06073	32.80206941	-117.1288355	San Diego County
226844	Fee-for-Service	1164058293	1164058293	1	1	DOVE, ERIK P MD	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	185322	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
226860	Fee-for-Service	1477575686	1477575686	1	1	DAVID MOHLMAN	10/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
226946	Fee-for-Service	1801224092	1801224092	1	1	DESAI, PRITAL J MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150768	36	Psychiatry	0	In state provider	None	480B TESCONI CIRCLE	None	SANTA ROSA	CA	95401	4691	49	06097	38.44950583	-122.7351601	Sonoma County
226976	Fee-for-Service	1174507370	1174507370	1	1	DEMOTT, MEGAN C MD	7/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96269	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
227012	Fee-for-Service	1285498295	1285498295	1	1	DUPREY, AMY POSTPARTUM DOUL	2/14/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	29	06057	0	0	None
227016	Fee-for-Service	1164527537	1164527537	1	1	DOWNS, WILLIAM M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	WILCOX MEMORIAL HOSP	3420 KUHIO HWY	None	LIHUE	HI	96766	1099	00	None	21.98583	-159.362658	Kauai County
227027	Fee-for-Service	1699302430	1699302430	1	1	DROLEN, CLAIRE E MD	6/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186589	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
227041	Fee-for-Service	1285912725	1285912725	1	1	DANIEL NOBREGA DA COSTA	4/22/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
227067	Fee-for-Service	1114657970	1114657970	1	1	DANMAR VILLAS LLC	7/14/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1007 N MARTEL AVE	None	WEST HOLLYWOOD	CA	90046	6611	19	06037	34.088931	-118.351149	Los Angeles County
227137	Fee-for-Service	1902408404	1902408404	1	1	DLR MANAGEMENT GROUP	11/10/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON SERVICES	300 SPECTRUM CENTER DRIV	STE 488	IRVINE	CA	92618	2938	30	06059	33.65318028	-117.7464324	Orange County
227139	Fee-for-Service	1255496196	1255496196	1	1	DIEP, MY	10/5/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2009 TULLY RD	None	SAN JOSE	CA	95122	1801	43	06085	37.32593186	-121.8208486	Santa Clara County
227176	Fee-for-Service	1164480943	1164480943	1	1	DANIELS, GREGORY A MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92515	68	Hematology	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
227219	Fee-for-Service	1316157456	1316157456	1	1	DYER, SUSAN A PHD	1/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	820 LAS GALLINAS	None	SAN RAFAEL	CA	94903	3410	21	06041	38.00702954	-122.5471567	Marin County
227228	Fee-for-Service	1730157009	1730157009	4	1	DESERT MEDICAL EQUIPMENT INC	2/28/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	17189 YUMA STREET	UNIT 2	VICTORVILLE	CA	92395	0844	36	06071	34.47340554	-117.2880799	San Bernardino County
227251	Fee-for-Service	1518154087	1518154087	2	1	DARAWAL, ASSAD U MD INC	4/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51602	41	Internal Medicine	0	In state provider	None	81893 DR CARREON BLVD	STE 1	INDIO	CA	92201	5592	33	06065	33.7073755	-116.2355895	Riverside County
227261	Fee-for-Service	1871600122	1871600122	1	1	DOUGLAS P HANSEN, OD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9951 MICKELBERRY RD NW	STE 123	SILVERDALE	WA	98383	8309	00	None	47.653146	-122.6823285	Kitsap County
227275	Fee-for-Service	1598898249	1598898249	3	1	DR ZHUBLAWAR OPTOMETRIC	11/10/2015	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1575 B STREET	None	HAYWARD	CA	94541	3017	01	06001	37.67905755	-122.072805	Alameda County
227285	Fee-for-Service	1518018191	1518018191	5	1	DIGNITY HEALTH	3/2/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
227307	Fee-for-Service	1023517711	1023517711	1	1	DAY, TERRY CNP	10/4/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
227365	Fee-for-Service	1073522207	1073522207	1	1	DEL PAINE, LOUIS M MD	1/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	42341	None	None	0	In state provider	None	845 JACKSON ST	None	SAN FRANCISCO	CA	94133	4851	38	06075	37.79571919	-122.4089166	San Francisco County
227393	Fee-for-Service	1063435824	1063435824	1	1	DUTSON, ERIK P MD	11/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84613	02	General Surgery	0	In state provider	None	1245 E 16TH ST	# 120	LOS ANGELES	CA	90021	2623	19	06037	34.02665752	-118.2491703	Los Angeles County
227405	Fee-for-Service	1205423878	1205423878	1	1	DEVOTION HOSPICE CARE, INC	7/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	24301 SOUTHLAND DR	STE 214D	HAYWARD	CA	94545	1546	01	06001	37.65344508	-122.1045736	Alameda County
227466	Fee-for-Service	1164480943	1164480943	1	1	DANIELS, GREGORY A MD	9/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92515	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	DEPT 8201	SAN DIEGO	CA	92103	8201	37	06073	32.7537975	-117.1658298	San Diego County
227469	Fee-for-Service	1942629548	1942629548	1	1	DEVOE, CATHERINE W MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150759	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
227487	Fee-for-Service	1598537292	1598537292	1	1	DIELENTHEIS, ELIZABETH J BIR	1/30/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
227495	Fee-for-Service	1598961245	1598961245	1	22	DIGNITY HEALTH MEDICAL FOUND	10/5/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1505 SOQUEL DR	SUITE 7	SANTA CRUZ	CA	95065	1716	44	06087	36.98803429	-121.9848045	Santa Cruz County
227573	Fee-for-Service	1225184765	1225184765	1	1	DATTA, GAURAV MD	9/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153705	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
227574	Fee-for-Service	1518018191	1518018191	5	1	DIGNITY HEALTH	3/2/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
227575	Fee-for-Service	1457829095	1457829095	1	1	DRIESSEN, SHARON LCSW	3/25/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92563	7906	30	06059	33.62516256	-117.7353393	Orange County
227590	Fee-for-Service	1801213285	1801213285	1	1	DALLABETTA, MICHAEL B DO	11/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15225	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
227600	Fee-for-Service	1609823921	1609823921	1	1	DON BENSON, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	22101 MOROSS	None	DETROIT	MI	48236	2148	00	None	42.41918818	-82.91538222	Wayne County
227636	Fee-for-Service	1538222013	1538222013	1	1	DONIGER, STEPHANIE J MD	6/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80240	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
227659	Fee-for-Service	1154745404	1154745404	1	1	DUONG, ANDREW Q PT	5/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12648 POWAY ROAD	None	POWAY	CA	92064	4416	37	06073	32.95481776	-117.0563777	San Diego County
227690	Fee-for-Service	1336404557	1336404557	1	1	DHP OF NORTHBAY MEDICAL	8/10/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
227693	Fee-for-Service	1205423878	1205423878	1	1	DEVOTION HOSPICE CARE, INC	7/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	24301 SOUTHLAND DR	STE 214D	HAYWARD	CA	94545	1546	01	06001	37.65344508	-122.1045736	Alameda County
227722	Fee-for-Service	1073536322	1073536322	1	1	DAVID, WHITNEY MD	11/30/2010	208600000X	NA	General Surgery	026	PHYSICIANS	52616	02	General Surgery	0	In state provider	None	800 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8359	08	06015	41.77272521	-124.1940494	Del Norte County
227726	Fee-for-Service	1194888545	1194888545	1	1	DIANGI, YUMI T MD	9/6/2017	207R00000X	NA	Other	026	PHYSICIANS	137442	41	Internal Medicine	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
227782	Fee-for-Service	1598961245	1598961245	1	21	DIGNITY HEALTH MEDICAL FOUND	3/25/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1505 SOQUEL DRIVE	SUITE 5A	SANTA CRUZ	CA	95065	1716	44	06087	36.98803429	-121.9848045	Santa Cruz County
227848	Fee-for-Service	1144247974	1144247974	1	1	DURST, KAREN L PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BLDG C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
227858	Fee-for-Service	1386727535	1386727535	1	1	DATTO, MICHEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DUKE UNIV MED CTR	100 TRENT DR	None	DURHAM	NC	27710	0001	00	None	36.0049947	-78.93520336	Durham County
227861	Fee-for-Service	1598961245	1598961245	1	4	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1820 41ST AVE	STE D	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
227929	Fee-for-Service	1326134115	1326134115	1	1	DHAMI, KANWER R MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64661	None	None	0	In state provider	None	2570 JENSEN AVE	STE 103	SANGER	CA	93657	2269	10	06019	36.70680647	-119.5736715	Fresno County
227934	Fee-for-Service	1972608289	1972608289	1	1	DR. STEPHEN KORBET	9/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1426 W WASHINGTON BLVD	None	CHICAGO	IL	60607	1821	00	None	41.88290348	-87.663744	Cook County
228022	Fee-for-Service	1215950076	1215950076	1	1	DEGIORGIO, CHRISTOPHER	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	49184	13	Neurology (M.D. only)	0	In state provider	M MD	300 MEDICAL PLAZA STE B2	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
228050	Fee-for-Service	1639312887	1639312887	1	2	DIAZ, PATRICIA L LMFT	1/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
228140	Fee-for-Service	1821146564	1821146564	1	1	DALLMAN, ANN L MD	2/11/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	74481	-	NOT APPLICABLE	0	In state provider	None	1050 WISCONSIN ST	None	SAN FRANCISCO	CA	94107	3328	38	06075	37.7540295	-122.3986796	San Francisco County
228142	Fee-for-Service	1396189254	1396189254	1	1	D'AGATI, DOUGLAS V MD	7/19/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	156315	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
228143	Fee-for-Service	1780601286	1780601286	1	1	DHALIWAL, GURPREET S MD	2/8/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	45059	13	Neurology (M.D. only)	0	In state provider	None	1401 SPANOS CT	STE 102	MODESTO	CA	95355	2811	50	06099	37.66975543	-120.9724048	Stanislaus County
228154	Fee-for-Service	1215510060	1215510060	1	1	DEVAUGHN, SASKIA PHD	2/13/2023	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
228229	Fee-for-Service	1639752553	1639752553	1	7	DISPATCHHEALTH-CA, PC	3/14/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1331 W AVENUE J	104	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
228240	Fee-for-Service	1639242696	1639242696	1	1	DAHL, PATRICIA J MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	37658	41	Internal Medicine	0	In state provider	None	717 CENTER ST	None	HEALDSBURG	CA	95448	3604	49	06097	38.61783	-122.8707965	Sonoma County
228248	Fee-for-Service	1215019641	1215019641	1	1	DAVID, ELMER S MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
228304	Fee-for-Service	1598143919	1598143919	1	1	DEHESA-WOODSON, VANESSA LMF	1/11/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
228321	Fee-for-Service	1215918354	1215918354	1	1	DING, JEAN MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78679	20	Orthopedic Surgery	0	In state provider	None	301 W HUNTINGTON DR	STE 408	ARCADIA	CA	91007	1502	19	06037	34.13481053	-118.0425638	Los Angeles County
228355	Fee-for-Service	1083802862	1083802862	1	1	DAOOD, MOHAMMAD MD INC	1/1/1979	174400000X	NA	Other	026	PHYSICIANS	25816	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2601 W ALAMEDA AVE	STE 202	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
228388	Fee-for-Service	1063787620	1063787620	1	1	DELPIZZO-CHENG, ELIZABETH A	2/7/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
228390	Fee-for-Service	1295911469	1295911469	1	1	DAVIS, JASON T MD	3/2/2009	207R00000X	NA	Other	026	PHYSICIANS	100799	None	None	0	In state provider	None	4020 FIFTH AVENUE	MER 14	SAN DIEGO	CA	92103	2106	37	06073	32.75032457	-117.1610686	San Diego County
228411	Fee-for-Service	1235586058	1235586058	1	1	DANESH, MELISSA J MD	9/6/2022	207ND0101X	NA	Dermatology	026	PHYSICIANS	172317	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
228455	Fee-for-Service	1275779100	1275779100	1	1	DESAI, HEMANGINI A MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105815	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91944	3019	37	06073	32.781483	-117.007182	San Diego County
228469	Fee-for-Service	1598961245	1598961245	1	31	DIGNITY HEALTH MEDICAL FOUND	10/24/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	-DOMINICAN	245 MOUNT HERMON RD	STE L	SCOTTS VALLEY	CA	95066	4035	44	06087	37.0460243	-122.0286812	Santa Cruz County
228518	Fee-for-Service	1639752553	1639752553	1	7	DISPATCHHEALTH-CA, PC	3/14/2024	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1331 W AVENUE J	104	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
228537	Fee-for-Service	1316973084	1316973084	1	1	DIX, GENA M CRNA	7/28/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
228552	Fee-for-Service	1427512862	1427512862	1	1	DIAZ-CAPORGNO, SOFIA J RCP	12/29/2023	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
228562	Fee-for-Service	1346260411	1346260411	1	1	DEGROOT, HENRY E MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	55665	07	Dermatology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
228564	Fee-for-Service	1962403865	1962403865	1	1	DEKALB MEDICAL CENTER, INC	4/20/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2801 DEKALB MEDICAL PARK	None	LITHONIA	GA	30058	4996	00	None	33.70756905	-84.14688751	DeKalb County
228600	Fee-for-Service	1265801732	1265801732	1	1	DELANY, JOSHUA CRNA	1/1/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	869 CHERRY STREET	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
228626	Fee-for-Service	1679138531	1679138531	1	1	D'SOUZA, GRETEL D MD	9/9/2024	207RR0500X	NA	Other	026	PHYSICIANS	178675	83	Rheumatology	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
228635	Fee-for-Service	1881988830	1881988830	1	1	DESAI, KUMAR MD INC	1/6/2012	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	115599	10	Gastroenterology (M.D. only)	0	In state provider	None	227 W JANSS RD	STE 315	THOUSAND OAKS	CA	91360	1869	56	06111	34.20611691	-118.883861	Ventura County
228671	Fee-for-Service	1821232778	1821232778	1	1	DELA VINA, JANELLE P NP	7/18/2017	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
228673	Fee-for-Service	1487800660	1487800660	1	1	DOHRING, LEEANN K MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98596	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
228688	Fee-for-Service	1194963462	1194963462	1	1	DEFREESE, MARISSA A MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152827	02	General Surgery	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
228720	Fee-for-Service	1568414548	1568414548	1	1	DE SILVA, PAMELA D MD	9/1/1994	207R00000X	NA	Other	026	PHYSICIANS	48894	41	Internal Medicine	0	In state provider	None	44105 N 15TH ST W	STE 301	LANCASTER	CA	93539	4037	19	06037	34.684218	-118.1568465	Los Angeles County
228757	Fee-for-Service	1598961245	1598961245	1	31	DIGNITY HEALTH MEDICAL FOUND	10/24/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	-DOMINICAN	245 MOUNT HERMON RD	STE L	SCOTTS VALLEY	CA	95066	4035	44	06087	37.0460243	-122.0286812	Santa Cruz County
228766	Fee-for-Service	1275066706	1275066706	1	1	DASTMALCHIAN, SARA MD	9/1/2023	2085R0204X	NA	Other	026	PHYSICIANS	177901	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
228813	Fee-for-Service	1043402621	1043402621	1	1	DAO, LE MD INC	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	44435	40	Pediatrics	0	In state provider	None	14554 BROOKHURST STREET	None	WESTMINSTER	CA	92683	5750	30	06059	33.7515705	-117.9548401	Orange County
228817	Fee-for-Service	1841295326	1841295326	1	1	DAMOUI, NASRIN MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77644	08	Family Practice	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
228830	Fee-for-Service	1194227017	1194227017	1	1	DUFFY, DIANE	6/24/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1850 DOUGLAS BLVD	STE 992	ROSEVILLE	CA	95661	3639	31	06061	38.74415734	-121.2570324	Placer County
228856	Fee-for-Service	1962403865	1962403865	1	1	DEKALB MEDICAL CENTER, INC	4/20/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2801 DEKALB MEDICAL PARK	None	LITHONIA	GA	30058	4996	00	None	33.70756905	-84.14688751	DeKalb County
228870	Fee-for-Service	1144391129	1144391129	1	1	DELEON, LEON C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39606	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
228893	Fee-for-Service	1104838663	1104838663	2	1	DINKINS, GRACIE-ANN E MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	77962	89	Surgery-Traumatic	0	In state provider	None	3628 E IMPERIAL HWY	STE 401	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
228898	Fee-for-Service	1538402839	1538402839	1	1	DUNN, KATHLEEN T MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132662	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
228923	Fee-for-Service	1881988830	1881988830	1	1	DESAI, KUMAR MD INC	1/6/2012	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	115599	41	Internal Medicine	0	In state provider	None	227 W JANSS RD	STE 315	THOUSAND OAKS	CA	91360	1869	56	06111	34.20611691	-118.883861	Ventura County
228942	Fee-for-Service	1285793000	1285793000	1	1	DIN, ALAUD MD	10/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	42837	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2545 WEST HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
228959	Fee-for-Service	1396958955	1396958955	1	1	DHAMIJA, RAJIV K MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88403	45	Nephrology (Renal-Kidney)	0	In state provider	None	18326 PIONEER BLVD	None	ARTESIA	CA	90701	5533	19	06037	33.864912	-118.082172	Los Angeles County
228996	Fee-for-Service	1568220812	1568220812	1	1	DR. SAEID KARANDISH INC.	9/5/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	16661 VENTURA BLVD	STE 313	ENCINO	CA	91436	1956	19	06037	34.15820737	-118.496492	Los Angeles County
229000	Fee-for-Service	1386708261	1386708261	1	1	DINAVAHI, RADHIKA	11/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55331	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
229002	Fee-for-Service	1659503290	1659503290	1	1	D'CROZ, MARIA C R MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108388	41	Internal Medicine	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
229005	Fee-for-Service	1730573023	1730573023	1	1	DIMAANO, LIEZEL R MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146941	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
229047	Fee-for-Service	1598961245	1598961245	1	31	DIGNITY HEALTH MEDICAL FOUND	10/24/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-DOMINICAN	245 MOUNT HERMON RD	STE L	SCOTTS VALLEY	CA	95066	4035	44	06087	37.0460243	-122.0286812	Santa Cruz County
229089	Fee-for-Service	1902893993	1902893993	1	1	DAVID NICHOLS	7/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1034 N 500 W	None	PROVO	UT	84604	3380	00	None	40.248072	-111.6673905	Utah County
229105	Fee-for-Service	1578823977	1578823977	1	1	DAHL, KATHARINE P PHD	10/1/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
229106	Fee-for-Service	1932219086	1932219086	1	1	DUNCAN, DOUGLAS B MD	1/1/2002	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	39970	08	Family Practice	0	In state provider	None	628 W MICHELTORENA ST	None	SANTA BARBARA	CA	93101	4131	42	06083	34.41910081	-119.7158618	Santa Barbara County
229158	Fee-for-Service	1144391129	1144391129	1	1	DELEON, LEON C MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39606	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
229179	Fee-for-Service	1104838663	1104838663	2	1	DINKINS, GRACIE-ANN E MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	77962	02	General Surgery	0	In state provider	None	3628 E IMPERIAL HWY	STE 401	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
229235	Fee-for-Service	1467073882	1467073882	1	1	DONALD W MORRIS ANESTHESIA S	4/17/2023	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ERVICES INC	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
229246	Fee-for-Service	1396958955	1396958955	1	1	DHAMIJA, RAJIV K MD	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88403	41	Internal Medicine	0	In state provider	None	18326 PIONEER BLVD	None	ARTESIA	CA	90701	5533	19	06037	33.864912	-118.082172	Los Angeles County
229288	Fee-for-Service	1942361894	1942361894	1	1	DUNAWAY-TSUJIHARA, SUSAN A	12/14/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	1434 3RD ST	STE 3A	NAPA	CA	94559	2860	28	06055	38.29592269	-122.2881544	Napa County
229345	Fee-for-Service	1265410021	1265410021	1	1	DOVRE, PER ARNE MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	19317	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6283 CLARK RD	STE 8	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
229347	Fee-for-Service	1447348966	1447348966	1	1	DERMODY, JOHN F MD	7/31/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43495	08	Family Practice	0	In state provider	None	1001 PROFESSIONAL DR	None	NAPA	CA	94558	6413	28	06055	38.32002271	-122.2937213	Napa County
229369	Fee-for-Service	1841071792	1841071792	1	1	DONATE FOR CHARITY, INC.	12/28/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2284 SECOND ST	None	NAPA	CA	94559	2219	28	06055	38.29714251	-122.2988648	Napa County
229402	Fee-for-Service	1912438763	1912438763	1	1	DIPRINZIO, DOMINIC DO	8/8/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
229409	Fee-for-Service	1962604124	1962604124	1	1	DEVANI, ARPITA A DO	5/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9513	41	Internal Medicine	0	In state provider	None	4857 HUNTINGTON DR N	None	LOS ANGELES	CA	90032	1939	19	06037	34.08633288	-118.1781988	Los Angeles County
229418	Fee-for-Service	1588603450	1588603450	1	1	DU PLESSIS, ELAINE MD	2/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110632	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
229483	Fee-for-Service	1922665272	1922665272	1	1	DELGADO, SAMUEL	6/4/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1300 W 155TH ST	107	GARDENA	CA	90247	4049	19	06037	33.89049013	-118.2982407	Los Angeles County
229510	Fee-for-Service	1477948750	1477948750	1	1	DESMOND, SUZI LMFT	11/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125504	-	NOT APPLICABLE	0	In state provider	None	440 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	1430	38	06075	37.76420358	-122.4074414	San Francisco County
229539	Fee-for-Service	1598832339	1598832339	1	1	DO, CHUONG K MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92516	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
229541	Fee-for-Service	1922392901	1922392901	1	1	DONNELLY, LAUREN B DO	6/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13279	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
229551	Fee-for-Service	1902388697	1902388697	1	1	DOWNTOWN PHARMACY INC	11/1/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	60 N 13TH ST	STE A	SAN JOSE	CA	95112	3525	43	06085	37.34297359	-121.8787654	Santa Clara County
229561	Fee-for-Service	1275246704	1275246704	1	1	DESERT MALLOW HEALTHCARE INC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7781 GARFIELD AVENUE	None	HUNTINGTON BEACH	CA	92648	2026	30	06059	33.68671949	-117.992403	Orange County
229569	Fee-for-Service	1669440350	1669440350	1	1	DAVID PATRICK O'BRIEN MD	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
229585	Fee-for-Service	1871608125	1871608125	1	1	DAMODARAN-NAIR, HARIKRISHNAN	7/24/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	81249	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
229631	Fee-for-Service	1265410021	1265410021	1	1	DOVRE, PER ARNE MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	19317	01	General Practice	0	In state provider	None	6283 CLARK RD	STE 8	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
229693	Fee-for-Service	1699770511	1699770511	1	1	DAVIES, JAMES A MD	1/31/1992	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41798	18	Ophthalmology	0	In state provider	None	655 LAGUNA DR	None	CARLSBAD	CA	92008	1610	37	06073	33.16517432	-117.3508982	San Diego County
229700	Fee-for-Service	1962604124	1962604124	1	1	DEVANI, ARPITA A DO	5/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9513	20	Orthopedic Surgery	0	In state provider	None	4857 HUNTINGTON DR N	None	LOS ANGELES	CA	90032	1939	19	06037	34.08633288	-118.1781988	Los Angeles County
229703	Fee-for-Service	1043456106	1043456106	1	3	DIGNITY HEALTH MEDICAL FOUND	8/16/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	155 GLASSON WAY	SUITE L10	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
229705	Fee-for-Service	1336117696	1336117696	1	1	DOTSON, RIICO J MD	8/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83526	20	Orthopedic Surgery	0	In state provider	None	6512 WESTSIDE RD	STE F	REDDING	CA	96001	4868	45	06089	40.52111546	-122.3824845	Shasta County
229711	Fee-for-Service	1225605538	1225605538	1	1	DALY, AMY B LCSW	8/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 N MARKET	STE 950	SAN JOSE	CA	95113	1112	43	06085	37.33791617	-121.8939388	Santa Clara County
229734	Fee-for-Service	1063436111	1063436111	1	1	DILLON, MICHAEL L MD	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	35028	66	Emergency Medicine (Urgent Care)	0	In state provider	None	150 PIONEER LANE	None	BISHOP	CA	93514	2556	14	06027	37.36193834	-118.4073304	Inyo County
229764	Fee-for-Service	1134626260	1134626260	1	1	DANIALIAN, SALAR DO	7/22/2022	207L00000X	NA	Other	026	PHYSICIANS	19249	None	None	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
229809	Fee-for-Service	1598961245	1598961245	1	33	DIGNITY HEALTH MEDICAL FOUND	11/5/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ATION	1661 SOQUEL DR	None	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
229810	Fee-for-Service	1215241542	1215241542	1	1	DAHMOUSH, HISHAM M MD	1/20/2017	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	134719	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
229825	Fee-for-Service	1083860787	1083860787	1	1	DHILLON, KIRANBIR K MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104177	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
229892	Fee-for-Service	1164693347	1164693347	1	1	DIAA BAHGAT	3/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
229894	Fee-for-Service	1477725984	1477725984	1	1	DIXON, NIKITA MD	9/17/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	116123	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
229895	Fee-for-Service	1457504029	1457504029	1	1	DANESHVAR, DANIEL A MD	11/23/2010	390200000X	NA	Other	026	PHYSICIANS	111947	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
229932	Fee-for-Service	1447223318	1447223318	1	1	DVA HEALTHCARE RENA	11/23/2005	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	CARE INC	3010 S 4TH AVE	None	YUMA	AZ	85364	8103	00	None	32.67149897	-114.624179	Yuma County
229935	Fee-for-Service	1952776205	1952776205	1	1	DJUOGOUO, JUDITH E CNP	10/23/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
229938	Fee-for-Service	1801004205	1801004205	1	1	DUPLESSIS, HELEN M MD	3/4/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	57767	-	NOT APPLICABLE	0	In state provider	None	808 WEST 58TH STREET	None	LOS ANGELES	CA	90037	3632	19	06037	33.98965917	-118.287673	Los Angeles County
229996	Fee-for-Service	1447585161	1447585161	1	1	DHOND, MILIND MD INC	4/7/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56062	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1261 TRAVIS BLVD	STE 200	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
230014	Fee-for-Service	1053422741	1053422741	1	1	DOOLITTLE, JOHN K MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	69624	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
230018	Fee-for-Service	1417186610	1417186610	1	1	DEZFULI, BOBBY MD	10/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122659	20	Orthopedic Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
230023	Fee-for-Service	1114482783	1114482783	1	1	DIAZ, GENARO F RCP	4/23/2021	2279P1004X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
230037	Fee-for-Service	1508209164	1508209164	1	1	DO, HAU D MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135184	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
230160	Fee-for-Service	1588730238	1588730238	1	1	DREJET, ANNE E MD	2/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	52434	22	Pathology (M.D. only)	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
230179	Fee-for-Service	1366974602	1366974602	1	1	DOTTERWEICH, WILLIAM MD	7/22/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	190798	20	Orthopedic Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
230194	Fee-for-Service	1437137262	1437137262	1	1	DONAHOE, NANCY A MD	6/6/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	3131 LA CANADA ST	STE 217	LAS VEGAS	NV	89109	2579	00	None	36.13267814	-115.132162	Clark County
230197	Fee-for-Service	1700320751	1700320751	1	1	DWYER, LANCE C LCSW	7/28/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	73859	-	NOT APPLICABLE	0	In state provider	None	730 POLK STREET	4TH FLOOR	SAN FRANCISCO	CA	94109	7813	38	06075	37.78379532	-122.4192766	San Francisco County
230209	Fee-for-Service	1376168690	1376168690	1	1	DESAI, ALISHA	4/12/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
230275	Fee-for-Service	1093073090	1093073090	1	1	DATTA, DEBAJYOTI MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137105	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230282	Fee-for-Service	1447585161	1447585161	1	1	DHOND, MILIND MD INC	4/7/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	56062	41	Internal Medicine	0	In state provider	None	1261 TRAVIS BLVD	STE 200	FAIRFIELD	CA	94533	4800	48	06095	38.25812361	-122.0495417	Solano County
230301	Fee-for-Service	1477655082	1477655082	1	1	DREHOBL, MARGARET A MD	1/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40969	08	Family Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
230311	Fee-for-Service	1902022817	1902022817	1	1	DICKER.LANCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	875 OAK STREET SE 5070	None	SALEM	OR	97301	0000	00	None	44.933598	-123.0339735	Marion County
230343	Fee-for-Service	1831139757	1831139757	1	1	DELANEY-SATHY, LYDIA	8/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87970	30	Radiology	0	In state provider	O MD	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
230430	Fee-for-Service	1750800652	1750800652	1	1	DE LEON, KEVIN S S CRNA	12/7/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
230472	Fee-for-Service	1033170832	1033170832	1	1	DONALD E GILES, M.D.	11/15/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10123 SE MARKET ST	None	PORTLAND	OR	97216	2532	00	None	45.51158947	-122.5586205	Multnomah County
230483	Fee-for-Service	1437137262	1437137262	1	1	DONAHOE, NANCY A MD	6/6/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	3131 LA CANADA ST	STE 217	LAS VEGAS	NV	89109	2579	00	None	36.13267814	-115.132162	Clark County
230501	Fee-for-Service	1588967855	1588967855	1	2	DAMMAN, JENNIFER L MD	8/13/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	127630	40	Pediatrics	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
230509	Fee-for-Service	1013067644	1013067644	1	1	DAVID ZANE	9/10/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10200 NE 132ND ST	None	KIRKLAND	WA	98034	2831	00	None	47.71853274	-122.2042278	King County
230512	Fee-for-Service	1689877888	1689877888	1	1	DALISAY, ROMEO Y	10/7/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
230560	Fee-for-Service	1295940013	1295940013	1	1	DOOR TO HOPE	1/23/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	130 WEST GABILAN STREET	None	SALINAS	CA	93901	2762	27	06053	36.67518004	-121.6586136	Monterey County
230563	Fee-for-Service	1093073090	1093073090	1	1	DATTA, DEBAJYOTI MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137105	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
230580	Fee-for-Service	1902837651	1902837651	1	1	DONOHOE, JOHN W MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41908	08	Family Practice	0	In state provider	None	1060 SAN BERNARDINO RD	None	UPLAND	CA	91786	4913	36	06071	34.10086611	-117.6372323	San Bernardino County
230673	Fee-for-Service	1487672192	1487672192	1	1	DHINGRA, HEMANT MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100412	13	Neurology (M.D. only)	0	In state provider	None	568 E HERNDON AVE	STE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
230680	Fee-for-Service	1427053560	1427053560	1	1	DAINER, ROGER D DO	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	4823	20	Orthopedic Surgery	0	In state provider	None	5601 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5407	07	06013	37.77772182	-121.9579459	Contra Costa County
230722	Fee-for-Service	1962177535	1962177535	1	1	DYNASTY HOSPICE AND PALLIATI	1/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	6365 VAN NUYS BLVD	SUITE 1	VAN NUYS	CA	91401	2674	19	06037	34.18619819	-118.4487575	Los Angeles County
230786	Fee-for-Service	1013043272	1013043272	1	1	DI GIULIO, DANIEL B MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86328	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
230809	Fee-for-Service	1982661435	1982661435	1	1	DARRAGH, TERESA, M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61187	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
230865	Fee-for-Service	1902837651	1902837651	1	1	DONOHOE, JOHN W MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41908	01	General Practice	0	In state provider	None	1060 SAN BERNARDINO RD	None	UPLAND	CA	91786	4913	36	06071	34.10086611	-117.6372323	San Bernardino County
230866	Fee-for-Service	1982840617	1982840617	1	1	DE RIERA, MALGORZATA E	1/13/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3900 ALAMO ST	None	SIMI VALLEY	CA	93063	2111	56	06111	34.28628637	-118.7195497	Ventura County
230868	Fee-for-Service	1275619736	1275619736	1	1	DANESHGAR, KOUROSH K MD	1/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	64700	None	None	0	In state provider	None	3710 CESAR CHAVEZ AVE	2ND FLOOR	LOS ANGELES	CA	90063	2219	19	06037	34.04048853	-118.1854845	Los Angeles County
230892	Fee-for-Service	1275913766	1275913766	1	1	DREW, BENJAMIN A MD	3/3/2022	207L00000X	NA	Other	026	PHYSICIANS	173121	None	None	0	In state provider	None	75 NIELSON	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
230893	Fee-for-Service	1508443722	1508443722	1	1	DIAZ, VICTORIA MD	9/13/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
230918	Fee-for-Service	1588786933	1588786933	1	1	DIJULIO, THOMAS P MD INC	11/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30897	13	Neurology (M.D. only)	0	In state provider	None	1703 TERMINO AVE	STE 208	LONG BEACH	CA	90804	2128	19	06037	33.7883073	-118.1459488	Los Angeles County
230935	Fee-for-Service	1457786907	1457786907	1	1	DAMIANI, VANESSA PT	10/26/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
230962	Fee-for-Service	1033794805	1033794805	1	1	DAVIDSON MARIE LANE LLC	7/27/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2834 MARIE LANE	None	MERCED	CA	95340	2611	24	06047	37.31334034	-120.4494508	Merced County
230977	Fee-for-Service	1639257322	1639257322	1	1	DUONG, HOA C MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54720	41	Internal Medicine	0	In state provider	None	3701 J ST	STE 201	SACRAMENTO	CA	95816	5542	34	06067	38.571237	-121.4566245	Sacramento County
231009	Fee-for-Service	1962177535	1962177535	1	1	DYNASTY HOSPICE AND PALLIATI	1/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	6365 VAN NUYS BLVD	SUITE 1	VAN NUYS	CA	91401	2674	19	06037	34.18619819	-118.4487575	Los Angeles County
231010	Fee-for-Service	1295594059	1295594059	1	1	DECARLO, KAREN CD	3/19/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
231023	Fee-for-Service	1255442919	1255442919	1	1	DENNEHY, CAROLYN F MD	1/1/1993	207RR0500X	NA	Other	026	PHYSICIANS	71612	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
231072	Fee-for-Service	1811076342	1811076342	1	1	DENNIS-ZARATE, KATHLEEN	8/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MD INC	222 W EULALIA ST	STE 110	GLENDALE	CA	91204	2850	19	06037	34.12653215	-118.257121	Los Angeles County
231075	Fee-for-Service	1013043272	1013043272	1	1	DI GIULIO, DANIEL B MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86328	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
231088	Fee-for-Service	1972637676	1972637676	1	1	DOSANJH, AMRITA K MD	6/30/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	62024	None	None	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
231093	Fee-for-Service	1801974654	1801974654	1	1	DUNFIELD, DEBORA, M MD	6/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50596	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
231098	Fee-for-Service	1982661435	1982661435	1	1	DARRAGH, TERESA, M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61187	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
231152	Fee-for-Service	1699382325	1699382325	1	1	DUNLAP, CARLY C CRNA	3/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
231194	Fee-for-Service	1285325605	1285325605	1	1	DIAZ, YVETTE P OD	10/6/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
231202	Fee-for-Service	1356964233	1356964233	1	1	DELZER, HALEY LMFT	2/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
231217	Fee-for-Service	1649506171	1649506171	1	1	DIRECT CARE MEDICAL RESPITE	6/1/2015	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	INC	38742 ANNETTE AVE	None	PALMDALE	CA	93551	4562	19	06037	34.58638678	-118.1656122	Los Angeles County
231247	Fee-for-Service	1285987875	1285987875	1	1	DURANT, EDWARD J MD	4/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128734	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
231264	Fee-for-Service	1558555409	1558555409	1	1	DUNN, JENNIFER LMFT	9/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
231334	Fee-for-Service	1073598389	1073598389	1	1	DEPREY, LESLEY PHD	12/16/2003	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
231335	Fee-for-Service	1700489648	1700489648	1	1	DCRUZ, MIGNONNE J CNP	4/14/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2505 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2011	19	06037	34.03287856	-118.4748782	Los Angeles County
231360	Fee-for-Service	1760861520	1760861520	1	1	DUNAMIS INC GROUP HOME	10/27/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5090 E CHURCH AVENUE	ROOM A-1	FRESNO	CA	93725	1230	10	06019	36.71467949	-119.7239115	Fresno County
231380	Fee-for-Service	1801974654	1801974654	1	1	DUNFIELD, DEBORA, M MD	6/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50596	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
231384	Fee-for-Service	1801882600	1801882600	1	1	DIETRICH, DAMON M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 MEDICAL CENTER BLVD	None	MARRERO	LA	70072	3147	00	None	29.89168678	-90.09584835	Jefferson Parish
231385	Fee-for-Service	1215979141	1215979141	1	1	DESAI, JITENDRA N MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	25062	40	Pediatrics	0	In state provider	None	14624 SHERMAN WAY	STE 401	VAN NUYS	CA	91405	2289	19	06037	34.20078354	-118.450843	Los Angeles County
231386	Fee-for-Service	1982661435	1982661435	1	1	DARRAGH, TERESA, M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	61187	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
231450	Fee-for-Service	1710951918	1710951918	1	1	DANIEL L SILVASI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	44201 DEQUINDRE RD	None	TROY	MI	48085	1117	00	None	42.61849536	-83.09121784	Oakland County
231467	Fee-for-Service	1780142745	1780142745	1	1	DILIGENT HOME HEALTH CARE	2/15/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	960 E GREEN STREET	SUITE #302	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
231494	Fee-for-Service	1770128621	1770128621	1	1	DIAZ, PETER J PT	6/23/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	949 S STATE ST	None	HEMET	CA	92543	7182	33	06065	33.73230496	-116.9716029	Riverside County
231529	Fee-for-Service	1164841649	1164841649	1	1	DIANAT, SAEED MD	10/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175614	None	None	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
231591	Fee-for-Service	1336198910	1336198910	1	1	DAR, ELLEN MD	5/4/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86276	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
231602	Fee-for-Service	1225792369	1225792369	1	1	DOAN-NGUYEN, DIANA CNP	4/6/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 BAKER ST	None	COSTA MESA	CA	92626	4111	30	06059	33.68015852	-117.906831	Orange County
231615	Fee-for-Service	1972611655	1972611655	1	1	DANSO, ALEX K MD INC	11/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	51761	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	44215 15TH ST W	STE 305	LANCASTER	CA	93534	5504	19	06037	34.68666415	-118.1568572	Los Angeles County
231616	Fee-for-Service	1184832339	1184832339	1	1	DHINDSA, GURINDER S MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103197	01	General Practice	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
231643	Fee-for-Service	1811407869	1811407869	1	1	DE LA CRUZ, ADRIAN M CRNA	12/15/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
231775	Fee-for-Service	1205456191	1205456191	1	1	DENISOVA, ELIZABETH G DO	4/14/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	23283	15	Obstetrics (D.O. only)	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
231783	Fee-for-Service	1447287362	1447287362	1	1	DAVIS, TRACY L MD	1/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99627	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
231853	Fee-for-Service	1598961245	1598961245	1	6	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1595 SOQUEL DR	STE 411	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
231865	Fee-for-Service	1316025919	1316025919	1	1	DYKSTRA, ROSS A MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	52581	05	Anesthesiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
231896	Fee-for-Service	1184982340	1184982340	1	1	DEPARIS, SARAH W MD	5/25/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	127638	18	Ophthalmology	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
231902	Fee-for-Service	1184832339	1184832339	1	1	DHINDSA, GURINDER S MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103197	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
231916	Fee-for-Service	1073781886	1073781886	1	1	DJABOURIAN, BEN	1/14/2002	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	VITO'S PEDORTHIC CENTER	143 E ROWLAND ST	#2	COVINA	CA	91723	3000	19	06037	34.07907333	-117.8887268	Los Angeles County
231991	Fee-for-Service	1598961245	1598961245	1	9	DIGNITY HEALTH MEDICAL FOUND	12/4/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1595 SOQUEL DR	STE 310	SANTA CRUZ	CA	95065	1719	44	06087	36.98879599	-121.9826354	Santa Cruz County
232013	Fee-for-Service	1992920821	1992920821	1	1	DEBORAH JOAN NOVAK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
232017	Fee-for-Service	1871521666	1871521666	1	1	DANIEL JAMES WOODWARD, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
232064	Fee-for-Service	1205456191	1205456191	1	1	DENISOVA, ELIZABETH G DO	4/14/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	23283	09	Gynecology (D.O. only)	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
232071	Fee-for-Service	1912240706	1912240706	1	1	DIERICKX, QUYNH A MD	6/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131685	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
232124	Fee-for-Service	1922323856	1922323856	1	1	DEUKMEDJIAN, GRACE MD	1/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121322	40	Pediatrics	0	In state provider	None	10833 LE CONTE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
232188	Fee-for-Service	1922455971	1922455971	1	1	DEEM, JENNIFER R CNP	12/21/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1871 EL CAMINO REAL	None	BURLINGAME	CA	94010	3220	41	06081	37.59599909	-122.3855621	San Mateo County
232200	Fee-for-Service	1174535462	1174535462	1	1	DIONISIO, ANNE N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	315 MARTIN LUTHER KING J	None	TACOMA	WA	98405	4234	00	None	47.25960844	-122.4534238	Pierce County
232201	Fee-for-Service	1649084484	1649084484	1	1	DONATO DEWALD, ALYSSA A	2/3/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
232252	Fee-for-Service	1053767160	1053767160	1	1	DIRIBE, NNAEMEKA D DO	7/17/2019	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
232289	Fee-for-Service	1992885099	1992885099	1	1	DEMETRIOU, MICHAEL MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77231	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
232301	Fee-for-Service	1285600346	1285600346	1	1	DUTTON, JOHN P MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52209	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
232367	Fee-for-Service	1407345754	1407345754	1	1	DEFRANCESCO, CHARLES MD	4/16/2022	207L00000X	NA	Other	026	PHYSICIANS	176101	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
232389	Fee-for-Service	1417953878	1417953878	1	5	DIABLO VALLEY ONCOLOGY	7/23/2012	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3725 LONE TREE WAY	SUITE A2	ANTIOCH	CA	94509	6000	07	06013	37.98405918	-121.8056534	Contra Costa County
232430	Fee-for-Service	1255338604	1255338604	1	1	DELONG, LISA M MD	12/29/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160625	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
232451	Fee-for-Service	1861832347	1861832347	1	1	DUDAR, AHMAD D MD	6/27/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	162120	41	Internal Medicine	0	In state provider	None	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
232529	Fee-for-Service	1598961245	1598961245	1	3	DIGNITY HEALTH MEDICAL FOUND	9/6/2011	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	1667 DOMINICAN WY	STE 134	SANTA CRUZ	CA	95065	1529	44	06087	36.99032635	-121.9811719	Santa Cruz County
232539	Fee-for-Service	1801831219	1801831219	1	1	DEVGAN, UDAY MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65426	01	General Practice	0	In state provider	None	9375 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
232540	Fee-for-Service	1821801846	1821801846	1	1	DEVORA-HUIZAR, NANCY	1/31/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
232551	Fee-for-Service	1215026380	1215026380	1	1	DALSANIA, CHIRAG J MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99118	78	Neoplastic Diseases/Oncology	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
232553	Fee-for-Service	1811293939	1811293939	1	1	DOLAN, KEVIN B CRNA	12/27/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
232643	Fee-for-Service	1326753757	1326753757	1	1	DELIGHTSME IRVINE PSYCHOTHER	11/14/2023	101Y00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	APY INC	4695 MACARTHUR CT	SUITE 1100	NEWPORT BEACH	CA	92660	1882	30	06059	33.6705627	-117.8619817	Orange County
232658	Fee-for-Service	1558473413	1558473413	1	1	DONLEY, PATRICK J MD	4/27/2006	207L00000X	NA	Other	026	PHYSICIANS	64925	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
232679	Fee-for-Service	1275594657	1275594657	1	1	DAVE, KHAMAJ MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60040	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
232683	Fee-for-Service	1295760056	1295760056	1	1	DYKES, WILLIAM J MD	11/30/1991	207P00000X	NA	Other	026	PHYSICIANS	57768	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
232686	Fee-for-Service	1609826973	1609826973	1	1	DURAIRAJ, AZHIL MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54721	None	None	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
232701	Fee-for-Service	1881974707	1881974707	1	1	DEVOY, MONICA C MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117788	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
232719	Fee-for-Service	1265433288	1265433288	1	1	DIRAIMONDO, CAROL MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	49855	01	General Practice	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 101	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
232736	Fee-for-Service	1861832347	1861832347	1	1	DUDAR, AHMAD D MD	6/27/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	162120	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
232745	Fee-for-Service	1649449604	1649449604	1	1	DUGGAL, VANDANA MD	4/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110383	08	Family Practice	0	In state provider	None	5720 STONERIDGE MALL RD	STE 330	PLEASANTON	CA	94588	2895	01	06001	37.69247085	-121.9301884	Alameda County
232805	Fee-for-Service	1285011908	1285011908	1	1	DIAZ, OLGA V MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135754	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
232840	Fee-for-Service	1215026380	1215026380	1	1	DALSANIA, CHIRAG J MD	9/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99118	68	Hematology	0	In state provider	None	1700 N ROSE AVE	STE 320	OXNARD	CA	93030	7648	56	06111	34.21746	-119.155545	Ventura County
232843	Fee-for-Service	1023276748	1023276748	1	1	DALATI, STEVEN S MD	8/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120756	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
232872	Fee-for-Service	1740501683	1740501683	1	1	DE LIMA, MARIEARLYNNE L	10/19/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
232883	Fee-for-Service	1811296080	1811296080	1	1	DAGINAWALA, NAZNIN MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141783	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
232914	Fee-for-Service	1447815220	1447815220	1	1	DELANEY, ASHLEY DO	8/6/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21202	08	Family Practice	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
232930	Fee-for-Service	1326753757	1326753757	1	1	DELIGHTSME IRVINE PSYCHOTHER	11/14/2023	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	APY INC	4695 MACARTHUR CT	SUITE 1100	NEWPORT BEACH	CA	92660	1882	30	06059	33.6705627	-117.8619817	Orange County
232972	Fee-for-Service	1407840960	1407840960	1	1	DIMARANAN, LIZA F OD	7/5/2002	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5026 S PASSONS BLVD	STE B	PICO RIVERA	CA	90660	2800	19	06037	33.99796626	-118.0782746	Los Angeles County
233006	Fee-for-Service	1154455434	1154455434	1	1	DELANO COMM HEALTH CTR	3/1/1997	261QF0050X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1508 GARCES HWY	STE 1	DELANO	CA	93215	3687	15	06029	35.76141641	-119.2369096	Kern County
233030	Fee-for-Service	1598961245	1598961245	1	20	DIGNITY HEALTH MEDICAL FOUND	4/27/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FOUNDATION	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	44	06087	36.98031434	-122.004438	Santa Cruz County
233084	Fee-for-Service	1720218993	1720218993	1	1	DESHMUKH-RANE, SUVARNA A MD	6/9/2010	207ZC0500X	NA	Other	026	PHYSICIANS	102852	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
233130	Fee-for-Service	1174065866	1174065866	1	1	DAVILA, OSCAR IGNACIO L MD	4/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151277	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
233237	Fee-for-Service	1225488851	1225488851	1	1	DERMENDJIAN, BERJ DO	10/27/2021	207R00000X	NA	Other	026	PHYSICIANS	18670	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
233270	Fee-for-Service	1174610273	1174610273	1	1	DE PAIVA, HELDER MD	9/9/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	149852	41	Internal Medicine	0	In state provider	None	8635 W 3RD ST	STE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
233274	Fee-for-Service	1760552640	1760552640	1	1	DIANA TANG MD & SONJA	7/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	HUIE MD, INC	3905 SACRAMENTO ST	STE 100	SAN FRANCISCO	CA	94118	1651	38	06075	37.78684297	-122.4572728	San Francisco County
233321	Fee-for-Service	1912403718	1912403718	1	1	DESERT CANYON POST ACUTE LLC	3/19/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1642 WEST AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68939051	-118.159794	Los Angeles County
233334	Fee-for-Service	1043493455	1043493455	1	1	DUARTE, CARMELA LMFT	3/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
233369	Fee-for-Service	1548793219	1548793219	1	1	DOLL, ALISSA J MD	9/13/2023	2086X0206X	NA	General Surgery	026	PHYSICIANS	190513	None	None	0	In state provider	None	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	19	06037	34.02773198	-118.4862675	Los Angeles County
233402	Fee-for-Service	1285894659	1285894659	1	1	DAKWAR, JUBRAN S MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1910 OUTLET CENTER DR	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
233472	Fee-for-Service	1083687917	1083687917	1	1	DR CARLOS E. DIAZ	7/19/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11750 SW 40TH ST	None	MIAMI	FL	33175	3530	00	None	25.73191305	-80.38556739	Miami-Dade County
233532	Fee-for-Service	1073665360	1073665360	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
233553	Fee-for-Service	1174610273	1174610273	1	1	DE PAIVA, HELDER MD	9/9/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	149852	45	Nephrology (Renal-Kidney)	0	In state provider	None	8635 W 3RD ST	STE 1190W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
233563	Fee-for-Service	1902179146	1902179146	1	1	DAVID LUNDY MD	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2350 MEADOWS BLVD	None	CASTLE ROCK	CO	80109	8405	00	None	39.40523232	-104.8867306	Douglas County
233576	Fee-for-Service	1679575369	1679575369	1	1	DOOR TO HOPE	10/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	165 CLAY ST	None	SALINAS	CA	93901	2509	27	06053	36.67006578	-121.6591741	Monterey County
233609	Fee-for-Service	1467087007	1467087007	1	1	DESERT BLOOM INC	6/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1240 COLLEGE HEIGHTS BLV	None	RIDGECREST	CA	93555	8066	15	06029	35.60153751	-117.6704735	Kern County
233621	Fee-for-Service	1841649209	1841649209	1	1	DAVIS, KATERRA E LMFT	3/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 155	RANCHO CUCAMONGA	CA	91730	7605	36	06071	34.10227306	-117.5715643	San Bernardino County
233648	Fee-for-Service	1437465200	1437465200	1	1	DUONG, HEATHER M PSYD	8/27/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
233650	Fee-for-Service	1699966861	1699966861	1	1	DESAI, SHEETAL B MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87736	83	Rheumatology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
233658	Fee-for-Service	1598392540	1598392540	1	1	DESHPANDE, RIMA MD	11/21/2023	390200000X	NA	Other	026	PHYSICIANS	188651	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233720	Fee-for-Service	1225266463	1225266463	1	1	DIANA NGUYEN OPTOMETRY INC	8/10/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	903 SOUTH BRISTOL ST	UNIT A	SANTA ANA	CA	92703	4983	30	06059	33.73607851	-117.8850175	Orange County
233753	Fee-for-Service	1922064963	1922064963	1	1	DIXIT, MANJUL S MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84174	83	Rheumatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
233778	Fee-for-Service	1588638639	1588638639	1	1	DOMINIC C CEFALI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4007 GATEWAY BLVD	STE 100	NEWBURGH	IN	47630	0000	00	None	37.97460599	-87.44588955	Warrick County
233794	Fee-for-Service	1841483864	1841483864	1	1	DAVIS, KIMBERLY J MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103843	36	Psychiatry	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
233820	Fee-for-Service	1073665360	1073665360	1	1	DIGNITY HEALTH	9/30/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
233825	Fee-for-Service	1467989269	1467989269	1	1	DE SOUZA, LIENIO F NP	8/9/2017	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	700 W 19TH ST	None	COSTA MESA	CA	92627	3517	30	06059	33.64342564	-117.9280911	Orange County
233843	Fee-for-Service	1144561853	1144561853	1	1	DUNNIGAN, KERIANN CCC-SLP	6/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
233856	Fee-for-Service	1760520753	1760520753	1	1	DUONG, BAO D MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93270	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
233883	Fee-for-Service	1477958734	1477958734	1	1	DUNAGAN, KRISTEN M LCSW	3/6/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1835 SUNNYCREST DR	None	FULLERTON	CA	92835	3616	30	06059	33.89224326	-117.9312781	Orange County
233939	Fee-for-Service	1568465466	1568465466	1	6	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	6800 SOQUEL DR	None	APTOS	CA	95003	3225	44	06087	36.98726443	-121.9209838	Santa Cruz County
233974	Fee-for-Service	1588740906	1588740906	1	1	DODGE, JOSEPH M MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	70977	08	Family Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
233996	Fee-for-Service	1063515963	1063515963	1	1	DO, TRUTRANG DO INC	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8885	41	Internal Medicine	0	In state provider	None	15735 HAWTHORNE BLVD	STE 111	LAWNDALE	CA	90260	2664	19	06037	33.887664	-118.3527595	Los Angeles County
234034	Fee-for-Service	1922033729	1922033729	1	1	DUONG, TRUONG D AMC	11/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70137	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	399 E HIGHLAND AVE	STE 209	SAN BERNARDINO	CA	92404	3848	36	06071	34.1358627	-117.2757898	San Bernardino County
234042	Fee-for-Service	1922064963	1922064963	1	1	DIXIT, MANJUL S MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	84174	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
234048	Fee-for-Service	1134309222	1134309222	1	1	DRS BOECK & SCHISLER	8/1/1990	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CONVOY EYECARE	7420 CLAIREMONT MESA BLV	STE 109	SAN DIEGO	CA	92111	1546	37	06073	32.8327405	-117.158445	San Diego County
234067	Fee-for-Service	1619154788	1619154788	1	1	DEN OUDEN, DYAN NP	10/8/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
234110	Fee-for-Service	1194180711	1194180711	1	1	DELIGHT HOME HEALTH CARE	8/9/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14435 HAMLIN ST	STE 203	VAN NUYS	CA	91401	6205	19	06037	34.18869947	-118.447731	Los Angeles County
234114	Fee-for-Service	1568465466	1568465466	1	1	DOCTORS ON DUTY MEDICAL GROU	8/27/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
234192	Fee-for-Service	1871641845	1871641845	1	1	DURAND, JASON E MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67242	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
234228	Fee-for-Service	1568465466	1568465466	1	6	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P, INC	6800 SOQUEL DR	None	APTOS	CA	95003	3225	44	06087	36.98726443	-121.9209838	Santa Cruz County
234256	Fee-for-Service	1316334204	1316334204	1	1	DICONTI-GIBBS, ANALIESE M MD	9/2/2020	208M00000X	NA	Other	026	PHYSICIANS	144827	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
234274	Fee-for-Service	1225302516	1225302516	1	1	DAVE, DATTESH R MD	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147311	24	Plastic Surgery	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
234307	Fee-for-Service	1417935446	1417935446	1	1	DELTA COUNTY MEMORIAL	9/29/2002	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	1501 E 3RD ST	None	DELTA	CO	81416	2815	00	None	38.74319827	-108.0470522	Delta County
234310	Fee-for-Service	1720421613	1720421613	1	1	DURST, MICHAEL J MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
234312	Fee-for-Service	1578861613	1578861613	1	2	DR. PATRICIA'S HEALTH CLUB,	3/5/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC.	1310 STEWART DR	508	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
234325	Fee-for-Service	1922033729	1922033729	1	1	DUONG, TRUONG D AMC	11/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70137	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	STE 209	SAN BERNARDINO	CA	92404	3848	36	06071	34.1358627	-117.2757898	San Bernardino County
234335	Fee-for-Service	1417953878	1417953878	1	1	DIABLO VALLEY ONCOLOGY	3/1/2001	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	0	In state provider	& HEMATOLOGY MED GRP INC	400 TAYLOR BLVD	STE 202	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
234366	Fee-for-Service	1740582758	1740582758	1	1	DUARTE, SHIRLEY LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH ST W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
234390	Fee-for-Service	1568613313	1568613313	1	1	D'SOUZA, SHARON C MD	4/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105878	08	Family Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
234407	Fee-for-Service	1295396281	1295396281	1	1	DIJANIC, CHRISTOPHER MD	7/18/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
234488	Fee-for-Service	1194785758	1194785758	1	1	DEMERSSEMAN, JOHN A MD	1/1/1982	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	28169	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
234498	Fee-for-Service	1851595656	1851595656	1	1	DR. ARTURO PORTILLO JR. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
234551	Fee-for-Service	1649247974	1649247974	1	1	DOUGLAS HOSPITAL, INC.	5/19/2022	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8954 HOSPITAL DR	None	DOUGLASVILLE	GA	30134	2272	00	None	33.73923813	-84.73299495	Douglas County
234564	Fee-for-Service	1871253997	1871253997	1	1	DIEHL, AMY N	1/13/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11144 E SUSSEX AVE	None	SANGER	CA	93657	9350	10	06019	36.79056653	-119.589579	Fresno County
234580	Fee-for-Service	1295797595	1295797595	1	1	DAVID GUBLER	10/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E 3900 S	None	SALT LAKE CTY	UT	84124	1300	00	None	40.68703142	-111.857243	Salt Lake County
234586	Fee-for-Service	1699986141	1699986141	1	1	DINH, TRANG T MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83222	40	Pediatrics	0	In state provider	None	5953 ATLANTIC BLVD	None	MAYWOOD	CA	90270	3133	19	06037	33.98590138	-118.1858597	Los Angeles County
234588	Fee-for-Service	1417935446	1417935446	1	1	DELTA COUNTY MEMORIAL	9/29/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	1501 E 3RD ST	None	DELTA	CO	81416	2815	00	None	38.74319827	-108.0470522	Delta County
234600	Fee-for-Service	1578861613	1578861613	1	2	DR. PATRICIA'S HEALTH CLUB,	3/5/2024	208000000X	NA	Pediatric Primary Care	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC.	1310 STEWART DR	508	ORANGE	CA	92868	3854	30	06059	33.78236048	-117.8664975	Orange County
234608	Fee-for-Service	1760827265	1760827265	1	1	DOCKWEILER, CAITLIN M MD	9/18/2018	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	132371	38	Geriatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
234621	Fee-for-Service	1417953878	1417953878	1	1	DIABLO VALLEY ONCOLOGY	3/1/2001	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	& HEMATOLOGY MED GRP INC	400 TAYLOR BLVD	STE 202	PLEASANT HILL	CA	94523	2160	07	06013	37.96132631	-122.0740275	Contra Costa County
234649	Fee-for-Service	1922236611	1922236611	1	1	DIABETIC COMFORT SHOES, INC	11/2/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DIABETIC COMFORT SHOES	2311 W BURBANK BLVD	UNIT A	LOS ANGELES	CA	91506	1235	19	06037	34.17933621	-118.336428	Los Angeles
234658	Fee-for-Service	1346701398	1346701398	1	1	DESAI, MANSEE MD	8/2/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	178221	07	Dermatology	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
234660	Fee-for-Service	1679785166	1679785166	1	1	DWAIHY, JOSEPH R MD	9/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115844	36	Psychiatry	0	In state provider	None	2340 CLAY ST	7TH FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
234690	Fee-for-Service	1023717949	1023717949	1	1	DHANOA RCFE INC	10/25/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2100 MARCONI AVE	None	SACRAMENTO	CA	95821	1506	34	06067	38.618757	-121.41729	Sacramento County
234692	Fee-for-Service	1164570016	1164570016	1	1	DUNN, ERIN H CNM	10/18/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4405 VANDEVER AVE	None	SAN DIEGO	CA	92120	3315	37	06073	32.78765609	-117.09908	San Diego County
234723	Fee-for-Service	1730566738	1730566738	1	1	DASHARATHY, SONYA S MD	3/31/2021	207R00000X	NA	Other	026	PHYSICIANS	146574	None	None	0	In state provider	None	2655 1ST STREET	360, 380	SIMI VALLEY	CA	93065	1581	56	06111	34.28400453	-118.778978	Ventura County
234729	Fee-for-Service	1922274620	1922274620	1	1	DIAZ, EDWARD C MD	9/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137436	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
234732	Fee-for-Service	1346345949	1346345949	1	1	DIAMANT, CAROLINE T MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	66865	10	Gastroenterology (M.D. only)	0	In state provider	None	3737 MORAGA AVE	STE A305	SAN DIEGO	CA	92117	5465	37	06073	32.8086683	-117.2109991	San Diego County
234775	Fee-for-Service	1770650608	1770650608	1	1	DONAHUE, TIMOTHY J MD	2/18/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	31916	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
234804	Fee-for-Service	1831202647	1831202647	1	1	DENES, ZOLTAN D MD	7/22/2009	174400000X	NA	Other	026	PHYSICIANS	48534	02	General Surgery	0	In state provider	None	243 EL DORADO ST	SUITE 100	MONTEREY	CA	93940	2914	27	06053	36.59353243	-121.8967447	Monterey County
234806	Fee-for-Service	1699207217	1699207217	1	1	DESJARDIN, JACQUELINE T MD	7/23/2024	207RA0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	160404	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
234819	Fee-for-Service	1407846207	1407846207	1	1	DUNCAN, JEFFREY S OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3940 S BRISTOL ST	STE 111	SANTA ANA	CA	92704	7451	30	06059	33.69557976	-117.8855948	Orange County
234823	Fee-for-Service	1609059856	1609059856	1	1	DAVIS, ARTHUR R JR MD AMC	11/1/2002	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	81709 DR CARREON BLVD	STE C5	INDIO	CA	92201	5577	33	06065	33.70733082	-116.2400326	Riverside County
234836	Fee-for-Service	1649247974	1649247974	1	1	DOUGLAS HOSPITAL, INC.	5/19/2022	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	8954 HOSPITAL DR	None	DOUGLASVILLE	GA	30134	2272	00	None	33.73923813	-84.73299495	Douglas County
234853	Fee-for-Service	1871253997	1871253997	1	1	DIEHL, AMY N	1/13/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11144 E SUSSEX AVE	None	SANGER	CA	93657	9350	10	06019	36.79056653	-119.589579	Fresno County
234858	Fee-for-Service	1972512820	1972512820	1	1	DEMARCO, PAUL NP	5/4/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	517 S MYRTLE AVE	SUITE 101	MONROVIA	CA	91016	6100	19	06037	34.14639513	-118.0009744	Los Angeles County
234930	Fee-for-Service	1306259759	1306259759	1	1	DHRUV, PARTHA MD	5/5/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	170036	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
235010	Fee-for-Service	1578052379	1578052379	1	1	DUNAMIS CENTER INCORPORATED	5/4/2021	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
235014	Fee-for-Service	1326206301	1326206301	1	1	DAWKINS, MANJU C MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121539	07	Dermatology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
235078	Fee-for-Service	1548712011	1548712011	1	1	DIMENGO, JEFF R	5/24/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
235091	Fee-for-Service	1831202647	1831202647	1	1	DENES, ZOLTAN D MD	7/22/2009	174400000X	NA	Other	026	PHYSICIANS	48534	33	Thoracic Surgery	0	In state provider	None	243 EL DORADO ST	SUITE 100	MONTEREY	CA	93940	2914	27	06053	36.59353243	-121.8967447	Monterey County
235163	Fee-for-Service	1649869389	1649869389	1	1	DIAZ-RODRIGUEZ, LORENA D CNP	11/17/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	987 E HILLSDALE BLVD	None	FOSTER CITY	CA	94404	2112	41	06081	37.55686846	-122.273705	San Mateo County
235297	Fee-for-Service	1578052379	1578052379	1	1	DUNAMIS CENTER INCORPORATED	10/2/2018	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
235327	Fee-for-Service	1255329520	1255329520	1	1	DAMOURS, RAY H MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86236	05	Anesthesiology	0	In state provider	None	1220 E AVENUE S	STE C	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
235338	Fee-for-Service	1710002050	1710002050	1	1	DINSMORE, GREGORY H	5/27/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
235367	Fee-for-Service	1356444822	1356444822	1	1	DESAI, ATMAN M MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132060	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
235379	Fee-for-Service	1831202647	1831202647	1	1	DENES, ZOLTAN D MD	7/22/2009	174400000X	NA	Other	026	PHYSICIANS	48534	66	Emergency Medicine (Urgent Care)	0	In state provider	None	243 EL DORADO ST	SUITE 100	MONTEREY	CA	93940	2914	27	06053	36.59353243	-121.8967447	Monterey County
235381	Fee-for-Service	1235102880	1235102880	1	1	DO, MICHAEL H MD	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	80334	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
235391	Fee-for-Service	1720406408	1720406408	1	1	DELA CRUZ, MARK JOSHUA L MD	6/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141814	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
235400	Fee-for-Service	1619985033	1619985033	1	1	DURHAM, SUSAN R MD	2/5/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	74989	14	Neurological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
235437	Fee-for-Service	1598151722	1598151722	1	1	DAO, NHUCHI DO	3/10/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14924	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
235443	Fee-for-Service	1225014673	1225014673	1	1	D'AMATO, RALPH MD	11/30/1986	207P00000X	NA	Other	026	PHYSICIANS	50304	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
235498	Fee-for-Service	1811157050	1811157050	1	1	DAI, SUN-CHUAN MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103227	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
235508	Fee-for-Service	1699855619	1699855619	1	1	DE, ELISE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	25 HUCKETT BLVD	MC 208	ALBANY	NY	12208	3499	00	None	42.646437	-73.7797545	Albany County
235525	Fee-for-Service	1528647096	1528647096	1	1	DORIS, ROBERT J MD	7/31/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1100 LARKSPUR LANDING CI	STE 10	LARKSPUR	CA	94939	1827	21	06041	37.94817177	-122.5100062	Marin County
235549	Fee-for-Service	1073665360	1073665360	1	6	DIGNITY HEALTH	5/16/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 LOMA VISTA ROAD	SUITE 201	VENTURA	CA	93003	2909	56	06111	34.27545839	-119.2569382	Ventura County
235567	Fee-for-Service	1699818567	1699818567	1	1	DIABETIC HEALTH AGENCY, INC.	4/29/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	DIABETIC HEALTH AGENCY	150 N US HWY 1	SUITE 22A	TEQUESTA	FL	33469	2723	00	None	26.96125622	-80.084688	Palm Beach County
235585	Fee-for-Service	1578052379	1578052379	1	1	DUNAMIS CENTER INCORPORATED	10/2/2018	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	748 N MARKET ST	None	REDDING	CA	96003	3606	45	06089	40.5960907	-122.38781	Shasta County
235602	Fee-for-Service	1740441716	1740441716	1	1	DEWAR, CHRISTOPHER M MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116385	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
235637	Fee-for-Service	1407175359	1407175359	1	1	DEQIN MA	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
235658	Fee-for-Service	1285701029	1285701029	1	1	DELANGE, KELLY D OD	1/22/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2295 S VINEYARD AVE	None	ONTARIO	CA	91761	7925	36	06071	34.031889	-117.608112	San Bernardino County
235675	Fee-for-Service	1649672809	1649672809	1	1	D & K BROTHERS INC	12/31/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10431 LEMON AVE	STE G	RANCHO CUCAMONGA	CA	91737	3763	36	06071	34.13966252	-117.5775255	San Bernardino County
235708	Fee-for-Service	1619339991	1619339991	1	1	DESAI, ARNON D MD	3/16/2020	207R00000X	NA	Other	026	PHYSICIANS	158648	None	None	0	In state provider	None	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	36	06071	34.13682	-117.243687	San Bernardino County
235710	Fee-for-Service	1417953878	1417953878	1	2	DIABLO VALLEY ONCOLOGY	7/23/2012	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2222 EAST STREET	SUITE 250	CONCORD	CA	94520	2096	07	06013	37.98125538	-122.0329375	Contra Costa County
235746	Fee-for-Service	1285750448	1285750448	1	1	DILIBERO, JULIETTE A OD	5/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2601 E MAIN ST	None	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
235764	Fee-for-Service	1679657316	1679657316	1	1	DARLING, MESHIA R MD	10/5/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	525857	-	NOT APPLICABLE	0	In state provider	None	1628 BROADWAY	STE B	VALLEJO	CA	94590	2405	48	06095	38.12477216	-122.250021	Solano County
235778	Fee-for-Service	1376706929	1376706929	1	1	DO, LY V	8/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88783	None	None	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
235784	Fee-for-Service	1811157050	1811157050	1	1	DAI, SUN-CHUAN MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103227	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
235792	Fee-for-Service	1376500579	1376500579	1	1	DAVISON, JONATHAN M MD	5/4/2020	207U00000X	NA	Other	026	PHYSICIANS	148697	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
235816	Fee-for-Service	1003936154	1003936154	1	1	DAVANI, SOHYILA PSYD	8/17/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6363 CHRISTIE AVE	1502	EMERYVILLE	CA	94608	1914	01	06001	37.84216498	-122.2953054	Alameda County
235839	Fee-for-Service	1154611499	1154611499	1	1	DURAN, DANIEL S AU	10/9/2012	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	12791 NEWPORT AVE	SUITE 101	TUSTIN	CA	92780	2785	30	06059	33.75168784	-117.808677	Orange County
235864	Fee-for-Service	1770578817	1770578817	1	1	DOUGLAS A SCOTT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 N SEWYER RD	None	KENDALLVILLE	IN	46755	2568	00	None	41.44839012	-85.29566515	Noble County
235896	Fee-for-Service	1770607186	1770607186	1	1	DYER, ELIZABETH G MD	9/2/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70406	40	Pediatrics	0	In state provider	None	4968 BOOTH	106	IRVINE	CA	92604	3360	30	06059	33.68590715	-117.7855253	Orange County
235899	Fee-for-Service	1285727032	1285727032	2	1	DAMERON EMERGENCY PHYSICIANS	8/5/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP INC	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
235923	Fee-for-Service	1235573239	1235573239	1	1	DJUNAIDI, ANDREW C MD	1/3/2020	207L00000X	NA	Other	026	PHYSICIANS	135054	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
236022	Fee-for-Service	1922446921	1922446921	1	1	DUDUKGIAN, ALISS M DO	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13806	25	Physical Medicine and Rehabilitation	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
236046	Fee-for-Service	1386042489	1386042489	1	1	DR GHAZALEH BAHRAMI	12/22/2014	193400000X	NA	Other	026	PHYSICIANS	117471	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
236067	Fee-for-Service	1598389389	1598389389	1	1	DEBLAUW, KAYLA DPM	5/15/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	71 N MAIN ST	None	TEMPLETON	CA	93465	5326	40	06079	35.55712018	-120.7011706	San Luis Obispo County
236081	Fee-for-Service	1760756860	1760756860	1	5	DR. JAMIE A. LIPELES, A PROF	2/1/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	4500 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6334	19	06037	33.94274481	-118.192551	Los Angeles County
236134	Fee-for-Service	1093146003	1093146003	1	1	DIETER, MICHELLE D DO	8/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13278	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
236155	Fee-for-Service	1700327921	1700327921	1	1	DECESARE, LAURA MD	10/28/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
236174	Fee-for-Service	1831659945	1831659945	1	1	DUONG, CHRISTOPHER MD	6/22/2023	207L00000X	NA	Other	026	PHYSICIANS	182268	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
236183	Fee-for-Service	1184622532	1184622532	1	1	DAVIS, RONALD T MD	10/1/1976	174400000X	NA	Other	026	PHYSICIANS	21783	30	Radiology	0	In state provider	DEPT RAD ONCOLOGY	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
236217	Fee-for-Service	1376693408	1376693408	1	1	DOAN STEWART, HUYEN D OD	9/6/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
236253	Fee-for-Service	1528338159	1528338159	1	1	D H KIM CHIROPRACTIC INC.	7/13/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	3828 W. COMMONWEALTH AVE	None	FULLERTON	CA	92833	2851	30	06059	33.86998148	-117.978156	Orange County
236256	Fee-for-Service	1942902986	1942902986	1	1	DAUGHERTY, STEPHAN W CNP	5/15/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10889 WELLWORTH AVE	None	LOS ANGELES	CA	90024	4918	19	06037	34.05707768	-118.4424488	Los Angeles County
236282	Fee-for-Service	1972065480	1972065480	1	1	DEHGHANI FIROUZABADI, ALI	10/21/2024	390200000X	NA	Other	026	PHYSICIANS	184639	25	Physical Medicine and Rehabilitation	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
236285	Fee-for-Service	1841361607	1841361607	1	1	DON, DEBRA M MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	77140	04	Otology, Laryngology, Rhinology	0	In state provider	None	3020 CHILDRENS WAY	MC 5024	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
236300	Fee-for-Service	1902948086	1902948086	1	1	DOMINGO, BENJAMIN J NP	5/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
236328	Fee-for-Service	1649358474	1649358474	1	1	DIAMANT, JONATHAN I MD	6/20/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	83886	18	Ophthalmology	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
236369	Fee-for-Service	1760756860	1760756860	1	5	DR. JAMIE A. LIPELES, A PROF	2/1/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	4500 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6334	19	06037	33.94274481	-118.192551	Los Angeles County
236383	Fee-for-Service	1588240071	1588240071	1	1	DEL POZO, ROLANDO MD	9/17/2024	390200000X	NA	Other	026	PHYSICIANS	182080	08	Family Practice	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
236393	Fee-for-Service	1457884413	1457884413	1	1	DEAN, RACHAEL D MD	10/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169678	08	Family Practice	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
236480	Fee-for-Service	1942361282	1942361282	1	1	DR RUCKERS WELLNESS CENTER	8/18/2009	193400000X	NA	Other	026	PHYSICIANS	44598	08	Family Practice	0	In state provider	INC	2305 MIDVALLEY AVE	None	VISALIA	CA	93277	9455	54	06107	36.287289	-119.315682	Tulare County
236503	Fee-for-Service	1780889691	1780889691	1	1	DE RIDDER, CATHERINE A MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	111949	40	Pediatrics	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
236529	Fee-for-Service	1073737318	1073737318	1	2	DOROW, CHRISTINA MD	4/10/2024	207P00000X	NA	Other	026	PHYSICIANS	100267	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
236559	Fee-for-Service	1750556007	1750556007	1	1	DOSSETT, MICHELLE L MD	11/1/2019	207R00000X	NA	Other	026	PHYSICIANS	166104	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
236576	Fee-for-Service	1548637952	1548637952	1	1	DESERT SPRINGS	11/17/2015	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	137634	10	Gastroenterology (M.D. only)	0	In state provider	GASTROENTEROLOGY CORP	1140 NORTH INDIAN CANYON	SUITE 100	PALM SPRINGS	CA	92262	4872	33	06065	33.838542	-116.5455735	Riverside County
236623	Fee-for-Service	1336586437	1336586437	1	1	DAVIS, STEPHANIE M LMFT	1/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43533 RIDGE PARK	STE B	TEMECULA	CA	92590	3615	33	06065	33.49548792	-117.1598552	Riverside County
236635	Fee-for-Service	1356729388	1356729388	1	1	DE JESUS, EMMANUEL MD	11/9/2019	208M00000X	NA	Other	026	PHYSICIANS	146470	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
236720	Fee-for-Service	1104272525	1104272525	1	1	DUH, NICOLE S MD	10/5/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151398	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
236739	Fee-for-Service	1063473528	1063473528	1	1	DONOHOE CHIROPRACTIC INC	4/21/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	41880 KALMIA ST	135	MURRIETA	CA	92562	8825	33	06065	33.55740114	-117.2157733	Riverside County
236751	Fee-for-Service	1184638488	1184638488	1	1	DARDEN, IVY L MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55952	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
236755	Fee-for-Service	1336112663	1336112663	1	1	DRAKE, ANGELA I PSY	9/25/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
236764	Fee-for-Service	1295305753	1295305753	1	1	DOESCHL, ELIZA CRNA	5/1/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
236809	Fee-for-Service	1851072227	1851072227	1	1	DE LA MERCED, RYAN MICHAEL	3/27/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	CRNA	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
236810	Fee-for-Service	1932308137	1932308137	1	1	DISCEPOLO, WILLIAM	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85753	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
236868	Fee-for-Service	1962496588	1962496588	1	1	DINH, KIM-THANH T OD INC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	EYEQ OPTOMETRY	1652 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1839	43	06085	37.3066751	-121.8111896	Santa Clara County
236885	Fee-for-Service	1043659634	1043659634	1	1	DOMINICK, CHRISTA	4/26/2022	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	133574	None	None	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
237027	Fee-for-Service	1306924154	1306924154	1	1	DOWNEY, JOHN A MD	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	77914	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
237048	Fee-for-Service	1306208095	1306208095	1	1	DESAI, CHIRAG A MD	8/19/2020	207L00000X	NA	Other	026	PHYSICIANS	153923	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
237075	Fee-for-Service	1417005406	1417005406	1	1	DE MARQUETTE, BRADLEY MD	4/1/1992	207P00000X	NA	Other	026	PHYSICIANS	53337	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
237100	Fee-for-Service	1225203151	1225203151	1	1	DOBRE, MIRCEA C MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118893	30	Radiology	0	In state provider	None	300 PASTUER DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
237163	Fee-for-Service	1952949620	1952949620	1	1	DIETZ, BRIAN PT	10/27/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4572 TELEPHONE RD	STE 903	VENTURA	CA	93003	5663	56	06111	34.25635267	-119.2348313	Ventura County
237231	Fee-for-Service	1386477859	1386477859	1	1	DOBBINS, ARNITA TOLABOR CER	1/30/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
237264	Fee-for-Service	1285958090	1285958090	1	1	DESOUZA, NATALIE T MD	1/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119194	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
237265	Fee-for-Service	1962405993	1962405993	1	1	DAVID A SMITH M.D.	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7613 W JEFFERSON BLVD	STE 200	FORT WAYNE	IN	46804	4182	00	None	41.04018001	-85.23556741	Allen County
237284	Fee-for-Service	1477944114	1477944114	1	1	DIDARI, FARID DPM	12/3/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1141 W REDONDO BEACH BLV	STE 302	GARDENA	CA	90247	3583	19	06037	33.89247036	-118.2941482	Los Angeles County
237289	Fee-for-Service	1710055256	1710055256	1	1	DEVESHWAR, SANGITA MD	7/1/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55756	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
237293	Fee-for-Service	1689963340	1689963340	1	1	DAVID, CONSUELO V MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122615	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
237336	Fee-for-Service	1952729428	1952729428	1	1	DANIEL, ROSNY L MD	3/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140849	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
237397	Fee-for-Service	1942971478	1942971478	1	1	DOSWELL, JEANNETTE LCSW	10/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
237448	Fee-for-Service	1952017055	1952017055	1	1	DECARLI, TRICIA N	3/8/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
237477	Fee-for-Service	1114977865	1114977865	1	1	DE C0NINCK, ELLEN C MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79762	07	Dermatology	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
237479	Fee-for-Service	1669669008	1669669008	1	1	DUDDERAR, RAQUEL L MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122853	41	Internal Medicine	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
237490	Fee-for-Service	1760497135	1760497135	1	1	D'ANDREA-SMITH, VIVIEN	11/30/1989	207R00000X	NA	Other	026	PHYSICIANS	61512	41	Internal Medicine	0	In state provider	None	596 CARROLL ST	None	SUNNYVALE	CA	94086	6207	43	06085	37.36853041	-122.0305901	Santa Clara County
237501	Fee-for-Service	1316952005	1316952005	1	1	DRESNER, STEVEN C MD	5/17/2002	174400000X	NA	Other	026	PHYSICIANS	34472	18	Ophthalmology	0	In state provider	None	2121 WILSHIRE BLVD	STE 301	SANTA MONICA	CA	90403	5743	19	06037	34.03262306	-118.4817131	Los Angeles County
237521	Fee-for-Service	1184709313	1184709313	1	1	DIAGNOSTIC PATH MED GRP	6/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	2820 L ST	None	SACRAMENTO	CA	95816	5616	34	06067	38.571165	-121.469643	Sacramento County
237540	Fee-for-Service	1073665360	1073665360	1	4	DIGNITY HEALTH	5/16/2017	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	500 PASEO CAMARILLO	SUITE 107	CAMARILLO	CA	93010	5900	56	06111	34.220511	-119.0630415	Ventura County
237561	Fee-for-Service	1861830580	1861830580	1	1	DEL REAL, CHRISTINE A MFT	3/13/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	92782	-	NOT APPLICABLE	0	In state provider	None	2101 ALEXIAN DR	SUITE 110	SAN JOSE	CA	95116	4209	43	06085	37.35943657	-121.848055	Santa Clara County
237621	Fee-for-Service	1447622667	1447622667	1	1	DEROSS, REBECCA A MD	2/1/2018	207P00000X	NA	Other	026	PHYSICIANS	138632	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
237623	Fee-for-Service	1043477896	1043477896	1	1	DALUGDUGAN, RANDY G MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110181	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
237628	Fee-for-Service	1063430791	1063430791	1	1	DAVID J CLARDY MD	12/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
237638	Fee-for-Service	1215071907	1215071907	1	1	DEL VALLE, ROSA M MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	48945	40	Pediatrics	0	In state provider	None	1437 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	5015	19	06037	34.01175497	-118.159261	Los Angeles County
237705	Fee-for-Service	1639298581	1639298581	1	1	DEJESUS, DINO NICOL E DO	8/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15345	20	Orthopedic Surgery	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
237774	Fee-for-Service	1811017254	1811017254	1	1	DAVIS, JAMES A MD	6/5/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	28191	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
237914	Fee-for-Service	1306874995	1306874995	1	1	DRAGO, BONNY B MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151201	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
237916	Fee-for-Service	1891999215	1891999215	2	1	DABBS, DANIELLE N MD	1/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8807	02	General Surgery	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
237944	Fee-for-Service	1114958592	1114958592	1	1	DUDLEY, VARNER E III MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55075	05	Anesthesiology	0	In state provider	INC	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
237969	Fee-for-Service	1497758510	1497758510	1	1	DR. AHMAD B HADID MD	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	575 HUDSON VALLEY AVE	STE 200	NEW WINDSOR	NY	12553	4746	00	None	41.483844	-74.1016575	Orange County
237987	Fee-for-Service	1790025351	1790025351	1	1	DALY, JOLENE L LMFT	3/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1231 8TH ST	STE 760	MODESTO	CA	95354	2232	50	06099	37.64160693	-121.0052759	Stanislaus County
238012	Fee-for-Service	1548208242	1548208242	1	1	DE VENTE, JEROME MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71061	None	None	0	In state provider	None	500 S ANAHEIM HILLS RD	STE 206	ANAHEIM	CA	92807	4759	30	06059	33.8427954	-117.7772895	Orange County
238034	Fee-for-Service	1912199704	1912199704	1	1	DRURY, PAUL C MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106009	01	General Practice	0	In state provider	None	24022 CALLE DE LA PLATA	STE 500	LAGUNA HILLS	CA	92637	7612	30	06059	33.6104493	-117.7110924	Orange County
238046	Fee-for-Service	1821679416	1821679416	1	1	DUMAGUING, GLORIELY NP	1/3/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	302 SILVER AVE	None	SAN FRANCISCO	CA	94112	1510	38	06075	37.72851602	-122.4296638	San Francisco County
238071	Fee-for-Service	1538332325	1538332325	1	1	DOYLE, KATHRYN A CNP	5/17/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 WEST HENDERSON AVE	None	PORTERVILLE	CA	93257	1731	54	06107	36.0804034	-119.0217006	Tulare County
238181	Fee-for-Service	1609989532	1609989532	1	1	DAVIS, PAUL R DO	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7013	08	Family Practice	0	In state provider	None	3184 CHURN CREEK RD	None	REDDING	CA	96002	2122	45	06089	40.56138796	-122.3531253	Shasta County
238197	Fee-for-Service	1649755240	1649755240	1	1	DIVERSIFIED TRANSPORTATION	10/9/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ACCESS LLC	5777 W CENTURY BLVD	STE 1601	LOS ANGELES	CA	90045	5696	19	06037	33.94561146	-118.382661	Los Angeles County
238224	Fee-for-Service	1922186717	1922186717	1	1	DIEDEN, JEFFREY MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	52292	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238228	Fee-for-Service	1952327587	1952327587	1	1	D'AMORE, TANCREDI F MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51587	46	Hand Surgery	0	In state provider	A PROF CORP	21 TAMAL VISTA BLVD	STE 103	CORTE MADERA	CA	94925	1133	21	06041	37.93173997	-122.5179353	Marin County
238233	Fee-for-Service	1649699505	1649699505	1	2	DINH, CHRISTOPHER MD	8/18/2021	207LC0200X	NA	Other	026	PHYSICIANS	141876	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
238240	Fee-for-Service	1194788778	1194788778	1	1	DRURY, BERNARD J MD	11/1/1995	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	58175	04	Otology, Laryngology, Rhinology	0	In state provider	None	2961 SUMMIT ST	STE 1	OAKLAND	CA	94609	3482	01	06001	37.81865235	-122.2647856	Alameda County
238267	Fee-for-Service	1922421569	1922421569	1	1	DE BOER, AGLAIA K MD	6/21/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	128593	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238273	Fee-for-Service	1871037838	1871037838	1	1	DNALOR CARE HOMES, LLC	7/7/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2706 106TH AVENUE	None	OAKLAND	CA	94605	5210	01	06001	37.74377406	-122.151017	Alameda County
238301	Fee-for-Service	1972820660	1972820660	1	1	DAS, KRISHNA K	11/7/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161201	30	Radiology	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
238357	Fee-for-Service	1235358367	1235358367	1	1	DUONG, BETTY LCSW	11/15/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	64549	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
238382	Fee-for-Service	1740757533	1740757533	1	1	DIAZ, RAMON RCP	5/23/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
238455	Fee-for-Service	1952434094	1952434094	1	1	DANIELS, TREVOR A PSYD	3/14/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	100 E NORTH STREET	None	TAFT	CA	93268	3606	15	06029	35.13962803	-119.4517471	Kern County
238482	Fee-for-Service	1073996781	1073996781	1	1	DR JUN YANG CORPORATION	1/2/2019	261QM0801X	NA	Other	026	PHYSICIANS	108968	36	Psychiatry	0	In state provider	None	25 S RAYMOND AVE	STE 201	ALHAMBRA	CA	91801	7146	19	06037	34.09042452	-118.1450725	Los Angeles County
238489	Fee-for-Service	1154790731	1154790731	1	1	DESIRE HOME CARE LLC	3/2/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3742 TIBBETS ST	SUITE 203	RIVERSIDE	CA	92506	2641	33	06065	33.9472255	-117.3982995	Riverside County
238512	Fee-for-Service	1922186717	1922186717	1	1	DIEDEN, JEFFREY MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	52292	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
238518	Fee-for-Service	1952327587	1952327587	1	1	D'AMORE, TANCREDI F MD	3/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51587	24	Plastic Surgery	0	In state provider	A PROF CORP	21 TAMAL VISTA BLVD	STE 103	CORTE MADERA	CA	94925	1133	21	06041	37.93173997	-122.5179353	Marin County
238541	Fee-for-Service	1831131424	1831131424	1	1	DE ALDAY, MARIETTA Y MD	11/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	53001	40	Pediatrics	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
238543	Fee-for-Service	1952508848	1952508848	1	1	DESADIER, JASON M DO	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13739	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
238555	Fee-for-Service	1922421569	1922421569	1	1	DE BOER, AGLAIA K MD	6/21/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	128593	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
238597	Fee-for-Service	1891237756	1891237756	1	1	DANG, ERIC A PT	6/13/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
238629	Fee-for-Service	1760402655	1760402655	1	1	DAUBER, IRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 SOUTHPARK DR	None	LITTLETON	CO	80120	5654	00	None	39.566916	-105.000642	Arapahoe County
238652	Fee-for-Service	1235634148	1235634148	1	1	DHAWAN, TANIA MD	9/21/2021	390200000X	NA	Other	026	PHYSICIANS	174592	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
238707	Fee-for-Service	1205880697	1205880697	1	1	DARNEY, PHILIP MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23577	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
238740	Fee-for-Service	1316959240	1316959240	1	1	DAVIS, BRET E MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84892	07	Dermatology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
238838	Fee-for-Service	1750095717	1750095717	1	1	DE LA TORRE, DIANE	1/28/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
238841	Fee-for-Service	1700964434	1700964434	1	1	DEYOUNG, CLAUDIA A MD	10/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82777	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
238846	Fee-for-Service	1528100393	1528100393	1	1	DEFELICE, RANDAL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5633 N LIDGERWOOD ST	None	SPOKANE	WA	99208	1224	00	None	47.709423	-117.406944	Spokane County
238871	Fee-for-Service	1821830134	1821830134	1	1	DILLOW, JONATHAN N CRNA	7/10/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
238884	Fee-for-Service	1972819316	1972819316	1	1	DURETT, DONALD R PA	8/25/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	12392	-	NOT APPLICABLE	0	In state provider	None	201 D STREET	SUITE G	MARYSVILLE	CA	95901	5957	58	06115	39.13753087	-121.5885645	Yuba County
238898	Fee-for-Service	1023193646	1023193646	2	1	DHARMA, KALAMANI R MD	7/8/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40393	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1508 GARCES HWY	SUITE 1	DELANO	CA	93215	3607	15	06029	35.76141641	-119.2369096	Kern County
238958	Fee-for-Service	1477149094	1477149094	1	1	DOWNARD, JESSE L LMFT	10/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
238990	Fee-for-Service	1316939978	1316939978	2	1	DAVIS, WILLIAM B MD	1/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	28619	41	Internal Medicine	0	In state provider	None	7877 PARKWAY DRIVE	STE 18	LA MESA	CA	91942	2000	37	06073	32.77448693	-117.02783	San Diego County
239002	Fee-for-Service	1013792613	1013792613	1	1	D&J'S TRANSITIONS, INC.	4/15/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	115 S BENWILEY AVE	None	SANTA MARIA	CA	93458	4213	42	06083	34.952568	-120.4457801	Santa Barbara County
239018	Fee-for-Service	1952945974	1952945974	1	1	DAVID, RYAN A	3/31/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3832 LA SIERRA	None	RIVERSIDE	CA	92505	3528	33	06065	33.90447335	-117.4771776	Riverside County
239108	Fee-for-Service	1134354079	1134354079	1	1	DAO, TUAN V MD	3/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139553	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
239124	Fee-for-Service	1376602938	1376602938	1	1	DIBBLE, GARY R MD	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	39148	41	Internal Medicine	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
239129	Fee-for-Service	1326465949	1326465949	1	1	DOZIER, LINDSAY LMFT	4/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18640 QUAIL RIDGE ROAD	None	COTTONWOOD	CA	96022	9058	52	06103	40.30693131	-122.3442555	Tehama County
239135	Fee-for-Service	1538236401	1538236401	1	1	DAVIDOFF, RAMIN MD	8/1/1998	208800000X	NA	Other	026	PHYSICIANS	79295	34	Urology and Urological Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
239143	Fee-for-Service	1144494261	1144494261	1	1	DICKMAN, JEROME I MD	2/8/2015	261QM2500X	NA	Other	026	PHYSICIANS	21070	04	Otology, Laryngology, Rhinology	0	In state provider	INC	7345 MEDICAL CENTER DR	STE 510	WEST HILLS	CA	91307	1910	19	06037	34.20369349	-118.629837	Los Angeles County
239168	Fee-for-Service	1730157876	1730157876	1	1	DHALLA, RAJA MD	9/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73993	20	Orthopedic Surgery	0	In state provider	None	4444 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4136	33	06065	33.97614344	-117.3797664	Riverside County
239179	Fee-for-Service	1225065576	1225065576	1	1	DIMODICA, PAUL L DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8624	None	None	0	In state provider	None	117 W BUNNY AVE	None	SANTA MARIA	CA	93458	2805	42	06083	34.96327701	-120.4368111	Santa Barbara County
239221	Fee-for-Service	1215085246	1215085246	1	1	DUBLIN, ANDREW J MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92916	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1450 TREAT BLVD	STE 220B	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
239232	Fee-for-Service	1518018191	1518018191	5	4	DIGNITY HEALTH	3/7/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1260 D STREET	None	MERCED	CA	95341	6248	24	06047	37.29231484	-120.4740268	Merced County
239257	Fee-for-Service	1871913764	1871913764	1	1	DANDEKAR, FRANCESCO N MD	8/20/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	139366	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239295	Fee-for-Service	1265426530	1265426530	1	1	DOWNS, DAVID L MD	4/1/1989	207L00000X	NA	Other	026	PHYSICIANS	55125	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
239298	Fee-for-Service	1760756860	1760756860	1	3	DR. JAMIE A. LIPELES, A PROF	5/27/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	OB GYN	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	19	06037	33.98364904	-118.4449069	Los Angeles County
239309	Fee-for-Service	1780843458	1780843458	1	1	DIGESTIVE DISEASE CONSULTANT	7/29/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	OF ORANGE COUNTY INC	1 HOAG DR	None	NEWPORT BEACH	CA	92658	4162	30	06059	33.62421676	-117.9309656	Orange County
239314	Fee-for-Service	1487728077	1487728077	1	1	DOWNES, MAUREEN C MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	36655	40	Pediatrics	0	In state provider	None	16300 SAND CANYON AVE	STE 311	IRVINE	CA	92618	3703	30	06059	33.66115075	-117.7742405	Orange County
239333	Fee-for-Service	1881611721	1881611721	1	1	DEVASKAR, UDAVAKUMAR MD	7/1/1998	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	30408	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	# 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
239347	Fee-for-Service	1467632661	1467632661	1	1	DANG, HANG T DO	9/16/2019	208600000X	NA	General Surgery	026	PHYSICIANS	13277	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
239389	Fee-for-Service	1730451840	1730451840	1	1	DUVAL-BOLENDER, LAURA R LCSW	10/15/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8665 WILSHIRE BLVD	SUITE 220	BEVERLY HILLS	CA	90211	2975	19	06037	34.06625528	-118.380319	Los Angeles County
239390	Fee-for-Service	1629393459	1629393459	1	1	DEOL, AJIT MD INC	6/28/2010	208600000X	NA	General Surgery	026	PHYSICIANS	73499	02	General Surgery	0	In state provider	None	6608 MERCY CT	STE C	FAIR OAKS	CA	95628	3133	34	06067	38.665917	-121.3106895	Sacramento County
239396	Fee-for-Service	1134354079	1134354079	1	1	DAO, TUAN V MD	3/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139553	30	Radiology	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
239413	Fee-for-Service	1366700320	1366700320	1	1	DEOL, RAVEEN MD	6/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123541	13	Neurology (M.D. only)	0	In state provider	None	1900 N CALIFORNIA ST	None	STOCKTON	CA	95204	6005	39	06077	37.97152857	-121.2894373	San Joaquin County
239441	Fee-for-Service	1003998261	1003998261	1	1	DEL AMO OPTOMETRY APC	2/1/1997	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4505 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2207	19	06037	33.82629455	-118.3603387	Los Angeles County
239486	Fee-for-Service	1619923778	1619923778	1	1	DE ARMOND, STEPHEN J MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	33858	22	Pathology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
239521	Fee-for-Service	1518018191	1518018191	5	4	DIGNITY HEALTH	3/7/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1260 D STREET	None	MERCED	CA	95341	6248	24	06047	37.29231484	-120.4740268	Merced County
239583	Fee-for-Service	1760756860	1760756860	1	3	DR. JAMIE A. LIPELES, A PROF	5/27/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	OB GYN	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	19	06037	33.98364904	-118.4449069	Los Angeles County
239589	Fee-for-Service	1811074586	1811074586	1	1	DHAR, SANJAY MD	1/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55003	None	None	0	In state provider	None	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06593048	-118.2708351	Los Angeles County
239596	Fee-for-Service	1780843458	1780843458	1	1	DIGESTIVE DISEASE CONSULTANT	7/29/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	OF ORANGE COUNTY INC	1 HOAG DR	None	NEWPORT BEACH	CA	92658	4162	30	06059	33.62421676	-117.9309656	Orange County
239609	Fee-for-Service	1629333893	1629333893	1	1	DOLBIER, CANDICE M DO	2/9/2020	208M00000X	NA	Other	026	PHYSICIANS	13525	None	None	0	In state provider	None	1 MARCELA DRIVE	None	WILLITS	CA	95490	4225	23	06045	39.3901086	-123.339055	Mendocino County
239615	Fee-for-Service	1407140080	1407140080	1	1	DO, DANH MD	8/29/2023	207L00000X	NA	Other	026	PHYSICIANS	121465	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
239643	Fee-for-Service	1720168230	1720168230	1	1	DRISCOLL, HELEN L MD	10/1/2000	174400000X	NA	Other	026	PHYSICIANS	68281	None	None	0	In state provider	None	1411 E 31ST ST	# A3	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
239651	Fee-for-Service	1225289580	1225289580	1	1	DOSHI, NEEL R DO	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10418	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
239654	Fee-for-Service	1669646550	1669646550	1	1	DE LEON, ERNESTO MD	2/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94887	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH STREET	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
239659	Fee-for-Service	1821083171	1821083171	1	1	DEKKERS, ROBERT J MD	1/20/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40656	66	Emergency Medicine (Urgent Care)	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
239667	Fee-for-Service	1114976594	1114976594	1	1	DAVIS, TIMOTHY A MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70793	02	General Surgery	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
239692	Fee-for-Service	1063884757	1063884757	1	1	DEIS, NATHAN P MD	3/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139370	14	Neurological Surgery	0	In state provider	None	45 RIVER PARK PLACE WEST	SUITE 104	FRESNO	CA	93720	1565	10	06019	36.85901695	-119.7893872	Fresno County
239757	Fee-for-Service	1487733101	1487733101	1	1	DAYLIGHT ADULT DAY	10/8/2009	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE	915 E COLORADO ST	None	GLENDALE	CA	91205	1223	19	06037	34.14267653	-118.243044	Los Angeles County
239764	Fee-for-Service	1093821274	1093821274	1	1	DAMIANI, JOSEPH M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37765	46	Hand Surgery	0	In state provider	None	12637 HESPERIA RD	STE B	VICTORVILLE	CA	92395	7774	36	06071	34.48068114	-117.2907223	San Bernardino County
239776	Fee-for-Service	1619923778	1619923778	1	1	DE ARMOND, STEPHEN J MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	33858	90	Pathology-Forensic	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
239784	Fee-for-Service	1578918421	1578918421	1	1	DAYRIT, JEREMY KAY MD	7/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166787	08	Family Practice	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
239846	Fee-for-Service	1538743752	1538743752	1	1	DERMESURGE INC	9/27/2023	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SER CENTER	1111 GRAND AVE	STE K	DIAMOND BAR	CA	91765	4172	19	06037	34.00172352	-117.813184	Los Angeles County
239869	Fee-for-Service	1639246515	1639246515	1	1	DAVIS, SYBIL MD	2/28/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62444	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
239873	Fee-for-Service	1265866446	1265866446	1	1	DEMPSEY, VANESSA M NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
239874	Fee-for-Service	1962491118	1962491118	1	1	DEAN JAMES PHILLIPS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	830 WASHINGTON STREET	None	WATERTOWN	NY	13601	0000	00	None	43.964964	-75.914586	Jefferson County
239889	Fee-for-Service	1053473785	1053473785	1	1	DRUMMOND, RITA K OD	11/7/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9041 MAGNOLIA AVE	201	RIVERSIDE	CA	92503	3900	33	06065	33.92541585	-117.4378266	Riverside County
239895	Fee-for-Service	1740274067	1740274067	1	1	DOYKOS, GEORGE G MD	1/31/1986	207L00000X	NA	Other	026	PHYSICIANS	29684	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
239925	Fee-for-Service	1619904158	1619904158	1	1	DRONKOWSKI, CARL W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2700 SE STRATUS AVE	None	MCMINNVILLE	OR	97128	6255	00	None	45.20010494	-123.1656951	Yamhill County
239958	Fee-for-Service	1144299926	1144299926	1	1	DAVILA, ALVARO D MD	10/31/1995	207RE0101X	NA	Endocrinology	026	PHYSICIANS	75546	10	Gastroenterology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 3D5	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
239969	Fee-for-Service	1225184963	1225184963	1	2	DIGNITY HEALTH	8/18/1999	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	506 E PLAZA DR	STE 6	SANTA MARIA	CA	93454	6952	42	06083	34.93728283	-120.4299643	Santa Barbara County
240011	Fee-for-Service	1881668788	1881668788	1	1	DVA HEALTHCARE RENAL	2/19/1995	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1620 W YOSEMITE AVE	None	MANTECA	CA	95337	5190	39	06077	37.79730934	-121.2429198	San Joaquin County
240022	Fee-for-Service	1649889916	1649889916	1	1	DIVINE HEALTH INC	10/21/2020	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	348 RHEEM BLVD	None	MORAGA	CA	94556	1516	07	06013	37.86118691	-122.1278716	Contra Costa County
240052	Fee-for-Service	1093821274	1093821274	1	1	DAMIANI, JOSEPH M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37765	24	Plastic Surgery	0	In state provider	None	12637 HESPERIA RD	STE B	VICTORVILLE	CA	92395	7774	36	06071	34.48068114	-117.2907223	San Bernardino County
240083	Fee-for-Service	1336155258	1336155258	1	1	DONG, DAVID K MD	10/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	92705	40	Pediatrics	0	In state provider	None	10362 BOLSA AVENUE	None	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
240157	Fee-for-Service	1639246515	1639246515	1	1	DAVIS, SYBIL MD	2/28/1989	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	62444	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
240159	Fee-for-Service	1033758362	1033758362	1	1	DELMA INC	2/4/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	STE 115	VAN NUYS	CA	91405	4640	19	06037	34.195401	-118.4487235	Los Angeles County
240162	Fee-for-Service	1982953816	1982953816	1	1	DIAZ, SABRINA LMFT	8/25/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	19	06037	34.03321301	-118.4109122	Los Angeles County
240173	Fee-for-Service	1538502158	1538502158	1	1	DAVIS, ANDREW J MD	9/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131931	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240184	Fee-for-Service	1942373618	1942373618	1	1	DEFAII, PAYAM	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
240220	Fee-for-Service	1235560947	1235560947	1	1	DEVINA HOSPICE CARE INC	1/28/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	24404 VERMONT AVENUE	SUITE 307G	HARBOR CITY	CA	90710	2305	19	06037	33.80302968	-118.2902917	Los Angeles County
240233	Fee-for-Service	1376967224	1376967224	1	1	DIGNICARE HOSPICE SERVICES	11/19/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	520 E WILSON AVE	STE 105	GLENDALE	CA	91206	4374	19	06037	34.14812361	-118.2491324	Los Angeles County
240270	Fee-for-Service	1578759809	1578759809	1	1	DANG, NGA P N PSYD	6/11/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
240281	Fee-for-Service	1518159961	1518159961	1	1	DINH, PAUL T MD	11/5/2008	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	84161	20	Orthopedic Surgery	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
240302	Fee-for-Service	1407274541	1407274541	1	1	DESAI, MONAL H MD	5/29/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	154456	25	Physical Medicine and Rehabilitation	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
240353	Fee-for-Service	1588689814	1588689814	1	1	DO, LAM H MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	79296	01	General Practice	0	In state provider	None	1642 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1800	43	06085	37.3061289	-121.8119182	Santa Clara County
240366	Fee-for-Service	1407315476	1407315476	1	1	DOSAJ, ANKITA MD	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	186950	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
240369	Fee-for-Service	1386731909	1386731909	1	1	DEPRY, DENNIS L DO	9/2/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	3375	36	Psychiatry	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
240442	Fee-for-Service	1255483061	1255483061	1	1	DAWES, ELIABETH R MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64429	36	Psychiatry	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
240454	Fee-for-Service	1487034039	1487034039	1	1	DUHON, GREGORY MD	8/8/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
240466	Fee-for-Service	1801144050	1801144050	1	1	DURAN, ANGELI DO	2/4/2023	207R00000X	NA	Other	026	PHYSICIANS	20091	None	None	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
240467	Fee-for-Service	1558625285	1558625285	1	1	DOWNEY, CHRISTINA D MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133281	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240508	Fee-for-Service	1235560947	1235560947	1	1	DEVINA HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	24404 VERMONT AVENUE	SUITE 307G	HARBOR CITY	CA	90710	2305	19	06037	33.80302968	-118.2902917	Los Angeles County
240516	Fee-for-Service	1639601909	1639601909	1	1	DUDUM, RAMZI E MD	7/25/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169951	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
240523	Fee-for-Service	1376967224	1376967224	1	1	DIGNICARE HOSPICE SERVICES	11/19/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	520 E WILSON AVE	STE 105	GLENDALE	CA	91206	4374	19	06037	34.14812361	-118.2491324	Los Angeles County
240591	Fee-for-Service	1710411848	1710411848	1	1	DEL PRINCE, CLAYTON L MD	5/26/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176781	None	None	0	In state provider	None	1225 15TH ST	2100	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
240610	Fee-for-Service	1083971501	1083971501	1	1	DESAI, MANSI I MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132418	40	Pediatrics	0	In state provider	None	2828 FRESNO STREET	SUITE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
240616	Fee-for-Service	1407827660	1407827660	1	1	DARWIN, AMY L MD	8/30/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	108093	08	Family Practice	0	In state provider	None	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
240636	Fee-for-Service	1124082730	1124082730	1	1	DAJEE, HIMMET MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33528	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11100 WARNER AVE	STE 258	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
240640	Fee-for-Service	1295834091	1295834091	1	1	DANIEL C ZOVICH MD INC	2/25/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	1551 BISHOP ST	D 450	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
240642	Fee-for-Service	1588689814	1588689814	1	1	DO, LAM H MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	79296	41	Internal Medicine	0	In state provider	None	1642 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1800	43	06085	37.3061289	-121.8119182	Santa Clara County
240664	Fee-for-Service	1770593196	1770593196	1	1	DANZIGER, RICHARD E MD	4/30/1989	2080P0201X	NA	Neurology	026	PHYSICIANS	39874	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
240696	Fee-for-Service	1548236268	1548236268	1	1	DVA HLTHCARE RENAL CARE	10/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	TRACY DIALYSIS	425 W BEVERLY DR	STE A	TRACY	CA	95376	3086	39	06077	37.74498779	-121.4322156	San Joaquin County
240715	Fee-for-Service	1881892511	1881892511	1	1	DUTILE, ROBERT L PHD	9/30/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6365 N CONSTELLATION AVE	None	CLOVIS	CA	93619	6301	10	06019	36.82846543	-119.6066325	Fresno County
240722	Fee-for-Service	1144253527	1144253527	1	1	DIALYSIS CLINIC, INC	12/23/1996	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5222 MADISON AVE	None	SACRAMENTO	CA	95841	3004	34	06067	38.660391	-121.3425495	Sacramento County
240765	Fee-for-Service	1790856698	1790856698	1	1	DADERIAN, ASDGHIG D MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	40687	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
240779	Fee-for-Service	1861517245	1861517245	1	1	DUARTE RADIOLOGY MEDICAL	11/8/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	9999	30	Radiology	0	In state provider	GROUP, INC.	159 E HUNTINGTON DR	#9	ARCADIA	CA	91006	3225	19	06037	34.14017618	-118.0259279	Los Angeles County
240785	Fee-for-Service	1689694689	1689694689	1	1	DAO, HUY N MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9483	02	General Surgery	0	In state provider	HUY N DAO DO GENERAL SUR	1199 DELBON AVE	STE 5	TURLOCK	CA	95382	2006	50	06099	37.51067196	-120.835684	Stanislaus County
240786	Fee-for-Service	1104110105	1104110105	1	1	DUMLAO, JHOETTE M MD	1/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143279	01	General Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
240791	Fee-for-Service	1801166681	1801166681	1	1	DURBOROUGH, ROBERT D LMFT	4/27/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
240806	Fee-for-Service	1073007936	1073007936	1	1	DICKSON, MEGAN MD	7/1/2021	207P00000X	NA	Other	026	PHYSICIANS	163445	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
240887	Fee-for-Service	1235355942	1235355942	1	1	DELGADO, PHILIP ANTHONY DO	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10319	08	Family Practice	0	In state provider	None	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
240891	Fee-for-Service	1285173849	1285173849	1	1	DOWNING, CHRISTINA B DO	2/25/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16729	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
240896	Fee-for-Service	1942289798	1942289798	1	1	DICKINSON, MICHAEL G MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MICHIGAN ST NE	None	GRAND RAPIDS	MI	49503	2560	00	None	42.97047638	-85.66482877	Kent County
240924	Fee-for-Service	1124082730	1124082730	1	1	DAJEE, HIMMET MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33528	33	Thoracic Surgery	0	In state provider	None	11100 WARNER AVE	STE 258	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
240925	Fee-for-Service	1952476947	1952476947	1	1	DAVIDSON, TANIA A PSYD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 GRAND AVENUE	SUITE A16	CARLSBAD	CA	92008	1876	37	06073	33.16296903	-117.34566	San Diego County
240957	Fee-for-Service	1083610570	1083610570	1	1	DUNHILL, JULIE A MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61921	78	Neoplastic Diseases/Oncology	0	In state provider	None	8635 W 3RD ST	STE 665W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
240962	Fee-for-Service	1841378338	1841378338	1	1	DADDIO-RILEY, KARYN DO	12/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	9460	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
240971	Fee-for-Service	1912188152	1912188152	1	1	DORAISWAMY, ACHALA B	1/29/2008	207RX0202X	NA	Oncology	026	PHYSICIANS	101431	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
240984	Fee-for-Service	1336334960	1336334960	1	1	DALMACIO, MARIA CONCEPCION J	4/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
241020	Fee-for-Service	1497927644	1497927644	1	1	DORN, JILL G LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
241047	Fee-for-Service	1396366050	1396366050	1	1	DANG, LAUREL K MD	10/9/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187346	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
241068	Fee-for-Service	1003185885	1003185885	1	1	DAO, TRI D MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119273	01	General Practice	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
241104	Fee-for-Service	1902268121	1902268121	1	1	DO, THAO MD	2/27/2024	207R00000X	NA	Other	026	PHYSICIANS	176483	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
241138	Fee-for-Service	1932235587	1932235587	1	1	DESAI, PRITI N MD	8/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80894	40	Pediatrics	0	In state provider	None	315 N THIRD AVE	# 205	COVINA	CA	91723	1905	19	06037	34.08873786	-117.8923869	Los Angeles County
241141	Fee-for-Service	1073187134	1073187134	1	1	DANG, ANNA MD	10/6/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
241182	Fee-for-Service	1740410836	1740410836	1	1	DOCTOR AZAD MEDICAL CORPORAT	4/1/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	93504	None	None	0	In state provider	None	2495 HOSPITAL DR.	STE 670	MOUNTAIN VIEW	CA	94040	4187	43	06085	37.369341	-122.0817635	Santa Clara County
241188	Fee-for-Service	1881787521	1881787521	1	1	DIEGO TORRES-RUSSOTTO	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
241190	Fee-for-Service	1396368585	1396368585	1	1	DEBWAN, SADEK MD	12/16/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	48	06095	38.23580279	-122.0858445	Solano County
241250	Fee-for-Service	1083610570	1083610570	1	1	DUNHILL, JULIE A MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61921	68	Hematology	0	In state provider	None	8635 W 3RD ST	STE 665W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
241251	Fee-for-Service	1588751002	1588751002	1	1	DAVIS, ELAINE S DPM	4/30/1984	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
241280	Fee-for-Service	1316146996	1316146996	1	1	DINH, MY T DO	3/18/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9907	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1332	42	06083	34.4458497	-119.779596	Santa Barbara County
241322	Fee-for-Service	1487658100	1487658100	1	1	DINH, SCOTT P OD INC	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INSIGHT OPTOMETRY	2086 N CAPITOL AVE	None	SAN JOSE	CA	95132	1015	43	06085	37.40651639	-121.8869407	Santa Clara County
241357	Fee-for-Service	1003185885	1003185885	1	1	DAO, TRI D MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119273	08	Family Practice	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
241376	Fee-for-Service	1134123185	1134123185	1	1	DR. ACHAL DESAI	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10787 NALL AVE	None	OVERLAND PARK	KS	66211	1375	00	None	38.93296396	-94.64881409	Johnson County
241409	Fee-for-Service	1225424799	1225424799	1	1	DISKIN, GERALDINE F CRNA	7/6/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241421	Fee-for-Service	1649571530	1649571530	1	1	DOPP, MONA R NP	10/9/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH STREET	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
241458	Fee-for-Service	1851428262	1851428262	1	1	DUNAI, MAGDOLNA MD	2/1/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	53216	36	Psychiatry	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
241485	Fee-for-Service	1407829658	1407829658	1	1	DEVERA, MICHAEL E MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	76794	02	General Surgery	0	In state provider	None	25865 BARTON RD	STE 101	LOMA LINDA	CA	92354	3128	36	06071	34.04824853	-117.2403225	San Bernardino County
241519	Fee-for-Service	1831480177	1831480177	1	1	DEVIREDDY, HARITA MD	5/2/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	157899	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
241533	Fee-for-Service	1104190826	1104190826	1	1	DIALYSIS OF SOUTH STOCKTON	11/8/2012	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	590 EAST HARDING WAY	None	STOCKTON	CA	95204	6110	39	06077	37.96868078	-121.2867274	San Joaquin County
241575	Fee-for-Service	1417959453	1417959453	1	1	DAVIDSON, NANCY A MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	32795	08	Family Practice	0	In state provider	None	6800 PALM AVE	STE A	SEBASTOPOL	CA	95472	4226	49	06097	38.39602719	-122.8185446	Sonoma County
241601	Fee-for-Service	1306195979	1306195979	1	1	DE SILVA, NIROSHIKA S N PSY	4/27/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
241636	Fee-for-Service	1386792372	1386792372	1	1	DELGADO, GUSTAVO A MD	11/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78699	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
241698	Fee-for-Service	1740773530	1740773530	1	1	DADSETAN, MALIA A DO	8/24/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17385	08	Family Practice	0	In state provider	None	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	19	06037	34.02648965	-118.4867439	Los Angeles County
241722	Fee-for-Service	1962031237	1962031237	1	1	DO, CHRISTOPHER DO	7/27/2023	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
241723	Fee-for-Service	1275917940	1275917940	1	1	DOCTORIAN, TANYA	2/24/2023	1835C0206X	NA	None	026	PHYSICIANS	147174	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
241741	Fee-for-Service	1649819988	1649819988	1	1	DELIGHT PHARMACY CORP	9/22/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21230 VENTURA BLVD	None	WOODLAND HILLS	CA	91364	2106	19	06037	34.16740726	-118.5952628	Los Angeles County
241798	Fee-for-Service	1710977566	1710977566	1	1	DAVIS, TIMOTHY L MD	7/15/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159588	30	Radiology	0	In state provider	None	2309 ANTONIO AVENUE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
241811	Fee-for-Service	1578876496	1578876496	1	1	DAVID AAMODT	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
241853	Fee-for-Service	1588243729	1588243729	1	1	DIVAGARAN, ADHIRA MD	12/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	188778	08	Family Practice	0	In state provider	None	1100 LARKSPUR LANDING CI	STE 10	LARKSPUR	CA	94939	1827	21	06041	37.94817177	-122.5100062	Marin County
241870	Fee-for-Service	1093044570	1093044570	1	1	DOSANJH, AMARJIT S MD	3/27/2014	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	24	Plastic Surgery	0	In state provider	A MEDICAL CORPORATION	2485 HIGH SCHOOL AVE	STE 222	CONCORD	CA	94520	1813	07	06013	37.98507961	-122.034189	Contra Costa County
241882	Fee-for-Service	1124462544	1124462544	1	1	DAMLE, NEHA MD	11/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135928	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
241914	Fee-for-Service	1073587986	1073587986	1	1	DVA HLTHCARE RENAL CARE	3/11/1996	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	NORTH HOLLYWOOD DIALYSIS	12126 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3205	19	06037	34.18665164	-118.3973943	Los Angeles County
241922	Fee-for-Service	1962714618	1962714618	1	1	DUBE, ANISH R MD	8/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134541	36	Psychiatry	0	In state provider	None	101 THE CITY DR S	BLDG 3	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
241954	Fee-for-Service	1487930657	1487930657	1	2	DOOR TO DOOR II INC	4/30/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	2405 W FLORENCE AVE	None	LOS ANGELES	CA	90043	5104	19	06037	33.97461945	-118.31994	Los Angeles County
241979	Fee-for-Service	1437449311	1437449311	1	1	DUARTE, VICTOR M MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117437	04	Otology, Laryngology, Rhinology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
242046	Fee-for-Service	1679547087	1679547087	1	1	DVA HEALTHCARE RENAL	8/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	4445 RIVERSIDE DR	None	CHINO	CA	91710	3961	36	06071	34.0189135	-117.7079265	San Bernardino County
242065	Fee-for-Service	1336585264	1336585264	1	1	D'ARCY, NICOLE T MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132859	None	None	0	In state provider	None	13855 EAST 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
242088	Fee-for-Service	1790080281	1790080281	1	1	DR THAKER MD A PROFESSIONAL	3/9/2011	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	415 E HARDING WAY	STE I	STOCKTON	CA	95204	6118	39	06077	37.96819912	-121.2900761	San Joaquin County
242114	Fee-for-Service	1235837246	1235837246	1	1	DAMINO, JESSE CNP	2/18/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7067 N MARIPOSA	103	FRESNO	CA	93720	2988	10	06019	36.838944	-119.7792995	Fresno County
242130	Fee-for-Service	1578244570	1578244570	1	1	DE HERRERA, SARA LMFT	9/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
242173	Fee-for-Service	1124462544	1124462544	1	1	DAMLE, NEHA MD	11/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135928	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
242186	Fee-for-Service	1386722536	1386722536	1	1	DAYLIGHT ADULT DAY HEALTH	10/8/2009	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE INC	2136 W WASHINGTON BLVD	None	LOS ANGELES	CA	90018	0000	19	06037	34.03990852	-118.3073849	Los Angeles County
242216	Fee-for-Service	1316426356	1316426356	1	1	DANG, KAYLEE PT	3/5/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
242236	Fee-for-Service	1487930657	1487930657	1	2	DOOR TO DOOR II INC	3/9/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2405 W FLORENCE AVE	None	LOS ANGELES	CA	90043	5104	19	06037	33.97461945	-118.31994	Los Angeles County
242239	Fee-for-Service	1588906036	1588906036	1	1	DOAN, MICHAEL H MD	6/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145605	05	Anesthesiology	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
242242	Fee-for-Service	1225597271	1225597271	1	1	DEL ROSSO, JAKE MD	5/3/2022	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	176824	None	None	0	In state provider	None	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	37	06073	32.82010691	-117.1788026	San Diego County
242246	Fee-for-Service	1356471015	1356471015	1	1	DANIEL, CAROLYN W LCSW	1/2/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1430 SECOND STREET	None	LIVERMORE	CA	94550	4212	01	06001	37.67810935	-121.7779183	Alameda County
242267	Fee-for-Service	1871520726	1871520726	1	1	DANIELYAN, NOUNEH O MD	2/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63520	01	General Practice	0	In state provider	None	5220 SANTA MONICA BLVD	STE E	LOS ANGELES	CA	90029	1234	19	06037	34.0907695	-118.304154	Los Angeles County
242297	Fee-for-Service	1992740765	1992740765	1	1	DOYAN, RICHARD MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50937	08	Family Practice	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
242344	Fee-for-Service	1669581732	1669581732	1	1	DHILLON, JATINDER S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42591	33	Thoracic Surgery	0	In state provider	A MEDICAL CORPORATION	2485 HIGH SCHOOL AVE	#312	CONCORD	CA	94520	1814	07	06013	37.98507961	-122.034189	Contra Costa County
242352	Fee-for-Service	1346774171	1346774171	1	1	DANG, HUE LCSW	7/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
242371	Fee-for-Service	1639240518	1639240518	1	1	DI STASIO, CHRISTOPHER C	3/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67864	13	Neurology (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
242381	Fee-for-Service	1659520534	1659520534	1	1	DOYCHEVA, ILIANA B MD	6/16/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	123718	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
242403	Fee-for-Service	1073906681	1073906681	1	1	DINUBA PHARMACY INC	4/10/2015	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	172 N L STREET	None	DINUBA	CA	93618	2104	54	06107	36.54160152	-119.3909939	Tulare County
242436	Fee-for-Service	1871119958	1871119958	1	1	DENISON, LONDON M PT	7/21/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
242453	Fee-for-Service	1093893588	1093893588	1	1	DAAMEN, NICOLE MD	7/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95338	84	Surgery-Head and Neck	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
242464	Fee-for-Service	1215696307	1215696307	1	1	DO, ELAINE T NP	12/8/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
242467	Fee-for-Service	1285684738	1285684738	1	1	DERENNE, JENNIFER L MD	2/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54949	26	Psychiatry (child)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
242498	Fee-for-Service	1972881035	1972881035	1	1	DEYOUNG, ELLIOT D MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	130456	30	Radiology	0	In state provider	None	6655 ALVARADO ROAD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
242553	Fee-for-Service	1285744433	1285744433	1	1	DY, MARIFE P MD	8/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86164	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
242557	Fee-for-Service	1871520726	1871520726	1	1	DANIELYAN, NOUNEH O MD	2/1/1999	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63520	41	Internal Medicine	0	In state provider	None	5220 SANTA MONICA BLVD	STE E	LOS ANGELES	CA	90029	1234	19	06037	34.0907695	-118.304154	Los Angeles County
242586	Fee-for-Service	1992740765	1992740765	1	1	DOYAN, RICHARD MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50937	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
242607	Fee-for-Service	1386138410	1386138410	1	1	DEVANI, MEHRAB MD	8/20/2021	207R00000X	NA	Other	026	PHYSICIANS	173447	None	None	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	4211	20	06039	37.06346603	-120.8593647	Merced County
242612	Fee-for-Service	1790542314	1790542314	1	1	DRAKE, JERICA L RCP	9/10/2024	2278C0205X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
242627	Fee-for-Service	1578768255	1578768255	1	1	DASH, ATREYA MD	10/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100410	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
242701	Fee-for-Service	1326045212	1326045212	1	1	DE LA VEGA, JOHN F MD	9/7/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62400	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
242720	Fee-for-Service	1609952126	1609952126	1	1	DAVIES, MARK R MD	9/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68804	20	Orthopedic Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
242734	Fee-for-Service	1821191446	1821191446	1	1	DAVE, SULABHA MD INC	3/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	30598	78	Neoplastic Diseases/Oncology	0	In state provider	RADIATION ONCOLOGY ASSOC	2440 E SOUTH ST	None	LONG BEACH	CA	90805	4426	19	06037	33.86013954	-118.163439	Los Angeles County
242743	Fee-for-Service	1790745776	1790745776	1	1	DIAZ-GONZALEZ, VICENTE MD	11/19/2021	207R00000X	NA	Other	026	PHYSICIANS	84160	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
242754	Fee-for-Service	1285684738	1285684738	1	1	DERENNE, JENNIFER L MD	2/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54949	36	Psychiatry	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
242774	Fee-for-Service	1518960467	1518960467	1	1	DALE H WYTOCK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 GLENN HENDREN DR	None	LIBERTY	MO	64068	9625	00	None	39.278767	-94.42102759	Clay County
242777	Fee-for-Service	1730252248	1730252248	1	1	DEL CARMEN, RUBY C MD	3/31/1992	207L00000X	NA	Other	026	PHYSICIANS	48944	01	General Practice	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
242779	Fee-for-Service	1629514948	1629514948	1	1	DOCK, RACHEL C LMFT	10/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
242803	Fee-for-Service	1235230798	1235230798	1	1	DUNCAN, VICKI L MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	46440	None	None	0	In state provider	None	1550 PROFESSIONAL DR	None	PETALUMA	CA	94954	6655	49	06097	38.25631812	-122.6300782	Sonoma County
242813	Fee-for-Service	1386710564	1386710564	1	1	DESERT OPHTHALMOLOGY MEDICAL	7/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77969	None	None	0	In state provider	CORPORATION	1180 N INDIAN CANYON DR	STE W100	PALM SPRINGS	CA	92262	4834	33	06065	33.839505	-116.5455735	Riverside County
242854	Fee-for-Service	1306859046	1306859046	1	1	DHAWAN, VIJAY M MD INC	3/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
242906	Fee-for-Service	1306377833	1306377833	1	1	DADASOVICH, RAND M MD	8/1/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	159611	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
242936	Fee-for-Service	1790949956	1790949956	1	1	DEREK R. ILLASTRON, MD	9/8/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2180 MAIN ST	None	WAILUKU	HI	96793	1625	00	None	20.88706871	-156.5045126	Maui County
242995	Fee-for-Service	1528542479	1528542479	1	1	DALISAY, ENRICO PT	6/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3535 E 7TH ST	None	LONG BEACH	CA	90804	5138	19	06037	33.77536647	-118.15047	Los Angeles County
243024	Fee-for-Service	1821191446	1821191446	1	1	DAVE, SULABHA MD INC	3/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	30598	30	Radiology	0	In state provider	RADIATION ONCOLOGY ASSOC	2440 E SOUTH ST	None	LONG BEACH	CA	90805	4426	19	06037	33.86013954	-118.163439	Los Angeles County
243028	Fee-for-Service	1043713795	1043713795	1	1	DESOUKY, HEBA M NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
243074	Fee-for-Service	1972001899	1972001899	1	1	DAUTOVIC, MEDINA LCSW	12/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
243090	Fee-for-Service	1720582604	1720582604	1	1	DUONG, MINDY MD	7/8/2022	207P00000X	NA	Other	026	PHYSICIANS	166655	None	None	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
243104	Fee-for-Service	1962579839	1962579839	1	1	DI FIORI, JAMIE L MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	55173	30	Radiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
243121	Fee-for-Service	1194873034	1194873034	1	1	DURBIN, THEODORE E MD	1/31/1987	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	60397	10	Gastroenterology (M.D. only)	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
243133	Fee-for-Service	1063470813	1063470813	1	1	DOUGAN, MICHAEL L MD	2/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87656	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92037	1300	37	06073	32.877999	-117.225891	San Diego County
243141	Fee-for-Service	1306859046	1306859046	1	1	DHAWAN, VIJAY M MD INC	3/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
243197	Fee-for-Service	1679705586	1679705586	1	1	DONALD GENE CORSON MD	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
243199	Fee-for-Service	1861928442	1861928442	1	1	DAVIDOVICS, HERMAN J MD	7/27/2021	207R00000X	NA	Other	026	PHYSICIANS	164326	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
243206	Fee-for-Service	1144423724	1144423724	1	1	DEMAR, ANDREW R MD INC	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	58869	02	General Surgery	0	In state provider	None	TWO MEDICAL PLAZA DR	STE 275	ROSEVILLE	CA	95661	3051	31	06061	38.76507948	-121.2477476	Placer County
243212	Fee-for-Service	1588765721	1588765721	1	1	DAVENPORT, MARY L MD	1/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	33883	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4440 SAN PABLO DAM RD	None	EL SOBRANTE	CA	94803	3052	07	06013	37.9665699	-122.301985	Contra Costa County
243227	Fee-for-Service	1760756860	1760756860	1	4	DR. JAMIE A. LIPELES, A PROF	6/30/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	301 W. CARSON ST	None	CARSON	CA	90745	2608	19	06037	33.83170545	-118.281879	Los Angeles County
243238	Fee-for-Service	1770727216	1770727216	1	1	DENNIS A FAITH MD	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	415 JEFFERSON ST N	None	WADENA	MN	56482	1264	00	None	46.44658422	-95.13270643	Wadena County
243268	Fee-for-Service	1366843294	1366843294	1	1	DIXON-JOHNSON, HEDWIG	8/25/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	108 GRACE AVENUE	None	SACRAMENTO	CA	95838	2009	34	06067	38.651229	-121.4684775	Sacramento County
243276	Fee-for-Service	1912079294	1912079294	1	1	DEVASKAR, PRAKASH P MD	1/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	35068	40	Pediatrics	0	In state provider	None	159 LYNCH CREEK WAY	None	PETALUMA	CA	94954	2342	49	06097	38.25161903	-122.6345283	Sonoma County
243349	Fee-for-Service	1447293501	1447293501	2	1	DABBS, MARCI L MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81714	None	None	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
243363	Fee-for-Service	1700841939	1700841939	1	3	DR LUQUE OD A PROFESSIONAL	1/27/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORPORATION	44665 VALLEY CENTRAL WY	None	LANCASTER	CA	93536	6500	19	06037	34.69311041	-118.1722239	Los Angeles County
243377	Fee-for-Service	1518018191	1518018191	5	3	DIGNITY HEALTH	3/7/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1248 D STREET	None	MERCED	CA	95341	6248	24	06047	37.29099962	-120.4748462	Merced County
243378	Fee-for-Service	1750575437	1750575437	1	1	DUGGAN, DANIEL P DO	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11369	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
243406	Fee-for-Service	1730299959	1730299959	1	1	DIDI HIRSCH PSYCHIATRIC SERV	8/17/2017	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	19	06037	34.00134941	-118.4039837	Los Angeles County
243422	Fee-for-Service	1194873034	1194873034	1	1	DURBIN, THEODORE E MD	1/31/1987	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	60397	41	Internal Medicine	0	In state provider	None	433 W BASTANCHURY RD	None	FULLERTON	CA	92835	3404	30	06059	33.89344341	-117.9338865	Orange County
243428	Fee-for-Service	1306859046	1306859046	1	1	DHAWAN, VIJAY M MD INC	3/15/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3420 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	1539	19	06037	34.02477209	-118.1409949	Los Angeles County
243446	Fee-for-Service	1679701189	1679701189	1	1	DARABOS, MICHAEL R MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130164	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
243457	Fee-for-Service	1275692048	1275692048	1	1	DESAI, ANUP M MD	5/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98388	08	Family Practice	0	In state provider	None	7400 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	3011	34	06067	38.700774	-121.271373	Sacramento County
243484	Fee-for-Service	1821280744	1821280744	1	1	DUONG, TRUONG D MD AMC	11/4/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	70137	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4500 BROCKTON AVE	STE 319	RIVERSIDE	CA	92501	4090	33	06065	33.97785263	-117.3836152	Riverside County
243513	Fee-for-Service	1760756860	1760756860	1	4	DR. JAMIE A. LIPELES, A PROF	6/30/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	301 W. CARSON ST	None	CARSON	CA	90745	2608	19	06037	33.83170545	-118.281879	Los Angeles County
243556	Fee-for-Service	1366843294	1366843294	1	1	DIXON-JOHNSON, HEDWIG	8/25/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	108 GRACE AVENUE	None	SACRAMENTO	CA	95838	2009	34	06067	38.651229	-121.4684775	Sacramento County
243557	Fee-for-Service	1023181658	1023181658	2	1	DUONG, PAUL T MD	10/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66325	41	Internal Medicine	0	In state provider	None	9433 BOLSA AVE	SUITE A	WESTMINSTER	CA	92683	5964	30	06059	33.74498152	-117.964368	Orange County
243560	Fee-for-Service	1962447425	1962447425	1	1	DEBRIER,-DESCALZI,LESLIE	3/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81328	08	Family Practice	0	In state provider	None	1510 S CENTRAL AVE	STE 300	GLENDALE	CA	91204	2569	19	06037	34.12709764	-118.2577911	Los Angeles County
243580	Fee-for-Service	1679096101	1679096101	1	1	DISTEFANO, CHARLOTTE A PHD	10/31/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
243587	Fee-for-Service	1427104462	1427104462	1	1	D'APUZZO, MASSIMO M MD	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88682	22	Pathology (M.D. only)	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
243667	Fee-for-Service	1518018191	1518018191	5	3	DIGNITY HEALTH	3/7/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1248 D STREET	None	MERCED	CA	95341	6248	24	06047	37.29099962	-120.4748462	Merced County
243719	Fee-for-Service	1316367949	1316367949	1	1	DAGHER, CHRISTOPHER F MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138220	None	None	0	In state provider	None	375 HUNTINGTON DR	STE G	SAN MARINO	CA	91108	2357	19	06037	34.1067704	-118.1349621	Los Angeles County
243740	Fee-for-Service	1003283961	1003283961	1	1	DISHNER, KATHERINE E	4/10/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	16766 BERNARDO CENTER DR	STE 206	SAN DIEGO	CA	92128	2502	37	06073	33.01756519	-117.0759175	San Diego County
243768	Fee-for-Service	1023014164	1023014164	1	1	DECKER, ROBERT W MD	10/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	48876	01	General Practice	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
243796	Fee-for-Service	1710040605	1710040605	1	1	DADA, STEPHEN A MD	6/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86832	02	General Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
243797	Fee-for-Service	1326072893	1326072893	1	1	DEWEESE, JEFFREY E MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68258	24	Plastic Surgery	0	In state provider	None	1199 BUSH ST	STE 590	SAN FRANCISCO	CA	94109	5976	38	06075	37.7891291	-122.4167087	San Francisco County
243805	Fee-for-Service	1063438174	1063438174	1	1	DEYNES, SOLISIS MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96059	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
243911	Fee-for-Service	1932400603	1932400603	1	1	DUBICH, SARAH K	2/22/2011	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11105 KNOTT AVE	STE B	CYPRESS	CA	90630	5137	30	06059	33.80083909	-118.0111199	Orange County
243953	Fee-for-Service	1366949604	1366949604	1	1	DUGUE, RACHELLE C MD	8/9/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	176806	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
243991	Fee-for-Service	1932166485	1932166485	1	1	DOUGLAS, CLIFFORD C MD	8/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	70288	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	SUITE 108A	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
244125	Fee-for-Service	1154681534	1154681534	1	1	DAUGHETY, JASON D DO	8/17/2020	207L00000X	NA	Other	026	PHYSICIANS	16016	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
244126	Fee-for-Service	1841940350	1841940350	1	1	DELICARE I HEALTH SERVICES	7/7/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	27143 SETTLEMENT STREET	None	MENIFEE	CA	92585	1314	33	06065	33.72538735	-117.1557505	Riverside County
244159	Fee-for-Service	1609948413	1609948413	1	1	DOWNES, JOD'ANN MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	74641	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
244179	Fee-for-Service	1184155715	1184155715	1	1	DAMGAARD, BIRGITTE U	9/12/2017	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	23141 MOULTON PKWY	108	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
244185	Fee-for-Service	1154435048	1154435048	1	1	DUONG, PHUONG L OD	5/17/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 BLOSSOM HILL RD	STE 20	SAN JOSE	CA	95123	3056	43	06085	37.25049949	-121.84425	Santa Clara County
244253	Fee-for-Service	1164981155	1164981155	1	1	DAVIS, NIAREE G MD	11/1/2024	207P00000X	NA	Other	026	PHYSICIANS	183613	66	Emergency Medicine (Urgent Care)	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	10	06019	36.60784193	-119.4520057	Fresno County
244322	Fee-for-Service	1821184490	1821184490	1	1	DANQUE, PAMELA O MD	1/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	51627	None	None	0	In state provider	None	555 EAST VALLEY PARKWAY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
244371	Fee-for-Service	1649362633	1649362633	1	1	DESAI, BHUPATRAI H MD	6/7/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	33896	13	Neurology (M.D. only)	0	In state provider	INC	630 N 13TH AVE	STE B	UPLAND	CA	91786	4978	36	06071	34.10137569	-117.6336729	San Bernardino County
244461	Fee-for-Service	1063591790	1063591790	1	1	DE JESUS, HECTOR M MD	11/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	43025	41	Internal Medicine	0	In state provider	None	6001B TRUXTUN AVE	STE 240	BAKERSFIELD	CA	93309	0611	15	06029	35.36254873	-119.0727158	Kern County
244462	Fee-for-Service	1275221103	1275221103	1	1	DA ROSA, MICHAEL MD	10/17/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185838	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
244469	Fee-for-Service	1447337654	1447337654	1	1	DONALDSON, ROSS I MD	3/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92704	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
244472	Fee-for-Service	1457350738	1457350738	1	1	DAVIDSON, SHELDON J MD	11/27/1985	207RH0000X	NA	Hematology	026	PHYSICIANS	15884	68	Hematology	0	In state provider	None	5400 BALBOA BLVD	STE 237	ENCINO	CA	91316	1502	19	06037	34.169283	-118.501072	Los Angeles County
244518	Fee-for-Service	1952047292	1952047292	1	1	DENIS, ASHELEY NP	3/26/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
244526	Fee-for-Service	1841676103	1841676103	1	1	DANG, MICHAEL Q DO	10/11/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
244563	Fee-for-Service	1396812228	1396812228	1	1	DASIKA, VINOD K MD	6/26/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66080	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
244719	Fee-for-Service	1235287848	1235287848	1	1	DELFIN, JOSEPH M LCSW	10/19/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8235 SANTA MONICA BLVD	400	WEST HOLLYWOOD	CA	90046	5914	19	06037	34.09076149	-118.3686795	Los Angeles County
244721	Fee-for-Service	1497303234	1497303234	1	1	DINH, VINCE L OT	9/6/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
244723	Fee-for-Service	1750313383	1750313383	1	1	DEUTSCH, MADELINE B MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80419	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
244759	Fee-for-Service	1588004840	1588004840	1	1	DELFOSSE, ERIN M NP	3/4/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
244760	Fee-for-Service	1457350738	1457350738	1	1	DAVIDSON, SHELDON J MD	11/27/1985	207RH0000X	NA	Hematology	026	PHYSICIANS	15884	41	Internal Medicine	0	In state provider	None	5400 BALBOA BLVD	STE 237	ENCINO	CA	91316	1502	19	06037	34.169283	-118.501072	Los Angeles County
244765	Fee-for-Service	1013968361	1013968361	1	1	DREHER, KIMBERLY A DO	5/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8203	None	None	0	In state provider	None	900 S MAIN ST	STE 209	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
244786	Fee-for-Service	1639752553	1639752553	1	4	DISPATCHHEALTH-CA, PC	8/4/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	604 E HUNTINGTON DR	B	MONROVIA	CA	91016	3637	19	06037	34.14043939	-117.9917084	Los Angeles County
244832	Fee-for-Service	1710900535	1710900535	1	1	DEMER, JOSEPH L MD	4/28/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	43662	18	Ophthalmology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
244850	Fee-for-Service	1396812228	1396812228	1	1	DASIKA, VINOD K MD	6/26/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66080	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
244898	Fee-for-Service	1649730888	1649730888	1	1	DHARMARAJA, ARJUNA MD	9/5/2023	207R00000X	NA	Other	026	PHYSICIANS	176861	None	None	0	In state provider	None	13355 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	5802	19	06037	33.91091877	-118.3527745	Los Angeles County
244899	Fee-for-Service	1689097842	1689097842	1	1	DAVIDSON-METHOT, DAVID G PHD	1/26/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1230 HIGH STREET	SUITE 211	AUBURN	CA	95603	5044	31	06061	38.89478358	-121.0744248	Placer County
244958	Fee-for-Service	1083336309	1083336309	1	1	DUNBAR, ALFIA M LMFT	1/31/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
245022	Fee-for-Service	1598755498	1598755498	1	1	DUNCAN, MYLINH T OD	9/28/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5200 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	2544	33	06065	33.937065	-117.4541295	Riverside County
245041	Fee-for-Service	1730265703	1730265703	1	1	DAYANI, JILA MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52716	40	Pediatrics	0	In state provider	None	12626 RIVERSIDE DR	STE 101	NORTH HOLLYWOOD	CA	91607	3448	19	06037	34.15758449	-118.408131	Los Angeles County
245059	Fee-for-Service	1598961245	1598961245	1	32	DIGNITY HEALTH MEDICAL FOUND	11/5/2024	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	ATION	1685 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1703	44	06087	36.98815465	-121.981096	Santa Cruz County
245070	Fee-for-Service	1265941876	1265941876	1	1	DERNER, BRIAN DPM	8/2/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245075	Fee-for-Service	1639752553	1639752553	1	4	DISPATCHHEALTH-CA, PC	8/4/2023	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	604 E HUNTINGTON DR	B	MONROVIA	CA	91016	3637	19	06037	34.14043939	-117.9917084	Los Angeles County
245139	Fee-for-Service	1790795540	1790795540	1	1	DORN, MARTHA R MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65861	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245200	Fee-for-Service	1235320565	1235320565	1	1	DOWNS, COREY C MD	6/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103024	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1778	19	06037	34.06373445	-118.443537	Los Angeles County
245234	Fee-for-Service	1902887433	1902887433	1	1	DERLET, ROBERT W MD	2/23/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32325	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
245274	Fee-for-Service	1134153752	1134153752	1	1	DICKEY, JAN V MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49405	41	Internal Medicine	0	In state provider	None	6301 3RD ST	None	SAN FRANCISCO	CA	94124	3501	38	06075	37.72070671	-122.3963144	San Francisco County
245279	Fee-for-Service	1851650097	1851650097	1	1	DOWLATSHAHI, SHADI MD	10/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129259	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
245311	Fee-for-Service	1598755498	1598755498	1	1	DUNCAN, MYLINH T OD	9/28/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5200 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	2544	33	06065	33.937065	-117.4541295	Riverside County
245317	Fee-for-Service	1679285449	1679285449	1	1	DEBELLIS, DELILAH A OT	5/3/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
245344	Fee-for-Service	1164768107	1164768107	1	1	DORSI, MICHAEL J MD APC	10/2/2015	193400000X	NA	Other	026	PHYSICIANS	116011	14	Neurological Surgery	0	In state provider	None	168 N BRENT STREET	SUITE 408	VENTURA	CA	93003	2824	56	06111	34.27448266	-119.2572489	Ventura County
245385	Fee-for-Service	1205415981	1205415981	1	1	DO IT FOR YOURSELF WELLNESS	5/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	COACHING & MARRIAGE & FA	2617 K STREET	SUITE 250	SACRAMENTO	CA	95816	4421	34	06067	38.573595	-121.4715825	Sacramento County
245396	Fee-for-Service	1518971522	1518971522	1	1	DUONG, VU T MD	2/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91693	05	Anesthesiology	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
245426	Fee-for-Service	1306894548	1306894548	1	1	DURAIRAJ, LALITHA MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	68392	13	Neurology (M.D. only)	0	In state provider	None	11100 WARNER AVENUE	SUITE 218	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
245429	Fee-for-Service	1790795540	1790795540	1	1	DORN, MARTHA R MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65861	02	General Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245453	Fee-for-Service	1881185544	1881185544	1	1	DOHERTY, THEODORE B DO	7/12/2022	207P00000X	NA	Other	026	PHYSICIANS	19301	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
245496	Fee-for-Service	1306804661	1306804661	1	1	DUTRA, CHRISTOPHER R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42629	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
245677	Fee-for-Service	1760631618	1760631618	1	1	DIBIASSI CORP	10/10/2014	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5363 ALHAMBRA AVE	None	LOS ANGELES	CA	90032	3411	19	06037	34.07657451	-118.1687807	Los Angeles County
245684	Fee-for-Service	1326102112	1326102112	1	1	DEUTSCH, HARVEY L MD FACS	12/14/1990	208600000X	NA	General Surgery	026	PHYSICIANS	46608	02	General Surgery	0	In state provider	None	2021 SANTA MONICA	STE 320E	SANTA MONICA	CA	90404	2208	19	06037	34.02922048	-118.4793681	Los Angeles County
245705	Fee-for-Service	1275173981	1275173981	1	1	DUBE, BRIAN J PT	4/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10255 LIVE OAK BLVD	None	LIVE OAK	CA	95953	2015	51	06101	39.28004385	-121.661271	Sutter County
245716	Fee-for-Service	1790795540	1790795540	1	1	DORN, MARTHA R MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
245755	Fee-for-Service	1902380314	1902380314	1	1	DOUGLASS, KIRSTEN M MD	7/29/2024	207P00000X	NA	Other	026	PHYSICIANS	188632	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
245763	Fee-for-Service	1124859756	1124859756	1	1	DORSEY, CHANA TOLABOR CERTI	8/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
245900	Fee-for-Service	1437654431	1437654431	1	1	DAUCHER, ANNAMARIA PT	8/22/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
245905	Fee-for-Service	1194770438	1194770438	1	1	DIXON, MATTHEW R MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	75589	28	Proctology (colon and rectal)	0	In state provider	None	280 W MAC ARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
245907	Fee-for-Service	1508881236	1508881236	1	1	DISHAKJIAN, RAFFI M MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	47717	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
245930	Fee-for-Service	1306370523	1306370523	1	1	DE MICHELE, SIMONA MD	3/14/2023	207ZP0102X	NA	Other	026	PHYSICIANS	16698	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
245971	Fee-for-Service	1063700664	1063700664	1	1	DAO, QUYNH V NP	11/2/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
245977	Fee-for-Service	1720005648	1720005648	1	1	DEMETER, SHARON NP	5/5/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
245978	Fee-for-Service	1417953878	1417953878	1	4	DIABLO VALLEY ONCOLOGY	7/23/2012	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	100 NORTH WIGET LANE	SUITE 290	WALNUT CREEK	CA	94598	5901	07	06013	37.92514495	-122.0237725	Contra Costa County
246046	Fee-for-Service	1083712236	1083712236	1	1	DE SILVA, BERTRAND R MD	6/21/2000	207R00000X	NA	Other	026	PHYSICIANS	46400	05	Anesthesiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
246192	Fee-for-Service	1255383444	1255383444	1	1	DORON, DAVID A	10/17/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
246211	Fee-for-Service	1073698734	1073698734	1	1	DALY, NICHOLAS	5/17/2004	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
246275	Fee-for-Service	1700814027	1700814027	1	1	D'ANTONIO, LINDA L PHD	7/24/2008	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
246283	Fee-for-Service	1598975328	1598975328	1	1	DENARO, STEPHEN A MD	10/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117787	30	Radiology	0	In state provider	None	2301 BAHAMAS DR	None	BAKERSFIELD	CA	93309	0663	15	06029	35.37447628	-119.0453594	Kern County
246307	Fee-for-Service	1962132910	1962132910	1	1	DEL BONO, CARL LMFT	10/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
246326	Fee-for-Service	1013416015	1013416015	1	1	DELLOTA, CHRISTOPHER ALMALBI	1/18/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	S PT	2838 OSWELL ST	None	BAKERSFIELD	CA	93306	2704	15	06029	35.39923633	-118.9499418	Kern County
246327	Fee-for-Service	1225011299	1225011299	1	1	DUBEY, RAJESH K MD	1/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83527	41	Internal Medicine	0	In state provider	None	1401 SPANOS CT	STE 230	MODESTO	CA	95355	2816	50	06099	37.66975543	-120.9724048	Stanislaus County
246333	Fee-for-Service	1083712236	1083712236	1	1	DE SILVA, BERTRAND R MD	6/21/2000	207R00000X	NA	Other	026	PHYSICIANS	46400	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
246334	Fee-for-Service	1821748328	1821748328	1	1	DO, CHRISTINE DO	8/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21652	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
246350	Fee-for-Service	1922483122	1922483122	1	1	DEVELOPMENTAL OCCUPATIONAL T	12/21/2021	225XP0200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ES OF SACRAMENTO	3416 AMERICAN RIVER DR	STE B	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
246373	Fee-for-Service	1629405618	1629405618	1	2	DR ADITYA JAIN MD INC	6/9/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL SPECIALIST	1532 150TH AVE	None	SAN LEANDRO	CA	94578	1823	01	06001	37.70718429	-122.1274288	Alameda County
246425	Fee-for-Service	1841653821	1841653821	1	1	DHILLON, RUPINDER K MD	2/24/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160462	08	Family Practice	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
246426	Fee-for-Service	1225278211	1225278211	1	1	DASKIVICH, TIMOTHY J MD	6/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103871	34	Urology and Urological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	4125	19	06037	34.07671715	-118.3799413	Los Angeles County
246430	Fee-for-Service	1306507397	1306507397	1	1	DAVAKIS, DANIELLE C CNP	6/30/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246441	Fee-for-Service	1073665360	1073665360	1	7	DIGNITY HEALTH	1/31/2020	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
246445	Fee-for-Service	1588252233	1588252233	1	1	DR. TINA WEBB LICENSED CLINI	2/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CAL SOCIAL WORKER INC.	1945 PALO VERDE AVE	203	LONG BEACH	CA	90815	3445	19	06037	33.791634	-118.1080175	Los Angeles County
246446	Fee-for-Service	1871582395	1871582395	1	1	DAVID, TERRI J LMFT	8/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14156 MAGNOLIA BLVD	STE 105	SHERMAN OAKS	CA	91423	6410	19	06037	34.1648345	-118.4420025	Los Angeles County
246477	Fee-for-Service	1053310821	1053310821	1	1	DAS, AKHIL K MD	3/8/2022	208800000X	NA	Other	026	PHYSICIANS	175917	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
246494	Fee-for-Service	1255494795	1255494795	1	1	DIAGNOSTIC IMAGING MEDI-	6/3/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CAL GROUP OF KENT	711 N ALVARADO ST	STE 110	LOS ANGELES	CA	90026	4016	19	06037	34.07424293	-118.2655575	Los Angeles County
246503	Fee-for-Service	1659384295	1659384295	1	1	DIZON, DOMINIC T MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62295	41	Internal Medicine	0	In state provider	None	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
246528	Fee-for-Service	1548362122	1548362122	1	1	DO, ANN T MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96272	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
246530	Fee-for-Service	1912165440	1912165440	1	1	DIXIT, NIHARIKA MD	8/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117064	78	Neoplastic Diseases/Oncology	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
246549	Fee-for-Service	1023699410	1023699410	1	1	DM SINALOA LLC	1/13/2022	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1432 SINALOA RD	None	SIMI VALLEY	CA	93065	3031	56	06111	34.26524832	-118.7875825	Ventura County
246610	Fee-for-Service	1114320371	1114320371	1	1	DICKER, DIANA L LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5330 PRIMROSE DR	STE 240	FAIR OAKS	CA	95628	3542	34	06067	38.662623	-121.275936	Sacramento County
246621	Fee-for-Service	1083712236	1083712236	1	1	DE SILVA, BERTRAND R MD	6/21/2000	207R00000X	NA	Other	026	PHYSICIANS	46400	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
246625	Fee-for-Service	1215768734	1215768734	1	1	DAVID LOPEZ MARRIAGE AND FAM	2/21/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPIST INC	3600 SISK RD	5A-16	MODESTO	CA	95356	0535	50	06099	37.69033236	-121.0612655	Stanislaus County
246637	Fee-for-Service	1922483122	1922483122	1	1	DEVELOPMENTAL OCCUPATIONAL T	12/21/2021	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ES OF SACRAMENTO	3416 AMERICAN RIVER DR	STE B	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
246730	Fee-for-Service	1073665360	1073665360	1	7	DIGNITY HEALTH	1/31/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
246817	Fee-for-Service	1366489502	1366489502	1	1	DONALD, DAVID A MD	7/17/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65429	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
246840	Fee-for-Service	1578906665	1578906665	1	2	DROTMAN, SPENCER W MD	7/2/2020	207L00000X	NA	Other	026	PHYSICIANS	156562	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
246897	Fee-for-Service	1417344797	1417344797	1	1	DRS E&E INVESTMENT LLC	9/1/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3426 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	19	06037	34.02740119	-118.2001649	Los Angeles County
247016	Fee-for-Service	1073665360	1073665360	1	7	DIGNITY HEALTH	1/31/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
247043	Fee-for-Service	1699849208	1699849208	1	1	DEPINA, MARIA A MD	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52344	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
247125	Fee-for-Service	1053766808	1053766808	1	1	DOLPHIN, ALLISON W CNP	8/6/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19353 VICTORY BLVD	None	RESEDA	CA	91335	6302	19	06037	34.18659936	-118.5552114	Los Angeles County
247157	Fee-for-Service	1922013739	1922013739	1	1	DAUGHARTY, MARIE G MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78708	05	Anesthesiology	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
247207	Fee-for-Service	1588040596	1588040596	1	1	DOUGHERTY, MAYA G LCSW	5/16/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
247210	Fee-for-Service	1992048193	1992048193	1	1	DARLING, CURTIS E II MD	7/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135315	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
247220	Fee-for-Service	1467028209	1467028209	1	1	DAVIDSON, STACY S NP	11/29/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
247232	Fee-for-Service	1336782259	1336782259	1	1	DESAI, ROMA M OD	8/22/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
247239	Fee-for-Service	1447678149	1447678149	1	1	DIAZ MELEAN, CARLOS M MD	8/7/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	148789	40	Pediatrics	0	In state provider	None	500 40TH STREET	None	BAKERSFIELD	CA	93301	1224	15	06029	35.39619932	-119.0074457	Kern County
247254	Fee-for-Service	1073775466	1073775466	1	1	DR JOHN OLIVER	5/1/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 NEW CASTLE RD	None	FORREST CITY	AR	72335	2218	00	None	35.03944565	-90.77194379	St. Francis County
247262	Fee-for-Service	1629368261	1629368261	1	1	DALAL, VIVEK MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138304	None	None	0	In state provider	None	465 W PUTNAM	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
247270	Fee-for-Service	1598141475	1598141475	2	1	DELCAMPO, MIGUEL MD	1/8/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
247271	Fee-for-Service	1336526888	1336526888	1	1	DESOUZA, PHILIP MD	7/7/2019	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	160606	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
247281	Fee-for-Service	1972940625	1972940625	1	1	DORRIZ, PARSHAW J MD	7/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137931	13	Neurology (M.D. only)	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 250	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
247282	Fee-for-Service	1154525822	1154525822	1	1	DEGUZMAN, DOROTHY A MD	11/29/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151985	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
247352	Fee-for-Service	1013046663	1013046663	1	1	DENG, DAVID F DPM	1/14/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
247363	Fee-for-Service	1538348453	1538348453	1	1	DUDUKGIAN, HAIG MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94890	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
247372	Fee-for-Service	1598929887	1598929887	1	1	DUBNER, SARAH E MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116689	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
247384	Fee-for-Service	1982982674	1982982674	1	1	DALMACIO, LIZA J LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
247412	Fee-for-Service	1750510251	1750510251	1	1	D'SA, JENNIFER J MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122614	08	Family Practice	0	In state provider	None	17500 FOOTHILL BLVD #A 2	None	SAN BERNARDINO	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino
247425	Fee-for-Service	1205839966	1205839966	1	1	DADMANESH, FARNAZ MD	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72879	22	Pathology (M.D. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
247433	Fee-for-Service	1235767948	1235767948	1	1	DAVE, RUTU M MD	2/20/2025	2084N0400X	NA	Neurology	026	PHYSICIANS	186901	13	Neurology (M.D. only)	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
247440	Fee-for-Service	1043084247	1043084247	1	1	DIAZ, KYLE PT	5/31/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
247452	Fee-for-Service	1114061421	1114061421	1	1	DELEAVER-RUSSELL, MARGO	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	38896	40	Pediatrics	0	In state provider	MD	3831 HUGHES AVE	STE 601	CULVER CITY	CA	90232	6844	19	06037	34.02243278	-118.3981492	Los Angeles County
247472	Fee-for-Service	1568774289	1568774289	1	1	DAY-SCARINCI, MORAG DO MD	10/19/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	11251	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
247496	Fee-for-Service	1104573153	1104573153	1	1	DILLARD, GINA L CCC-SLP	5/17/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
247506	Fee-for-Service	1497836977	1497836977	1	1	DOUGLAS CO & UNINC TOWNS	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	1	Border provider	EAST FORK FIRE & PARAMED	1594 ESMERALDA AVE	STE 101	MINDEN	NV	89423	4004	00	None	38.95317097	-119.7634286	Douglas County
247517	Fee-for-Service	1912135690	1912135690	1	1	DAVID LEE	3/16/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	940 E 5TH ST	None	COQUILLE	OR	97423	1666	00	None	43.17908426	-124.1788744	Coos County
247535	Fee-for-Service	1114979176	1114979176	1	1	DONNELLY, JOSEPH R MD	3/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78117	20	Orthopedic Surgery	0	In state provider	APC	1133 E STANLEY BLVD	STE 111	LIVERMORE	CA	94550	4270	01	06001	37.67914693	-121.7810206	Alameda County
247542	Fee-for-Service	1639756927	1639756927	1	1	DOWLEARN, THOMAS MD	10/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187281	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
247567	Fee-for-Service	1699906883	1699906883	1	1	DAHI, HOUMAN MD A	10/1/2009	207RP1001X	NA	Pulmonology	026	PHYSICIANS	98386	None	None	0	In state provider	PROFESSIONAL CORPORATION	501 WASHINGTON DR	STE 508	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
247585	Fee-for-Service	1528000627	1528000627	1	1	DOLL, JAMES S MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	52 MISSION CIRCLE	STE 121	SANTA ROSA	CA	95409	5370	49	06097	38.457882	-122.674104	Sonoma County
247586	Fee-for-Service	1689293284	1689293284	1	1	DAVIDSON, DAKOTA B DO	6/22/2023	207P00000X	NA	Other	026	PHYSICIANS	19858	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
247603	Fee-for-Service	1255650776	1255650776	1	1	DASS, NIRANAJAN MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125555	40	Pediatrics	0	In state provider	None	1041 N CHINA LAKE BLVD	STE B	RIDGECREST	CA	93555	3183	15	06029	35.63953945	-117.669891	Kern County
247670	Fee-for-Service	1760990592	1760990592	1	1	DENNIS, MEREDITH L PHD	12/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
247695	Fee-for-Service	1912933888	1912933888	1	1	DUARTE, MELINDA A NP	2/6/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10990 SAN DIEGO MISSION	None	SAN DIEGO	CA	92108	2417	37	06073	32.7850186	-117.1023292	San Diego County
247706	Fee-for-Service	1164459178	1164459178	1	1	DAVIDSON, MARK M MD	11/16/2007	207R00000X	NA	Other	026	PHYSICIANS	67586	10	Gastroenterology (M.D. only)	0	In state provider	None	8631 WEST 3RD ST	STE 1135E	LOS ANGELES	CA	90048	5917	19	06037	34.07361928	-118.3803143	Los Angeles County
247801	Fee-for-Service	1275006421	1275006421	1	1	DYNAMIC HOSPICE CARE INC	12/23/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5958 VINELAND AVE	STE D	NORTH HOLLYWOOD	CA	91601	1329	19	06037	34.179174	-118.370272	Los Angeles County
247804	Fee-for-Service	1891282075	1891282075	1	1	DRESSER, LAURIE D O INC	6/7/2018	193400000X	NA	Other	026	PHYSICIANS	6977	01	General Practice	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
247824	Fee-for-Service	1427688316	1427688316	1	1	DELTA MEDICAL PHARMACY ANTIO	4/18/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CH	1888 A ST	None	ANTIOCH	CA	94509	2602	07	06013	38.003931	-121.8060455	Contra Costa County
247906	Fee-for-Service	1194144485	1194144485	1	1	DANG & NGUYEN PHARMACY INC	1/26/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18120 BROOKHURST STREET	UNIT 57	FOUNTAIN VALLEY	CA	92708	6727	30	06059	33.70080507	-117.9542015	Orange County
247910	Fee-for-Service	1730126467	1730126467	1	1	DESERAN, MARK W MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	67376	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
247913	Fee-for-Service	1932272382	1932272382	1	1	DENNIS, DEBBIE A M MD	10/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69461	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1303 EAST HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
247915	Fee-for-Service	1770263352	1770263352	1	1	D'AVIGNON, AIMEE L CNM	12/8/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
247999	Fee-for-Service	1164459178	1164459178	1	1	DAVIDSON, MARK M MD	11/16/2007	207R00000X	NA	Other	026	PHYSICIANS	67586	41	Internal Medicine	0	In state provider	None	8631 WEST 3RD ST	STE 1135E	LOS ANGELES	CA	90048	5917	19	06037	34.07361928	-118.3803143	Los Angeles County
248006	Fee-for-Service	1851754642	1851754642	1	1	DONAHOE, JOHN	1/10/2025	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7124	00	None	32.683167	-114.633459	Yuma County
248008	Fee-for-Service	1033708797	1033708797	1	1	DOLOWICH, ELISA K NP	8/26/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
248015	Fee-for-Service	1043396690	1043396690	1	1	DINSMORE, STEPHEN C MD	1/1/1981	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32005	18	Ophthalmology	0	In state provider	A PROFESSIONAL CORP	19000 HAWTHORNE BLVD	STE 110	TORRANCE	CA	90503	1517	19	06037	33.85789054	-118.3535468	Los Angeles County
248039	Fee-for-Service	1477871473	1477871473	1	1	DESHPANDE, DURGA S MD	5/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	123716	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
248062	Fee-for-Service	1437723285	1437723285	1	1	DESERT INSIGHT FAMILY THERAP	10/14/2023	1041C0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	35325 DATE PALM DRIVE	STE 122	CATHEDRAL CITY	CA	92234	7002	33	06065	33.79144444	-116.4581341	Riverside County
248090	Fee-for-Service	1275006421	1275006421	1	1	DYNAMIC HOSPICE CARE INC	12/23/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5958 VINELAND AVE	STE D	NORTH HOLLYWOOD	CA	91601	1329	19	06037	34.179174	-118.370272	Los Angeles County
248114	Fee-for-Service	1548457245	1548457245	1	1	DEMERA, RICHARD S MD INC	4/29/2008	193400000X	NA	Other	026	PHYSICIANS	65003	None	None	0	In state provider	& IMMUNOLOGY CENTER	7045 N MAPLE AVE	STE 108	FRESNO	CA	93720	8008	10	06019	36.83898291	-119.7453487	Fresno County
248140	Fee-for-Service	1831726892	1831726892	1	1	DICKEY, BRIAN MD	7/5/2022	390200000X	NA	Other	026	PHYSICIANS	179111	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
248185	Fee-for-Service	1518018191	1518018191	5	5	DIGNITY HEALTH	3/7/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	315 E 13TH STREET	None	MERCED	CA	95341	6211	24	06047	37.29248035	-120.4730619	Merced County
248217	Fee-for-Service	1184201568	1184201568	1	1	DEVERETT, BENSON D MD	5/7/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
248243	Fee-for-Service	1184687121	1184687121	1	1	DELMAR KENT LAYTON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	AZ REG MED CTR	515 N MESA DR	None	MESA	AZ	85201	5914	00	None	33.424767	-111.8219445	Maricopa County
248271	Fee-for-Service	1164919221	1164919221	1	1	DALVIN, MARK MD	11/13/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
248281	Fee-for-Service	1558570119	1558570119	1	1	DO-DEVER, BICHLAN T MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	101150	26	Psychiatry (child)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
248289	Fee-for-Service	1932372562	1932372562	1	1	DEL PRIORE, JOSEPH DO	4/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10565	07	Dermatology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
248292	Fee-for-Service	1114219870	1114219870	1	1	DAS, SMITA MD	6/6/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	122139	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
248322	Fee-for-Service	1437916053	1437916053	1	1	DELGADO, KATHRYN	1/3/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	552 S. PASEO DOROTEA	STE 4	PALM SPRINGS	CA	92264	1437	33	06065	33.81460283	-116.5017722	Riverside County
248348	Fee-for-Service	1437723285	1437723285	1	1	DESERT INSIGHT FAMILY THERAP	6/14/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	35325 DATE PALM DRIVE	STE 122	CATHEDRAL CITY	CA	92234	7002	33	06065	33.79144444	-116.4581341	Riverside County
248439	Fee-for-Service	1427154541	1427154541	1	1	DEL SIGNORE, CLAIRE M MD	8/2/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50287	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
248455	Fee-for-Service	1982869954	1982869954	1	1	DENIKE, EMMANUEL J LMFT	9/23/2019	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
248457	Fee-for-Service	1457333973	1457333973	1	1	DIMSDALE, JASON M MD	9/20/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	76625	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
248466	Fee-for-Service	1104369198	1104369198	1	1	DONG, STEPHANIE MD	10/1/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	148032	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
248473	Fee-for-Service	1518018191	1518018191	5	5	DIGNITY HEALTH	3/7/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	315 E 13TH STREET	None	MERCED	CA	95341	6211	24	06047	37.29248035	-120.4730619	Merced County
248486	Fee-for-Service	1700059425	1700059425	1	1	DRUSANO, MICHAEL F MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144818	08	Family Practice	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
248492	Fee-for-Service	1942699699	1942699699	1	1	DEGUZMAN, AGNES C	7/26/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
248497	Fee-for-Service	1386273746	1386273746	1	1	DAZA, JENNIFER MD	11/27/2023	261QU0200X	NA	Other	026	PHYSICIANS	191246	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
248504	Fee-for-Service	1801072137	1801072137	1	1	DEBBIEREY BONGAR	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
248547	Fee-for-Service	1386399350	1386399350	1	1	DOVE-AUSTIN, DARRIAN KENDALL	3/30/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	32430 WHISPERING GLEN TR	None	WILDOMAR	CA	92595	7521	33	06065	33.59171414	-117.2564852	Riverside County
248549	Fee-for-Service	1467009084	1467009084	1	1	DEL ROSARIO, MICHELLE NP	7/27/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	421 N BROOKHURST ST	STE 218	ANAHEIM	CA	92801	5619	30	06059	33.83743497	-117.9590498	Orange County
248576	Fee-for-Service	1053342212	1053342212	1	1	DUTTA, DURBA MD	5/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87087	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248637	Fee-for-Service	1437723285	1437723285	1	1	DESERT INSIGHT FAMILY THERAP	6/14/2021	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	35325 DATE PALM DRIVE	STE 122	CATHEDRAL CITY	CA	92234	7002	33	06065	33.79144444	-116.4581341	Riverside County
248645	Fee-for-Service	1992281026	1992281026	1	1	DHILLON, RACHEL MD	7/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178513	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
248653	Fee-for-Service	1902083397	1902083397	1	1	DR GRACIE NER OPTOMETRY	3/27/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3171 GLENDALE BLVD	None	LOS ANGELES	CA	90039	1805	19	06037	34.11739432	-118.2615913	Los Angeles County
248738	Fee-for-Service	1598961245	1598961245	1	29	DIGNITY HEALTH MEDICAL FOUND	6/1/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	-DOMINICAN INC	575 AUTO CENTER DR	None	WATSONVILLE	CA	95076	3727	44	06087	36.91752728	-121.7672578	Santa Cruz County
248742	Fee-for-Service	1629288683	1629288683	1	1	DELA TORRE, TONY LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
248780	Fee-for-Service	1356453088	1356453088	1	1	DIKIO, NICHOLAS A MD INC	9/30/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40344	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3791 KATELLA AVE	STE 209	LOS ALAMITOS	CA	90720	2016	30	06059	33.80318449	-118.0672965	Orange County
248781	Fee-for-Service	1669452702	1669452702	1	1	DEVERAUX DENISE MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76275	01	General Practice	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
248818	Fee-for-Service	1174901128	1174901128	1	1	DAVID DESAI MD INC	6/14/2021	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	36	06071	34.13470788	-117.262434	San Bernardino County
248835	Fee-for-Service	1386399350	1386399350	1	1	DOVE-AUSTIN, DARRIAN KENDALL	3/30/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	32430 WHISPERING GLEN TR	None	WILDOMAR	CA	92595	7521	33	06065	33.59171414	-117.2564852	Riverside County
248859	Fee-for-Service	1568465466	1568465466	1	4	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	P, INC	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	44	06087	36.97734512	-122.0204895	Santa Cruz County
248899	Fee-for-Service	1437205093	1437205093	1	1	DIAMOND, MICHAEL LMFT	5/29/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
248935	Fee-for-Service	1912030255	1912030255	1	1	DELAO, SARA E NP	7/1/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
248938	Fee-for-Service	1043483837	1043483837	1	1	DIBRIELLE, WILLIAM R MD	1/27/2025	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
248985	Fee-for-Service	1659723914	1659723914	1	1	DRURY, BLAKE H DO	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	16698	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
248987	Fee-for-Service	1588211767	1588211767	1	1	DENHOLM, BROOKE S	6/9/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
249025	Fee-for-Service	1598961245	1598961245	1	29	DIGNITY HEALTH MEDICAL FOUND	6/1/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	-DOMINICAN INC	575 AUTO CENTER DR	None	WATSONVILLE	CA	95076	3727	44	06087	36.91752728	-121.7672578	Santa Cruz County
249039	Fee-for-Service	1790783025	1790783025	2	1	DT PHARMACY CORPORATION	5/16/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4616 EL CAJON BLVD	#6	SAN DIEGO	CA	92115	4426	37	06073	32.75567113	-117.0951834	San Diego County
249061	Fee-for-Service	1245264399	1245264399	1	1	DIXON, MICHAEL P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SOUTHERN IDAHO RADIOLOGY	650 ADDISON AVENUE WEST	None	TWIN FALLS	ID	83301	0000	00	None	42.56415243	-114.4940357	Twin Falls County
249067	Fee-for-Service	1225789910	1225789910	1	1	DENIK VR MANAGEMENT INC	10/31/2023	2278P4000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	132 PLAYA CIR	None	ALISO VIEJO	CA	92656	1627	30	06059	33.59543738	-117.7268554	Orange County
249109	Fee-for-Service	1326204082	1326204082	1	1	DOWNEY, LAURA A MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110725	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
249110	Fee-for-Service	1174901128	1174901128	1	1	DAVID DESAI MD INC	6/14/2021	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	36	06071	34.13470788	-117.262434	San Bernardino County
249118	Fee-for-Service	1265012348	1265012348	1	1	DYQUIANGCO, MONIQUE DPM	8/27/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1 SHRADER ST	SUITE 580	SAN FRANCISCO	CA	94117	1016	38	06075	37.77467326	-122.4529451	San Francisco County
249148	Fee-for-Service	1568465466	1568465466	1	4	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	P, INC	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	44	06087	36.97734512	-122.0204895	Santa Cruz County
249155	Fee-for-Service	1801021357	1801021357	1	1	DUBEY, SANDHYA A MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119925	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DRIVE	None	SAN LEANDRO	CA	94578	1009	01	06001	37.71083326	-122.1208841	Alameda County
249184	Fee-for-Service	1164532339	1164532339	1	1	DERMATOLOGY INSTITUTE AND	12/21/2015	193400000X	NA	Other	026	PHYSICIANS	53239	07	Dermatology	0	In state provider	SKIN CARE CENTER INC	2001 SANTA MONICA BLVD	SUITE 1160 W	SANTA MONICA	CA	90404	2120	19	06037	34.02891163	-118.4797466	Los Angeles County
249187	Fee-for-Service	1033709480	1033709480	1	1	DINH, JESSICA LCSW	9/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
249226	Fee-for-Service	1043483837	1043483837	1	1	DIBRIELLE, WILLIAM R MD	1/27/2025	207RR0500X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
249246	Fee-for-Service	1396885208	1396885208	1	1	DUNNING, RICHARD J MD	2/23/1982	207P00000X	NA	Other	026	PHYSICIANS	24851	08	Family Practice	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
249279	Fee-for-Service	1740708296	1740708296	1	1	DIGNIFIED HOME HEALTH CARE	3/25/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14547 TITUS ST	STE 208	PANORAMA CITY	CA	91402	4931	19	06037	34.21973977	-118.4503255	Los Angeles County
249289	Fee-for-Service	1659570992	1659570992	1	1	DABRA, SUNDEEP MD	11/8/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
249309	Fee-for-Service	1245006055	1245006055	1	1	DR. JENNIFER M. JONES FOUNDA	4/17/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	535 W 26TH ST	None	MERCED	CA	95340	2825	24	06047	37.31075109	-120.4789896	Merced County
249357	Fee-for-Service	1184694523	1184694523	1	1	DULA, EUGENE MD	4/30/1985	208800000X	NA	Other	026	PHYSICIANS	56131	02	General Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
249378	Fee-for-Service	1083086573	1083086573	1	1	DEVLIN, MEGHAN L NP	1/22/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
249396	Fee-for-Service	1174901128	1174901128	1	1	DAVID DESAI MD INC	5/15/2023	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	36	06071	34.13470788	-117.262434	San Bernardino County
249402	Fee-for-Service	1235609231	1235609231	1	1	DELGADO, BEATRIZ LMFT	9/16/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
249437	Fee-for-Service	1568465466	1568465466	1	4	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	P, INC	615 OCEAN ST	None	SANTA CRUZ	CA	95060	4005	44	06087	36.97734512	-122.0204895	Santa Cruz County
249459	Fee-for-Service	1326129529	1326129529	1	1	DURBIN, VALERIE A	11/10/2014	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1712 PICASSO AVENUE	SUITE A	DAVIS	CA	95618	0546	57	06113	38.56413437	-121.7303634	Yolo County
249471	Fee-for-Service	1548478928	1548478928	1	1	DIZON-SINOCRUZ, KAREN M PT	5/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
249486	Fee-for-Service	1487116950	1487116950	1	1	DURU, PAUL O MD	4/14/2023	390200000X	NA	Other	026	PHYSICIANS	181122	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
249496	Fee-for-Service	1407157621	1407157621	1	1	DUONG, PHILLIP P DO	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11438	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
249509	Fee-for-Service	1568527380	1568527380	1	1	DORFMANLERNER, NANCY S LCSW	5/23/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2535 TOWNSGATE RD	STE 209	WESTLAKE VILLAGE	CA	91361	5976	56	06111	34.15873583	-118.8307969	Ventura County
249534	Fee-for-Service	1396885208	1396885208	1	1	DUNNING, RICHARD J MD	2/23/1982	207P00000X	NA	Other	026	PHYSICIANS	24851	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
249546	Fee-for-Service	1073684536	1073684536	1	1	DAVIDSON, SUMMER R LCSW	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25416	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
249598	Fee-for-Service	1154645307	1154645307	1	1	DING, YILE MD	6/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111869	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
249602	Fee-for-Service	1114273117	1114273117	1	1	DHOLAKIA, KRISHMA D	7/7/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4010 ORANGE AVE	None	LONG BEACH	CA	90807	3717	19	06037	33.831612	-118.176291	Los Angeles County
249639	Fee-for-Service	1093958464	1093958464	1	1	DINH, CHINH T APMC	7/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65428	08	Family Practice	0	In state provider	None	3414 W BALL RD	STE F	ANAHEIM	CA	92804	3728	30	06059	33.81723326	-118.0087815	Orange County
249667	Fee-for-Service	1730208430	1730208430	1	1	D'SOUZA, GENEVIEVE MD	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92699	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
249691	Fee-for-Service	1326698564	1326698564	1	1	DEL RIO CARE LLC	8/20/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4171 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	4103	37	06073	32.7781767	-117.1043061	San Diego County
249707	Fee-for-Service	1518203207	1518203207	1	1	DOKEY, ADRIAN T MD	8/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122367	18	Ophthalmology	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
249797	Fee-for-Service	1649833815	1649833815	1	1	DUONG, TRUNG T MD	4/19/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183905	None	None	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
249920	Fee-for-Service	1447328794	1447328794	1	1	DODDS, MARGARET L MD	2/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87281	40	Pediatrics	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
249927	Fee-for-Service	1376600262	1376600262	1	1	DELGADILLO, VINCE OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3900 LAKEVIEW HWY	None	PETALUMA	CA	94954	5698	49	06097	38.32168809	-122.6254468	Sonoma County
249969	Fee-for-Service	1982956306	1982956306	2	2	DITTMANN, MEGAN LCSW	8/31/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	206 PROVIDENCE MIND RD	215	NEVADA CITY	CA	95959	9540	29	06057	39.25037109	-121.0307545	Nevada County
249998	Fee-for-Service	1841283397	1841283397	1	1	DAUGHTERS, THOMAS C MD	10/20/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	77781	None	None	0	In state provider	None	320 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4311	42	06083	34.42954414	-119.7230551	Santa Barbara County
250057	Fee-for-Service	1710094057	1710094057	1	1	DURRANI, KHURRAM K MD	12/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	72805	-	NOT APPLICABLE	0	In state provider	None	620 N AURORA STREET	SUITES 1, 3, 3A, S2-9	STOCKTON	CA	95202	2276	39	06077	37.96104648	-121.2811438	San Joaquin County
250093	Fee-for-Service	1962579706	1962579706	1	1	DURNA, LARA N MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78815	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
250153	Fee-for-Service	1457774770	1457774770	1	1	DE SA, MARX W MD	10/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126289	05	Anesthesiology	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
250211	Fee-for-Service	1174949945	1174949945	1	1	DESERT HAND AND PLASTIC	1/11/2017	208200000X	NA	General Surgery	026	PHYSICIANS	60193	24	Plastic Surgery	0	In state provider	SURGERY PC	300 OLD RIVER ROAD	SUITE 200	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
250215	Fee-for-Service	1306917208	1306917208	1	1	DAVENPORT, JOHN Y MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42876	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
250250	Fee-for-Service	1730525684	1730525684	1	1	DIRECT PROVIDER OF HOSPICE	1/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	9320 BASELINE RD	SUITE B2	RANCHO CUCAMONGA	CA	91701	5829	36	06071	34.12156453	-117.6018255	San Bernardino County
250272	Fee-for-Service	1861707861	1861707861	1	1	DANIELS, PATRICE CNP	11/30/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
250282	Fee-for-Service	1174704480	1174704480	1	1	DENNIS-JOHNSON, BELINDA M LM	9/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	21561 FLAMENCO	None	MISSION VIEJO	CA	92692	1212	30	06059	33.64939601	-117.6344447	Orange County
250298	Fee-for-Service	1285170951	1285170951	1	1	DETTLOFF, RENEE CNM	3/8/2019	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	583 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	5239	49	06097	38.45268	-122.672088	Sonoma County
250353	Fee-for-Service	1205922614	1205922614	1	1	DEFILIPPO, ROGER E MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81396	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
250396	Fee-for-Service	1629140371	1629140371	1	1	DEVINE, SUSAN H MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37948	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
250430	Fee-for-Service	1538528674	1538528674	1	1	DOTY, MATTHEW W DO	8/3/2022	208VP0014X	NA	Other	026	PHYSICIANS	19324	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
250451	Fee-for-Service	1225488687	1225488687	1	1	DODD, SARA E LCSW	7/28/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87264	-	NOT APPLICABLE	0	In state provider	None	2620 INDUSTRY WAY	SUITE A	LYNWOOD	CA	90262	4008	19	06037	33.92360701	-118.2254995	Los Angeles County
250525	Fee-for-Service	1679006274	1679006274	1	1	DIXON, ROBERT C MD	10/14/2022	207P00000X	NA	Other	026	PHYSICIANS	158696	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
250537	Fee-for-Service	1730525684	1730525684	1	1	DIRECT PROVIDER OF HOSPICE	1/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	9320 BASELINE RD	SUITE B2	RANCHO CUCAMONGA	CA	91701	5829	36	06071	34.12156453	-117.6018255	San Bernardino County
250582	Fee-for-Service	1205107836	1205107836	1	1	DAWSON-GILL, SHAYLA NP	10/29/2021	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
250621	Fee-for-Service	1902948516	1902948516	1	1	DAVID A.HALL MD	2/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	211 FOREST ST	None	MCCALL	ID	83638	5256	00	None	44.90892985	-116.1118421	Valley County
250641	Fee-for-Service	1205922614	1205922614	1	1	DEFILIPPO, ROGER E MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81396	34	Urology and Urological Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
250672	Fee-for-Service	1063916633	1063916633	1	1	DICKERSON, ANDREW B MD	8/1/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	164904	10	Gastroenterology (M.D. only)	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
250691	Fee-for-Service	1568465466	1568465466	1	7	DOCTORS ON DUTY MEDICAL GROU	11/25/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1756 N MAIN ST	None	SALINAS	CA	93906	5103	27	06053	36.71800104	-121.6534748	Monterey County
250692	Fee-for-Service	1518275973	1518275973	1	1	DELAPAZ, ANNA R G LMFT	3/21/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	103600	-	NOT APPLICABLE	0	In state provider	None	8665 GIBBS AVE	STE 150	SAN DIEGO	CA	92123	1739	37	06073	32.81043091	-117.1419105	San Diego County
250698	Fee-for-Service	1992978274	1992978274	1	1	DENISSOV, NATALYA V MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113162	01	General Practice	0	In state provider	None	1501 TROUSDALE DRIVE	4TH FLOOR	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
250730	Fee-for-Service	1811173115	1811173115	1	1	DICKINSON, BRIAN P MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86239	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 465	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
250745	Fee-for-Service	1043952369	1043952369	1	1	DICKSON, RILEY J MD	1/23/2025	207P00000X	NA	Other	026	PHYSICIANS	190125	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
250751	Fee-for-Service	1538182878	1538182878	1	1	DONENFELD, ROGER F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48336	05	Anesthesiology	0	In state provider	None	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90291	2032	19	06037	33.98160766	-118.4400667	Los Angeles County
250768	Fee-for-Service	1790879369	1790879369	1	1	DEL PIERO, ERIC J MD	1/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	46085	18	Ophthalmology	0	In state provider	None	1441 CONSTITUTION BLVD	STE 400	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
250793	Fee-for-Service	1427794494	1427794494	1	1	DE GUZMAN CORPORATION	6/23/2022	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2959 STATE ST	None	SANTA BARBARA	CA	93105	3417	42	06083	34.44028287	-119.7272634	Santa Barbara County
250796	Fee-for-Service	1902981517	1902981517	1	1	DEAR, WEYLAND B OD	8/11/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	42 S 1ST ST	None	SAN JOSE	CA	95113	2409	43	06085	37.33534508	-121.889988	Santa Clara County
250801	Fee-for-Service	1427092741	1427092741	1	1	DAWES, DONALD M MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73388	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
250807	Fee-for-Service	1598784415	1598784415	1	1	DELAPENA, WILLIAM C MD	4/30/1984	207W00000X	NA	Ophthalmology	026	PHYSICIANS	31272	18	Ophthalmology	0	In state provider	None	2715 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
250810	Fee-for-Service	1568542389	1568542389	1	1	DIKRANIAN, ARMEN H MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75231	34	Urology and Urological Surgery	0	In state provider	None	901 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08588	-118.123089	Los Angeles County
250835	Fee-for-Service	1952959348	1952959348	1	1	DEMOUCHET, DARRILYN B NP	10/12/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
250850	Fee-for-Service	1255887857	1255887857	1	1	DIGGORY, MATTHEW L OD	8/7/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9170 HAVEN AVE	STE 102	RANCHO CUCAMONGA	CA	91730	5416	36	06071	34.087491	-117.5758895	San Bernardino County
250865	Fee-for-Service	1851355614	1851355614	1	1	DAVISON, WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	305 HOSPITAL DR	STE 305	GLEN BURNIE	MD	21061	5862	00	None	39.13927851	-76.62379552	Anne Arundel County
250874	Fee-for-Service	1598180341	1598180341	1	1	DUVDEVANY, NETA S MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137556	40	Pediatrics	0	In state provider	None	1920 TIENDA DRIVE	STE 102	LODI	CA	95242	3931	39	06077	38.11678155	-121.2957005	San Joaquin County
250919	Fee-for-Service	1104236876	1104236876	1	1	DOAN, TERESA D MD	8/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143590	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
250923	Fee-for-Service	1215386560	1215386560	1	1	DOMADIA, MONA MD	7/20/2021	208M00000X	NA	Other	026	PHYSICIANS	171510	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
250951	Fee-for-Service	1710351077	1710351077	1	1	DELMAN, CONNOR M MD	2/1/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	158523	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
250960	Fee-for-Service	1063916633	1063916633	1	1	DICKERSON, ANDREW B MD	8/1/2024	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	164904	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
250976	Fee-for-Service	1174601918	1174601918	1	1	DAJANI, HASHEM MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66683	45	Nephrology (Renal-Kidney)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
250979	Fee-for-Service	1588049282	1588049282	1	1	DUARTE CHAVEZ, RODRIGO MD	3/27/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	174766	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
250980	Fee-for-Service	1568465466	1568465466	1	7	DOCTORS ON DUTY MEDICAL GROU	11/25/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1756 N MAIN ST	None	SALINAS	CA	93906	5103	27	06053	36.71800104	-121.6534748	Monterey County
250989	Fee-for-Service	1992978274	1992978274	1	1	DENISSOV, NATALYA V MD	5/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113162	08	Family Practice	0	In state provider	None	1501 TROUSDALE DRIVE	4TH FLOOR	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
250996	Fee-for-Service	1073556668	1073556668	1	1	DUFFIS, ALVARIS W MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7714	30	Radiology	0	In state provider	None	3325 CHANATE RD	None	SANTA ROSA	CA	95404	1707	49	06097	38.469537	-122.707314	Sonoma County
251006	Fee-for-Service	1154731792	1154731792	1	1	DOAN, LAURA L MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140590	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
251016	Fee-for-Service	1265402788	1265402788	1	1	DOAN, KIM T MD	2/21/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	74216	18	Ophthalmology	0	In state provider	ADVANCED EYECARE OF ORAN	19582 BEACH BLVD	STE 102	HUNTINGTON BEACH	CA	92648	2996	30	06059	33.67831649	-117.9885198	Orange County
251087	Fee-for-Service	1013072172	1013072172	1	1	DELANO JOINT UNION HSD	11/16/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1720 NORWALK STREET	None	DELANO	CA	93215	1456	15	06029	35.77816512	-119.2408949	Kern County
251137	Fee-for-Service	1124007604	1124007604	1	1	DIEMONT,STEPHEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
251199	Fee-for-Service	1750496121	1750496121	1	1	DIPP, MARTHA L MD	9/30/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	51763	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
251233	Fee-for-Service	1669468526	1669468526	1	1	D'ANGELO, MICHAEL	3/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
251235	Fee-for-Service	1962701003	1962701003	1	1	DUMONT-WALTER, REBECCA A MD	2/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	117692	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
251246	Fee-for-Service	1326010505	1326010505	1	1	DOMBO, KUDZAI R MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141928	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
251264	Fee-for-Service	1104924182	1104924182	1	1	DIALYSIS CLINIC INC	10/18/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	650 CARONDELET DRIVE	None	KANSAS CITY	MO	64114	4672	00	None	38.93681197	-94.59987238	Jackson County
251267	Fee-for-Service	1568465466	1568465466	1	7	DOCTORS ON DUTY MEDICAL GROU	11/25/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1756 N MAIN ST	None	SALINAS	CA	93906	5103	27	06053	36.71800104	-121.6534748	Monterey County
251307	Fee-for-Service	1053754309	1053754309	1	1	DESERT HEARING ASSOCIATES, I	7/23/2020	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	NC.	1180 N. INDIAN CANYON DR	SUITE E-324	PALM SPRINGS	CA	92262	4809	33	06065	33.839505	-116.5455735	Riverside County
251325	Fee-for-Service	1518345289	1518345289	1	1	DONALDSON, RACHEL A MD	5/10/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	150956	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251335	Fee-for-Service	1932286747	1932286747	1	1	DAVIS, EDWARD J MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78638	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
251344	Fee-for-Service	1174564819	1174564819	1	1	DOOSTAN, DAVID K MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73708	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
251349	Fee-for-Service	1821208190	1821208190	1	1	DARDEN, ALISSA R MD	11/24/2020	208M00000X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
251385	Fee-for-Service	1003873720	1003873720	1	1	DERWEESH, ITHAAR H MD	8/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53383	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
251387	Fee-for-Service	1497228431	1497228431	1	1	DIVINE, HERLAY LCSW	4/12/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
251406	Fee-for-Service	1023170289	1023170289	1	1	DJOKIC, MIROSLAV MD INC	8/23/2006	193400000X	NA	Other	026	PHYSICIANS	87463	28	Proctology (colon and rectal)	0	In state provider	None	1801 E MARCH LN	STE C300	STOCKTON	CA	95210	6674	39	06077	38.00315652	-121.2868715	San Joaquin County
251410	Fee-for-Service	1851580344	1851580344	1	1	DIMON, CYNTHIA LCSW	5/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2211 POST ST	300	SAN FRANCISCO	CA	94115	3442	38	06075	37.78446663	-122.4382772	San Francisco County
251422	Fee-for-Service	1528098431	1528098431	1	1	DESERT CRITICAL CARE	7/25/2006	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORT INC	140 N BROADWAY	None	BLYTHE	CA	92225	1608	33	06065	33.61119568	-114.5967733	Riverside County
251482	Fee-for-Service	1124292941	1124292941	1	1	DON, DARREN W MD	12/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	83804	25	Physical Medicine and Rehabilitation	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
251499	Fee-for-Service	1356336051	1356336051	1	1	DOBROW, ROBERT L MD	11/30/1987	207RR0500X	NA	Other	026	PHYSICIANS	47389	83	Rheumatology	0	In state provider	None	3801 SACRAMENTO ST	# 100	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
251522	Fee-for-Service	1689742140	1689742140	1	1	DEMILLE, DARCIE B CCC-SLP	11/4/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
251532	Fee-for-Service	1639145741	1639145741	1	1	DAVID DOUGLASS MD	10/18/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	# 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
251539	Fee-for-Service	1730593591	1730593591	1	1	DUONG, JASON DO	3/4/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	13565	14	Neurological Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
251622	Fee-for-Service	1306360797	1306360797	1	1	DETRICK, NICHOLAS A PT	4/15/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
251697	Fee-for-Service	1851583173	1851583173	1	1	DEARING, DAVID D MD	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	95954	02	General Surgery	0	In state provider	None	3110 PARK SIERRA	SUITE 105	RIVERSIDE	CA	92505	3071	33	06065	33.90356848	-117.470886	Riverside County
251725	Fee-for-Service	1902997661	1902997661	1	1	DODDANNA, KRISHNA MD APC	7/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	AV PULMONARY ASSOCIATES	44215 15TH ST W	STE 211	LANCASTER	CA	93534	5504	19	06037	34.68666415	-118.1568572	Los Angeles County
251727	Fee-for-Service	1861445249	1861445249	1	1	DAY, JAMES H JR MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	41207	30	Radiology	0	In state provider	None	401 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4227	42	06083	34.42940104	-119.7230763	Santa Barbara County
251747	Fee-for-Service	1720200470	1720200470	1	1	DAO, QUANG M MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101789	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
251772	Fee-for-Service	1144378001	1144378001	1	1	DAYKIN, EMILY L MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42931	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
251788	Fee-for-Service	1356336051	1356336051	1	1	DOBROW, ROBERT L MD	11/30/1987	207RR0500X	NA	Other	026	PHYSICIANS	47389	41	Internal Medicine	0	In state provider	None	3801 SACRAMENTO ST	# 100	SAN FRANCISCO	CA	94118	1625	38	06075	37.78707021	-122.4555217	San Francisco County
251810	Fee-for-Service	1124414297	1124414297	1	1	DESAI, ISHITA P MD	7/7/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145598	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
251853	Fee-for-Service	1558892075	1558892075	1	1	DECKER, JOHANNES H MD	3/15/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	157187	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251873	Fee-for-Service	1962446351	1962446351	1	1	DUNN, JAMES E MD	12/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86944	08	Family Practice	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
251885	Fee-for-Service	1508953100	1508953100	1	1	DUMAIN, KATHLEEN C LCSW	6/8/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
251887	Fee-for-Service	1194896084	1194896084	1	1	DOERNING, BRIAN J MD	10/9/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69961	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
251904	Fee-for-Service	1508641705	1508641705	1	1	DAUGHERTY, KIMBERLY NP	10/19/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
251984	Fee-for-Service	1427128354	1427128354	1	1	DOLLE, NAHLLA MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	50630	01	General Practice	0	In state provider	BROOKHURST MEDICAL CARE	512 S BROOKHURST ST	STE 4	ANAHEIM	CA	92804	2448	30	06059	33.82605	-117.9589215	Orange County
251986	Fee-for-Service	1194703827	1194703827	1	1	DEWALD, THOMAS E DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1037 W AVENUE N	STE 101	PALMDALE	CA	93551	2002	19	06037	34.63124053	-118.149021	Los Angeles County
252006	Fee-for-Service	1902997661	1902997661	1	1	DODDANNA, KRISHNA MD APC	7/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AV PULMONARY ASSOCIATES	44215 15TH ST W	STE 211	LANCASTER	CA	93534	5504	19	06037	34.68666415	-118.1568572	Los Angeles County
252013	Fee-for-Service	1588749162	1588749162	1	1	DIAGNOSTIC PATH MED GRP	6/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	52ND & F ST	None	SACRAMENTO	CA	95819	0000	34	06067	38.570607	-121.439502	Sacramento County
252014	Fee-for-Service	1790204931	1790204931	1	1	DUNG, PUI KING	3/1/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	333 W GARVEY AVENUE	B73	MONTEREY PARK	CA	91754	7430	19	06037	34.06255751	-118.127178	Los Angeles County
252068	Fee-for-Service	1740437441	1740437441	1	1	DUA, SUMIT MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124109	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
252126	Fee-for-Service	1992090088	1992090088	1	1	DOCKMAN, TIMOTHY DO	1/15/2021	390200000X	NA	Other	026	PHYSICIANS	18587	None	None	0	In state provider	None	3140 BALFOUR RD	SUITE C	BRENTWOOD	CA	94513	5518	07	06013	37.9252364	-121.7233035	Contra Costa County
252145	Fee-for-Service	1184753121	1184753121	1	1	DONLON, DEBORAH T MD	3/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80414	08	Family Practice	0	In state provider	None	751 LOMBARDI CT	# B	SANTA ROSA	CA	95407	6793	49	06097	38.427804	-122.7493035	Sonoma County
252147	Fee-for-Service	1548771744	1548771744	1	1	DOLAN, MACKENZIE L LCSW	9/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
252198	Fee-for-Service	1659400166	1659400166	1	1	DIHH, HANG B OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INSIGHT OPTOMETRIC CTR	4255 CAMPUS DR	STE 112	IRVINE	CA	92612	2620	30	06059	33.64910596	-117.8394276	Orange County
252257	Fee-for-Service	1821062191	1821062191	1	1	D S PHARMACEUTICALS INC	11/12/1993	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9500 BOLSA AVE	STE N	WESTMINSTER	CA	92683	5943	30	06059	33.74475113	-117.9634694	Orange County
252268	Fee-for-Service	1639752553	1639752553	1	3	DISPATCHHEALTH-CA, PC	8/4/2023	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4719 VIEWRIDGE DR	SUITE 130	SAN DIEGO	CA	92123	1685	37	06073	32.8241389	-117.1211178	San Diego County
252270	Fee-for-Service	1255599593	1255599593	1	1	DHILLON, INDERPREET S MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112570	36	Psychiatry	0	In state provider	None	1305 TOMMYDON STREET	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
252272	Fee-for-Service	1801862396	1801862396	1	1	DURAN, MICHAEL G MD	1/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
252304	Fee-for-Service	1790204931	1790204931	1	1	DUNG, PUI KING	3/1/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	333 W GARVEY AVENUE	B73	MONTEREY PARK	CA	91754	7430	19	06037	34.06255751	-118.127178	Los Angeles County
252306	Fee-for-Service	1679540116	1679540116	1	1	DEHKORDI, REZA H MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54677	41	Internal Medicine	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
252384	Fee-for-Service	1437730405	1437730405	1	1	DEMPSEY, ELIZABETH V LCSW	5/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
252435	Fee-for-Service	1235155235	1235155235	1	1	DENDEL, PETER S MD	12/31/1990	207L00000X	NA	Other	026	PHYSICIANS	71536	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
252478	Fee-for-Service	1518950377	1518950377	1	1	DIXIT, SUDHAKAR MD	11/30/2001	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	71778	None	None	0	In state provider	None	24060 FIR AVE	STE B	MORENO VALLEY	CA	92553	2841	33	06065	33.93543049	-117.242604	Riverside County
252482	Fee-for-Service	1114984051	1114984051	1	1	DUONG, KIT T MD	9/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52024	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
252497	Fee-for-Service	1851452213	1851452213	1	1	DELPAINE, DENNIS MD	2/8/2015	207K00000X	NA	Other	026	PHYSICIANS	37345	03	Allergy	0	In state provider	None	5309 CARRINGTON CIR	None	STOCKTON	CA	95210	3516	39	06077	38.00514461	-121.293465	San Joaquin County
252506	Fee-for-Service	1427037571	1427037571	1	1	DUFF, STEPHANIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 W HAMPDEN AVE	STE 600	ENGLEWOOD	CO	80110	2336	00	None	39.65335027	-104.9924183	Arapahoe County
252534	Fee-for-Service	1578988507	1578988507	1	1	DIAZ, YVETTE M LMFT	12/27/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
252549	Fee-for-Service	1639752553	1639752553	1	3	DISPATCHHEALTH-CA, PC	8/4/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	4719 VIEWRIDGE DR	SUITE 130	SAN DIEGO	CA	92123	1685	37	06073	32.8241389	-117.1211178	San Diego County
252558	Fee-for-Service	1831846278	1831846278	1	1	DR DELFA ZAKER FARLEY OD INC	2/3/2023	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	H	4340 VON KARMAN AVE	SUITE 230	NEWPORT BEACH	CA	92660	1201	30	06059	33.664266	-117.8615225	Orange County
252564	Fee-for-Service	1073766895	1073766895	1	1	DHESI, PAVITTARPAUL S MD	8/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	110032	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
252607	Fee-for-Service	1568294577	1568294577	1	1	DANIEL, CHELSEA NP	9/17/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
252616	Fee-for-Service	1386710564	1386710564	1	2	DESERT OPHTHALMOLOGY MEDICAL	12/12/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	1180 N INDIAN CANYON DR	SUITE E130	PALM SPRINGS	CA	92262	4834	33	06065	33.839505	-116.5455735	Riverside County
252709	Fee-for-Service	1407850498	1407850498	1	1	DE ROUCHEY, LOUIS E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	47801	08	Family Practice	0	In state provider	None	444 BRUCE ST	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
252729	Fee-for-Service	1952860033	1952860033	1	1	DJRI HEALTH INC	3/26/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8555 AERO DR	STE 308	SAN DIEGO	CA	92123	1745	37	06073	32.80957998	-117.143477	San Diego County
252734	Fee-for-Service	1073873501	1073873501	1	1	DURNAN, CASSANDRA CCC-SLP	10/19/2023	2355S0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
252741	Fee-for-Service	1205010824	1205010824	2	1	DIAMOND GARDEN HOME CARE INC	4/24/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15319 SPINNING AVENUE	None	GARDENA	CA	90249	4866	19	06037	33.89187483	-118.3188687	Los Angeles County
252750	Fee-for-Service	1013545441	1013545441	1	1	DAS, ANUSHKA MD	7/2/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187389	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
252806	Fee-for-Service	1962903161	1962903161	1	1	DISCOVER HOPE MARRIAGE & FAM	5/3/2024	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPY INC	1650 OREGON ST	STE 216	REDDING	CA	96001	1757	45	06089	40.58198408	-122.3937903	Shasta County
252808	Fee-for-Service	1043398787	1043398787	1	1	DORFMAN, STEVEN MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60558	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
252849	Fee-for-Service	1437196813	1437196813	2	1	DIGNITY HEALTH	12/31/2005	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3400 DATA DR	None	RANCHO CORDOVA	CA	95670	7956	34	06067	38.584575	-121.294782	Sacramento County
252856	Fee-for-Service	1124409438	1124409438	1	1	DE KEYSER, ROBERTA EIMILE M	8/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	138653	77	Infectious Disease	0	In state provider	D	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
252870	Fee-for-Service	1538374525	1538374525	1	1	DAGERMANGY, DEAN E MD	8/21/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	94885	15	Obstetrics (D.O. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
252878	Fee-for-Service	1922539808	1922539808	1	1	DAOUD-GRAY, ADAM I MD	8/30/2021	207L00000X	NA	Other	026	PHYSICIANS	159381	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
252897	Fee-for-Service	1811473929	1811473929	1	1	DAVID BAILEY	2/28/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
252915	Fee-for-Service	1053317545	1053317545	1	1	DESANTIS, NICHOLAS N DPM	3/16/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	2306 6TH AVE	None	SAN DIEGO	CA	92101	1643	37	06073	32.72942583	-117.1594896	San Diego County
252917	Fee-for-Service	1043456106	1043456106	1	2	DIGNITY HEALTH MEDICAL FOUND	10/25/2010	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FOUNDATION	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
252969	Fee-for-Service	1437143872	1437143872	1	1	DR. SUKHDEEP S PADDA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20100 N 51ST AVE	STE F620	GLENDALE	AZ	85308	5084	00	None	33.666507	-112.1696865	Maricopa County
252982	Fee-for-Service	1194755363	1194755363	1	3	DICKSON, KIMBERLY K S MD	11/8/2017	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	7995	02	General Surgery	0	In state provider	None	1940 EL CAJON BLVD	None	SAN DIEGO	CA	92104	1005	37	06073	32.75537745	-117.1446525	San Diego County
252994	Fee-for-Service	1285990671	1285990671	1	1	DOWNING, JOHNATHON E MD	1/17/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148366	None	None	0	In state provider	None	1045 W REDONDO BEACH BLV	STE 400	GARDENA	CA	90247	4180	19	06037	33.89247044	-118.2931941	Los Angeles County
253019	Fee-for-Service	1952860033	1952860033	1	1	DJRI HEALTH INC	3/26/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8555 AERO DR	STE 308	SAN DIEGO	CA	92123	1745	37	06073	32.80957998	-117.143477	San Diego County
253032	Fee-for-Service	1417024654	1417024654	1	1	DORMADY, SHANE P MD	1/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87232	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
253039	Fee-for-Service	1568526861	1568526861	1	1	DEVANEY, BARBARA J LMFT	5/21/2015	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3637 SACRAMENTO ST	SUITE G	SAN FRANCISCO	CA	94118	1726	38	06075	37.78743747	-122.4526382	San Francisco County
253095	Fee-for-Service	1962903161	1962903161	1	1	DISCOVER HOPE MARRIAGE & FAM	5/3/2024	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ILY THERAPY INC	1650 OREGON ST	STE 216	REDDING	CA	96001	1757	45	06089	40.58198408	-122.3937903	Shasta County
253097	Fee-for-Service	1043398787	1043398787	1	1	DORFMAN, STEVEN MD	10/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	60558	40	Pediatrics	0	In state provider	None	2525 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
253113	Fee-for-Service	1689902496	1689902496	1	1	DELMAR, LAURA G LCSW	7/16/2019	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	36	06071	34.09544496	-117.5747968	San Bernardino County
253126	Fee-for-Service	1477623585	1477623585	1	1	DABRAL, MUDIT MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40705	41	Internal Medicine	0	In state provider	None	1505 SHEPARD DR	STE 105	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
253158	Fee-for-Service	1538374525	1538374525	1	1	DAGERMANGY, DEAN E MD	8/21/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	94885	09	Gynecology (D.O. only)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
253204	Fee-for-Service	1043456106	1043456106	1	2	DIGNITY HEALTH MEDICAL FOUND	10/25/2010	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	FOUNDATION	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
253223	Fee-for-Service	1215715966	1215715966	1	1	DO, JAINA R PT	9/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14682 CENTRAL AVE	None	CHINO	CA	91710	9505	36	06071	33.986601	-117.689039	San Bernardino County
253253	Fee-for-Service	1417450149	1417450149	1	1	DICHUPA, IRIS J	5/29/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
253285	Fee-for-Service	1932173481	1932173481	1	1	DVA HEALTHCARE RENAL	1/27/1986	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1211 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4234	19	06037	34.18890152	-118.319797	Los Angeles County
253298	Fee-for-Service	1417953878	1417953878	1	3	DIABLO VALLEY ONCOLOGY	7/23/2012	208800000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5401 NORRIS CANYON ROAD	SUITE 108	SAN RAMON	CA	94583	5406	07	06013	37.77752374	-121.9579277	Contra Costa County
253353	Fee-for-Service	1831536390	1831536390	1	1	DURSTENFELD, ANNE L MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	124824	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
253371	Fee-for-Service	1255489084	1255489084	1	1	DELINE, BERNICE R MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42291	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
253414	Fee-for-Service	1477623585	1477623585	1	1	DABRAL, MUDIT MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	40705	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1505 SHEPARD DR	STE 105	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
253434	Fee-for-Service	1316900236	1316900236	1	1	DANDILLAYA, RAMPRASAD C	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77410	None	None	0	In state provider	MD	150 N ROBERTSON BLVD	STE 115	BEVERLY HILLS	CA	90211	2121	19	06037	34.06812722	-118.3837146	Los Angeles County
253442	Fee-for-Service	1811087109	1811087109	1	1	DORKIN, GEORGINA NP	10/17/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
253445	Fee-for-Service	1851469852	1851469852	1	1	DHRUVA ANAND A MD	5/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81478	68	Hematology	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
253456	Fee-for-Service	1629332614	1629332614	1	1	DON SON MD INC	12/4/2012	261QP2300X	NA	Other	026	PHYSICIANS	121306	None	None	0	In state provider	None	408 S BEACH BLVD	STE 206	ANAHEIM	CA	92804	1853	30	06059	33.82709101	-117.9932293	Orange County
253459	Fee-for-Service	1003311747	1003311747	1	1	DISTASO, CASEY MD	6/10/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
253473	Fee-for-Service	1962817569	1962817569	1	1	DORFMAN, ERICA J MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141985	01	General Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
253493	Fee-for-Service	1043456106	1043456106	1	2	DIGNITY HEALTH MEDICAL FOUND	10/25/2010	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	FOUNDATION	280 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
253618	Fee-for-Service	1982773560	1982773560	1	1	DEBNATH, SHELIA MD	5/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	41650	40	Pediatrics	0	In state provider	None	1220 S CENTRAL AVE	STE 105	GLENDALE	CA	91204	3808	19	06037	34.131447	-118.2577905	Los Angeles County
253659	Fee-for-Service	1255489084	1255489084	1	1	DELINE, BERNICE R MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42291	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
253663	Fee-for-Service	1669004271	1669004271	1	1	DIEBEL, JOSHU C PT	4/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1201 23RD ST	None	BAKERSFIELD	CA	93301	2306	15	06029	35.38001554	-119.015649	Kern County
253719	Fee-for-Service	1083034466	1083034466	1	1	DUKOVICH, CAMPBELL R	9/25/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	151 N SUNRISE AVE	SUITE 1105	ROSEVILLE	CA	95661	2924	31	06061	38.74746043	-121.2655348	Placer County
253734	Fee-for-Service	1851469852	1851469852	1	1	DHRUVA ANAND A MD	5/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81478	41	Internal Medicine	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
253738	Fee-for-Service	1043456106	1043456106	1	9	DIGNITY HEALTH MEDICAL FOUND	9/15/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	-SIERRA NEVADA	360 SIERRA COLLEGE DR	STE 120	GRASS VALLEY	CA	95945	5088	29	06057	39.23622963	-121.0549676	Nevada County
253774	Fee-for-Service	1457315269	1457315269	1	1	DONALDSON, THOMAS K MD	9/30/1988	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	55682	20	Orthopedic Surgery	0	In state provider	None	900 EAST WASHINGTON	SUITE 200	COLTON	CA	92324	4192	36	06071	34.04820662	-117.3128102	San Bernardino County
253792	Fee-for-Service	1396128443	1396128443	1	1	DSY PHARMACY INC	12/25/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9171 WILSHIRE BLVD	STE B	BEVERLY HILLS	CA	90210	5560	19	06037	34.06708753	-118.391751	Los Angeles County
253799	Fee-for-Service	1205382108	1205382108	1	1	DEGUZMAN, VICTORIA C	7/14/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
253804	Fee-for-Service	1437707155	1437707155	1	1	DOCTOR'S CHOICE HOSPICE	6/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE INC	3434 TRUXTUN AVE	SUITE 271	BAKERSFIELD	CA	93301	3044	15	06029	35.37393792	-119.0422332	Kern County
253839	Fee-for-Service	1528044781	1528044781	1	1	DANGLEIS, KEITH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY IMAGING ASSOCI	4021 AVE B	None	SCOTTSBLUFF	NE	69361	4602	00	None	41.886845	-103.6658169	Scotts Bluff County
253843	Fee-for-Service	1740280882	1740280882	1	1	DELUCCA, MANNY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3929 E BELL RD	None	PHOENIX	AZ	85032	2112	00	None	33.639579	-111.996918	Maricopa County
253872	Fee-for-Service	1437116902	1437116902	1	1	DAN PATRICK GARWOOD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
253901	Fee-for-Service	1699270603	1699270603	1	1	DHILLON, SHABNAM MD	7/22/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	67	Endocrinology	0	In state provider	None	7230 N MILLBROOK AVE	None	FRESNO	CA	93720	3340	10	06019	36.84059039	-119.7656456	Fresno County
253993	Fee-for-Service	1801848452	1801848452	1	1	DESERT VALLEY MEDICAL GROUP,	10/1/1995	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
254021	Fee-for-Service	1851469852	1851469852	1	1	DHRUVA ANAND A MD	5/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81478	78	Neoplastic Diseases/Oncology	0	In state provider	None	1015 E MAIN ST	None	TURLOCK	CA	95380	3406	50	06099	37.50297054	-120.8343858	Stanislaus County
254090	Fee-for-Service	1356389183	1356389183	1	1	DESAI, GOPI D MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62875	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
254143	Fee-for-Service	1053483289	1053483289	1	1	DE LA CERNA, JAIME F MD	8/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	32749	41	Internal Medicine	0	In state provider	VISALIA COMM MED PLAZA	100 WILLOW PLZ	STE 210	VISALIA	CA	93291	6213	54	06107	36.328527	-119.292885	Tulare County
254192	Fee-for-Service	1699270603	1699270603	1	1	DHILLON, SHABNAM MD	7/22/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7230 N MILLBROOK AVE	None	FRESNO	CA	93720	3340	10	06019	36.84059039	-119.7656456	Fresno County
254198	Fee-for-Service	1407135940	1407135940	1	1	DEHAL, AHMED N MD	5/21/2018	208600000X	NA	General Surgery	026	PHYSICIANS	128057	02	General Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
254240	Fee-for-Service	1164982070	1164982070	1	1	DELANEY, CODY M DO	5/25/2022	207R00000X	NA	Other	026	PHYSICIANS	19507	None	None	0	In state provider	None	320 SANTA FE DRIVE	107-B	ENCINITAS	CA	92024	1334	37	06073	33.038847	-117.285579	San Diego County
254284	Fee-for-Service	1801848452	1801848452	1	1	DESERT VALLEY MEDICAL GROUP,	9/17/2020	207LP2900X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
254303	Fee-for-Service	1063616563	1063616563	2	1	DIVINE CARE HOME HEALTH	1/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1716 ERRINGER RD	SUITE 106	SIMI VALLEY	CA	93065	6527	56	06111	34.26903	-118.7613725	Ventura County
254346	Fee-for-Service	1063547461	1063547461	1	1	DEL POZO, SCHONZE F MD	12/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	123040	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
254383	Fee-for-Service	1932158748	1932158748	1	1	DANTI, JOANNE	6/26/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9132 CALDER WAY	None	SACRAMENTO	CA	95824	4123	34	06067	38.557575	-121.3621335	Sacramento County
254384	Fee-for-Service	1992999221	1992999221	1	1	DESERT COMMUNITIES	7/16/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION SERVICES	58923 BUSINESS CENTER DR	STE I	YUCCA VALLEY	CA	92284	7311	36	06071	34.12184824	-116.3781018	San Bernardino County
254403	Fee-for-Service	1134367691	1134367691	1	1	DAVID CONRAD LAWRY	4/1/2011	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11750 N DEVRIES ROAD	None	LODI	CA	95242	9512	39	06077	38.077416	-121.344228	San Joaquin County
254425	Fee-for-Service	1932718806	1932718806	1	1	DUPRE, REBECCA N CCC-SLP	7/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
254427	Fee-for-Service	1417498858	1417498858	1	1	DOERMANN, ALEX J MD	8/1/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	158164	None	None	0	In state provider	None	2323 DE LA VINA ST	STE 201	SANTA BARBARA	CA	93105	3879	42	06083	34.43202913	-119.7212339	Santa Barbara County
254443	Fee-for-Service	1407882947	1407882947	1	1	DELEVE, LAURIE D MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44134	10	Gastroenterology (M.D. only)	0	In state provider	None	1510 SAN PABLO ST	STE 451	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
254448	Fee-for-Service	1205410933	1205410933	1	1	DOCTORNOW	2/2/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	9335 RESEDA BLVD	STE 100A	NORTHRIDGE	CA	91324	2968	19	06037	34.24019062	-118.5361007	Los Angeles County
254455	Fee-for-Service	1003394057	1003394057	1	1	DALWADI FAMILY EYE CARE INC	2/21/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 INLAND CENTER DR	None	SAN BERNARDINO	CA	92408	1956	36	06071	34.08959257	-117.2965002	San Bernardino County
254458	Fee-for-Service	1336588870	1336588870	1	3	DIGNITY HEALTH	7/9/2015	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2480 SONOMA STREET	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
254482	Fee-for-Service	1104997683	1104997683	1	1	DEOROSAN, VERRETTA MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	73639	08	Family Practice	0	In state provider	None	11502 S VERMONT AVE	None	LOS ANGELES	CA	90044	6522	19	06037	33.929928	-118.291572	Los Angeles County
254492	Fee-for-Service	1740518547	1740518547	1	1	DOAN, LIEN N MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110184	30	Radiology	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
254509	Fee-for-Service	1598764193	1598764193	1	1	DAUGHTERS, KENNETH R MD	6/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74865	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
254536	Fee-for-Service	1588164446	1588164446	1	1	DUBIANSKY, JENNA M PT	12/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	521 E ELDER ST	SUITE 106/107	FALLBROOK	CA	92028	3081	37	06073	33.38015149	-117.246267	San Diego County
254551	Fee-for-Service	1861995276	1861995276	1	1	DANIEL J OFFIELD, MARRIAGE	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY THERAPIST, A	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
254568	Fee-for-Service	1801848452	1801848452	1	1	DESERT VALLEY MEDICAL GROUP,	6/22/2020	207LP2900X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
254642	Fee-for-Service	1235302514	1235302514	1	1	DAVIS, AIMEE C	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
254662	Fee-for-Service	1639193659	1639193659	1	1	DUNHAM, CHRISTOPHER MD	11/1/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	83339	36	Psychiatry	0	In state provider	None	37 QUAIL CT	STE 200	WALNUT CREEK	CA	94596	5593	07	06013	37.88807861	-122.0553842	Contra Costa County
254689	Fee-for-Service	1821354200	1821354200	1	1	DIYA, OMOLADE M MD	6/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128419	01	General Practice	0	In state provider	None	1805 E FIR AVE	STE 104	FRESNO	CA	93720	3859	10	06019	36.83911347	-119.749869	Fresno County
254691	Fee-for-Service	1134367691	1134367691	1	1	DAVID CONRAD LAWRY	4/1/2011	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11750 N DEVRIES ROAD	None	LODI	CA	95242	9512	39	06077	38.077416	-121.344228	San Joaquin County
254701	Fee-for-Service	1508509316	1508509316	1	1	DAL PONTE, JENNIFER	4/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
254724	Fee-for-Service	1407882947	1407882947	1	1	DELEVE, LAURIE D MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44134	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	STE 451	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
254756	Fee-for-Service	1841401445	1841401445	1	1	DALEY, CHRISTOPHER T MD	4/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	96463	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
254764	Fee-for-Service	1144582776	1144582776	1	1	DAVILA WILLIAMS, DANIEL MD	8/1/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
254769	Fee-for-Service	1104997683	1104997683	1	1	DEOROSAN, VERRETTA MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	73639	41	Internal Medicine	0	In state provider	None	11502 S VERMONT AVE	None	LOS ANGELES	CA	90044	6522	19	06037	33.929928	-118.291572	Los Angeles County
254839	Fee-for-Service	1861995276	1861995276	1	1	DANIEL J OFFIELD, MARRIAGE	11/30/2020	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY THERAPIST, A	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
254858	Fee-for-Service	1801848452	1801848452	1	1	DESERT VALLEY MEDICAL GROUP,	3/28/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
254903	Fee-for-Service	1679779870	1679779870	1	1	DE LOS SANTOS, IRENE D	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
254987	Fee-for-Service	1316381650	1316381650	1	1	DIXIT, AMAR MD	11/24/2020	207K00000X	NA	Other	026	PHYSICIANS	169117	03	Allergy	0	In state provider	None	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	33	06065	33.92940576	-116.9437965	Riverside County
255045	Fee-for-Service	1518978295	1518978295	1	1	DALE, WILLIAM MD	9/7/2017	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	150617	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
255061	Fee-for-Service	1235426636	1235426636	1	1	DESAI, VIMAL N MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136802	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
255063	Fee-for-Service	1487824579	1487824579	1	1	DELANEY, ALEXANDER P MD	9/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
255084	Fee-for-Service	1225353493	1225353493	1	1	DIGESTIVE HEALTH SPECIALISTS	7/26/2011	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	INC	1045 ATLANTIC AVENUE	SUITE 907	LONG BEACH	CA	90813	3416	19	06037	33.780267	-118.1850795	Los Angeles County
255092	Fee-for-Service	1780048991	1780048991	1	1	DANESHJOU, ROXANA R MD	6/10/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	150351	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
255094	Fee-for-Service	1710159447	1710159447	1	1	DASCALOS, JANE M MD	5/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88728	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
255127	Fee-for-Service	1861995276	1861995276	1	1	DANIEL J OFFIELD, MARRIAGE	11/5/2020	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	AND FAMILY THERAPIST, A	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
255144	Fee-for-Service	1801848452	1801848452	1	1	DESERT VALLEY MEDICAL GROUP,	8/8/2023	207LP2900X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
255153	Fee-for-Service	1356776603	1356776603	1	1	DICKERSON, NINA L	6/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30131 TOWN CENTER DR	STE 235	LAGUNA NIGUEL	CA	92677	2033	30	06059	33.52530096	-117.7148334	Orange County
255165	Fee-for-Service	1053754671	1053754671	1	1	DEGUCHY, QURIENO JR MD	4/16/2020	390200000X	NA	Other	026	PHYSICIANS	145262	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
255170	Fee-for-Service	1174875827	1174875827	1	1	DAVIDSON, SHANNON N CRNA	12/10/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	444 BRUCE STREET	None	YREKA	CA	96097	3450	47	06093	41.71863548	-122.6458755	Siskiyou County
255209	Fee-for-Service	1780684639	1780684639	1	1	DALLE, JOHN G DO	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	8441	None	None	0	In state provider	None	81719 DR CARREON BLVD	STE D	INDIO	CA	92201	5518	33	06065	33.70738353	-116.2386945	Riverside County
255265	Fee-for-Service	1285681122	1285681122	1	1	DAVIS, MARIA L MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60113	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
255273	Fee-for-Service	1740579796	1740579796	1	1	DOBROWOLSKY, ADRIAN B MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140117	02	General Surgery	0	In state provider	None	1450 SAN PABLO STREET	SUITE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
255298	Fee-for-Service	1265454201	1265454201	1	1	DING, WEI MD	7/6/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
255319	Fee-for-Service	1992921449	1992921449	1	2	DASARI, ARAVIND MD	9/21/2019	207P00000X	NA	Other	026	PHYSICIANS	97793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	57	06113	38.664027	-121.7933505	Yolo County
255320	Fee-for-Service	1427678127	1427678127	1	1	DOLLINGER, DANIELLE G PSYD	8/15/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
255337	Fee-for-Service	1629463484	1629463484	1	1	DOWNEY, AMANDA E MD	8/10/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	168899	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
255359	Fee-for-Service	1427053735	1427053735	1	1	DONALD R. SANTELLA, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	211 CHURCH ST	None	SARATOGA SPGS	NY	12866	1003	00	None	43.0857	-73.797057	Saratoga County
255397	Fee-for-Service	1093893786	1093893786	1	1	DUNLAP, STEVEN D MD	11/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	49886	41	Internal Medicine	0	In state provider	None	105 CATHERINE LN	None	GRASS VALLEY	CA	95945	5705	29	06057	39.23007785	-121.047319	Nevada County
255409	Fee-for-Service	1639752553	1639752553	1	6	DISPATCHHEALTH-CA, PC	2/20/2024	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
255429	Fee-for-Service	1679634406	1679634406	1	1	DUDAREWICZ, TERESA M MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65431	08	Family Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
255434	Fee-for-Service	1801848452	1801848452	1	1	DESERT VALLEY MEDICAL GROUP,	11/25/2019	207LP2900X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
255438	Fee-for-Service	1245307131	1245307131	1	1	DESAI, SUJATA K MD	4/30/1991	207R00000X	NA	Other	026	PHYSICIANS	47703	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
255463	Fee-for-Service	1205941481	1205941481	1	1	DRAKE, DAVID J MD	3/11/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166230	08	Family Practice	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
255554	Fee-for-Service	1285681122	1285681122	1	1	DAVIS, MARIA L MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60113	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
255573	Fee-for-Service	1558651000	1558651000	1	1	DANG, BINH N MD	5/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123574	41	Internal Medicine	0	In state provider	None	1499 WEST FIRST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
255586	Fee-for-Service	1265454201	1265454201	1	1	DING, WEI MD	7/6/2024	207RH0000X	NA	Hematology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
255660	Fee-for-Service	1508165598	1508165598	1	1	DAVID MICHAEL LUCAS MD	12/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
255666	Fee-for-Service	1194014415	1194014415	1	1	DROCTON, GERALD T MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153764	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
255697	Fee-for-Service	1639752553	1639752553	1	6	DISPATCHHEALTH-CA, PC	1/12/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
255843	Fee-for-Service	1487855367	1487855367	1	1	DAS, SNIGDHA MD	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78893	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
255870	Fee-for-Service	1225618622	1225618622	1	1	DASH, SWETALEENA MD	7/16/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
255901	Fee-for-Service	1457523060	1457523060	1	1	DYER, LINDA K	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
255917	Fee-for-Service	1649418351	1649418351	1	1	DRUGSCAN, INC.	11/21/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	200 PRECISION RD	SUITE 200	HORSHAM	PA	19044	1227	00	None	40.19018092	-75.1553278	Montgomery County
255946	Fee-for-Service	1396222949	1396222949	1	1	DUVAUCHELLE, LEILANI A LMFT	1/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
255955	Fee-for-Service	1033890447	1033890447	1	1	DOVE, CASSIE A LMFT	5/29/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	110732	-	NOT APPLICABLE	0	In state provider	None	2049 SKYLINE DR	None	LEMON GROVE	CA	91945	4221	37	06073	32.72729271	-117.0254695	San Diego County
255961	Fee-for-Service	1932726114	1932726114	1	1	DATTA, SATHI NP	1/19/2024	163WP0809X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
255968	Fee-for-Service	1053435891	1053435891	1	1	DELANO COMM HEALTH CTR	10/1/1995	261QM2500X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1508 GARCES HWY	None	DELANO	CA	93215	3687	15	06029	35.76141641	-119.2369096	Kern County
256022	Fee-for-Service	1710157920	1710157920	1	1	DELANEY, MICHAEL W MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146015	13	Neurology (M.D. only)	0	In state provider	None	6010 HIDDEN VALLEY ROAD	STE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
256111	Fee-for-Service	1699745539	1699745539	1	1	DR. MARK NEAGLE M.D.	9/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 ROCKY MOUNTAIN AVE	None	LOVELAND	CO	80538	9004	00	None	40.415778	-104.99715	Larimer County
256113	Fee-for-Service	1740305846	1740305846	1	2	DELTA RADIOLOGY, INC.	12/9/2019	174400000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	1031 S FAIRMONT AVE	None	LODI	CA	95240	5112	39	06077	38.12070793	-121.2858317	San Joaquin County
256130	Fee-for-Service	1346707221	1346707221	1	1	DIAZ, MARDY LINDT FIONNE	10/14/2024	207N00000X	NA	Dermatology	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	33	06065	33.4799323	-117.1033702	Riverside County
256152	Fee-for-Service	1255793378	1255793378	1	1	DASILVA, STACEY L MD	11/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154451	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
256154	Fee-for-Service	1710902622	1710902622	1	1	DONOVICK, ROGER A MD	5/1/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64431	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
256192	Fee-for-Service	1922080506	1922080506	1	1	DIEGO, SILVIA M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54944	08	Family Practice	0	In state provider	None	220 STANDIFORD AVE	STE F	MODESTO	CA	95350	1159	50	06099	37.68913027	-120.9969686	Stanislaus County
256227	Fee-for-Service	1639744303	1639744303	1	1	DHARMARPANDI, GNANASHREE MD	7/10/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
256292	Fee-for-Service	1912949850	1912949850	1	1	DETWILER, RICHARD P MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	31263	02	General Surgery	0	In state provider	APC	941 SPRING ST	STE 1	PLACERVILLE	CA	95667	4546	09	06017	38.73242647	-120.801216	El Dorado County
256311	Fee-for-Service	1245390228	1245390228	1	1	DIVI, VENU MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	55612	04	Otology, Laryngology, Rhinology	0	In state provider	None	350 W 5TH ST	STE 209	SAN PEDRO	CA	90731	2752	19	06037	33.73971779	-118.2852574	Los Angeles County
256323	Fee-for-Service	1851746150	1851746150	1	1	DORRELL, JENNIFER M LCSW	1/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
256333	Fee-for-Service	1700961927	1700961927	1	1	DIAGNOSTIC PATHOLOGY	2/28/1991	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	MEDICAL GROUP INC	2000 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
256339	Fee-for-Service	1932424793	1932424793	1	1	DIAZ, DIANA M MD	7/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118500	05	Anesthesiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
256429	Fee-for-Service	1215177092	1215177092	1	1	DESAI, SUMBUL A MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112827	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
256454	Fee-for-Service	1912330861	1912330861	1	1	DAVIS-BOOZER, DAVID L MD	4/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191430	08	Family Practice	0	In state provider	None	5100 W GOLDLEAF CIR	200	LOS ANGELES	CA	90056	1658	19	06037	33.98872349	-118.3661021	Los Angeles County
256484	Fee-for-Service	1730247057	1730247057	1	1	DAVID C NG, DPM INC	6/9/2006	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1333 E THOUSAND OAKS BLV	STE 108	THOUSAND OAKS	CA	91362	6271	56	06111	34.17831141	-118.8566489	Ventura County
256525	Fee-for-Service	1932172038	1932172038	1	1	DOUCETTE, MARK A. MD	12/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	340 PEAK ONE DRIVE	None	FRISCO	CO	80443	0000	00	None	39.57003029	-106.0781094	Summit County
256532	Fee-for-Service	1336233758	1336233758	1	1	DIAMOND, DANIEL AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1326 ROBBINS ST	None	SANTA BARBARA	CA	93101	4729	42	06083	34.41453628	-119.7179647	Santa Barbara County
256537	Fee-for-Service	1891776399	1891776399	1	1	DR. ANTHONY C PICCHIELLO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NEUROLOGY&PAIN RELIEF	3951 S NOVA RD	None	PORT ORANGE	FL	32127	0000	00	None	29.11866889	-80.99889747	Volusia County
256550	Fee-for-Service	1528285087	1528285087	1	2	DE LA TORRE, JAMES E MD	3/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93460	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
256583	Fee-for-Service	1912949850	1912949850	1	1	DETWILER, RICHARD P MD	1/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	31263	01	General Practice	0	In state provider	APC	941 SPRING ST	STE 1	PLACERVILLE	CA	95667	4546	09	06017	38.73242647	-120.801216	El Dorado County
256598	Fee-for-Service	1518302389	1518302389	1	1	DUKE, SARAH E MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141892	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
256608	Fee-for-Service	1649289976	1649289976	1	1	DELVICARIO, MICHELE MD	4/28/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	24434	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3475 TORRANCE BLVD	STE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
256625	Fee-for-Service	1407602469	1407602469	1	1	DELGADO, MARIA E AU	6/12/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1820 MARRON RD	STE 102	CARLSBAD	CA	92008	1177	37	06073	33.17711559	-117.3396763	San Diego County
256701	Fee-for-Service	1154795912	1154795912	1	1	DELAIRE CHIROPRACTIC CLINIC	11/25/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	INC	27620 LANDAU BLVD	STE 1	CATHEDRAL CITY	CA	92234	5540	33	06065	33.84709854	-116.4757864	Riverside County
256740	Fee-for-Service	1245446244	1245446244	1	1	DEFRANCISCI, RICHARD P	11/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	46388	20	Orthopedic Surgery	0	In state provider	MD INC	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
256765	Fee-for-Service	1508910589	1508910589	1	1	DODGE, ROBERT F MD	7/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43925	01	General Practice	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
256781	Fee-for-Service	1871591743	1871591743	1	1	DUTTON, SHARON C MD	7/27/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86117	None	None	0	In state provider	None	1 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
256797	Fee-for-Service	1780625160	1780625160	1	1	DALEO, JEANNINE M LMFT	10/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
256887	Fee-for-Service	1043456106	1043456106	1	8	DIGNITY HEALTH MEDICAL FOUND	3/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	-SIERRA NEVADA	107 MARGARET LN	None	GRASS VALLEY	CA	95945	5211	29	06057	39.22931377	-121.0463561	Nevada County
256897	Fee-for-Service	1649289976	1649289976	1	1	DELVICARIO, MICHELE MD	4/28/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	24434	41	Internal Medicine	0	In state provider	None	3475 TORRANCE BLVD	STE A	TORRANCE	CA	90503	5800	19	06037	33.83762089	-118.3467904	Los Angeles County
256910	Fee-for-Service	1659459717	1659459717	1	1	DINSTELL, STEVEN MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	38957	40	Pediatrics	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
256937	Fee-for-Service	1427407832	1427407832	1	1	DERRICK, MELISSA G NP	6/28/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16412 LOS GATOS BLVD	None	LOS GATOS	CA	95032	5525	43	06085	37.23046706	-121.9654506	Santa Clara County
256939	Fee-for-Service	1366459208	1366459208	1	1	DARWISH, RIAD MD	4/1/1983	207R00000X	NA	Other	026	PHYSICIANS	36607	41	Internal Medicine	0	In state provider	None	8235 PAINTER AVE	# 205	WHITTIER	CA	90602	3108	19	06037	33.963831	-118.0327295	Los Angeles County
256953	Fee-for-Service	1073970034	1073970034	1	1	DIAMOND, TERI Z MD	11/17/2017	207L00000X	NA	Other	026	PHYSICIANS	132054	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
256967	Fee-for-Service	1316147986	1316147986	1	1	DE, INDRA MD INC	6/26/2007	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	52396	41	Internal Medicine	0	In state provider	None	2333 W MARCH LN	STE A1	STOCKTON	CA	95207	5263	39	06077	37.98543037	-121.3365306	San Joaquin County
256972	Fee-for-Service	1346435245	1346435245	1	1	DHIYA, SABA L MD	4/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136484	05	Anesthesiology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
256976	Fee-for-Service	1366704777	1366704777	1	1	DLUGOS, SCOTT E MD INC	2/11/2019	193400000X	NA	Other	026	PHYSICIANS	77449	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
257023	Fee-for-Service	1043338411	1043338411	1	1	DE LA ROSA, MONICA LCSW	1/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
257032	Fee-for-Service	1679063127	1679063127	1	1	DEL JUNCO, MICHAEL A MD	7/30/2021	207R00000X	NA	Other	026	PHYSICIANS	173376	None	None	0	In state provider	None	1140 W LA VETA AVE	STE 520	ORANGE	CA	92868	4227	30	06059	33.7802984	-117.8651669	Orange County
257057	Fee-for-Service	1588839419	1588839419	1	1	DAN I SRAOW MD	12/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 E SOUTHERN AVE	STE I1	TEMPE	AZ	85282	7738	00	None	33.393357	-111.8821365	Maricopa County
257138	Fee-for-Service	1316213382	1316213382	1	1	DAVIS, KELLY F MD	8/3/2016	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	120241	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
257175	Fee-for-Service	1043456106	1043456106	1	8	DIGNITY HEALTH MEDICAL FOUND	3/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	-SIERRA NEVADA	107 MARGARET LN	None	GRASS VALLEY	CA	95945	5211	29	06057	39.22931377	-121.0463561	Nevada County
257215	Fee-for-Service	1699035113	1699035113	1	1	DAVID WARNICK MD	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1485 S HIGHWAY 40	STE G	HEBER CITY	UT	84032	3522	00	None	40.490019	-111.4061895	Wasatch County
257233	Fee-for-Service	1407915234	1407915234	1	1	DEYO, MELISSA D	1/24/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
257235	Fee-for-Service	1043456106	1043456106	1	5	DIGNITY HEALTH MEDICAL FOUND	8/18/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	FOUNDATION	150 CATHERINE LANE	STE D	GRASS VALLEY	CA	95945	5719	29	06057	39.22894557	-121.0489578	Nevada County
257241	Fee-for-Service	1215317599	1215317599	1	1	DEVISSER, MICHAEL MD	3/1/2022	207P00000X	NA	Other	026	PHYSICIANS	160125	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
257246	Fee-for-Service	1235593260	1235593260	1	1	DR TED Y FISHER A PROFESSION	4/20/2020	261QM2500X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	NTRE	628 G ST	None	BRAWLEY	CA	92227	2544	13	06025	32.97749348	-115.531407	Imperial County
257258	Fee-for-Service	1316147986	1316147986	1	1	DE, INDRA MD INC	6/26/2007	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	52396	77	Infectious Disease	0	In state provider	None	2333 W MARCH LN	STE A1	STOCKTON	CA	95207	5263	39	06077	37.98543037	-121.3365306	San Joaquin County
257277	Fee-for-Service	1689019812	1689019812	1	1	DOMBECK, MARK J PHD	2/12/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
257282	Fee-for-Service	1598173502	1598173502	1	1	DERMTECH OPERATIONS, INC.	11/11/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	12340 EL CAMINO REAL	None	SAN DIEGO	CA	92130	3078	37	06073	32.94083435	-117.2403423	San Diego County
257324	Fee-for-Service	1962476499	1962476499	1	1	DVA RENAL HEALTHCARE INC	1/14/2004	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	6090 W RAMSEY ST	None	BANNING	CA	92220	3052	33	06065	33.92920077	-116.9435302	Riverside County
257400	Fee-for-Service	1497998991	1497998991	1	1	DUGAL, BRIAN	11/29/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
257436	Fee-for-Service	1093087074	1093087074	1	1	DELGADO, SARAH A LMFT	1/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5861 PINE AVE	SUITE B-6	CHINO HILLS	CA	91709	6540	36	06071	33.94759807	-117.6760557	San Bernardino County
257444	Fee-for-Service	1255383188	1255383188	1	1	DESERT FAMILY PRACTICE	3/29/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	11919 HESPERIA RD	None	HESPERIA	CA	92345	1855	36	06071	34.46759507	-117.2925837	San Bernardino County
257462	Fee-for-Service	1043456106	1043456106	1	8	DIGNITY HEALTH MEDICAL FOUND	3/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	-SIERRA NEVADA	107 MARGARET LN	None	GRASS VALLEY	CA	95945	5211	29	06057	39.22931377	-121.0463561	Nevada County
257607	Fee-for-Service	1326244062	1326244062	1	1	DE LA LLANA, JOSE A MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101657	01	General Practice	0	In state provider	None	19341 BEAR VALLEY RD	STE 105	APPLE VALLEY	CA	92308	5152	36	06071	34.47101125	-117.2412548	San Bernardino County
257635	Fee-for-Service	1629043583	1629043583	1	1	DVA HEALTHCARE RENAL CARE	8/1/1997	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	600 N 13TH AVE	None	UPLAND	CA	91786	4957	36	06071	34.10113004	-117.6336234	San Bernardino County
257671	Fee-for-Service	1477703650	1477703650	1	1	DUGAN, CHERYL A LMFT	8/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
257733	Fee-for-Service	1255383188	1255383188	1	1	DESERT FAMILY PRACTICE	3/29/1991	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	11919 HESPERIA RD	None	HESPERIA	CA	92345	1855	36	06071	34.46759507	-117.2925837	San Bernardino County
257796	Fee-for-Service	1821129818	1821129818	1	1	DESPRES, JENNIFER N CNM	8/8/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
257834	Fee-for-Service	1588746887	1588746887	1	1	DESERT P & O GROUP LTD	11/2/1993	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	68860 PEREZ RD	STE G	CATHEDRAL CITY	CA	92234	7248	33	06065	33.78351921	-116.4604447	Riverside County
257866	Fee-for-Service	1922357110	1922357110	1	1	DEL CASTILLO GARCIA, MARIA A	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143515	41	Internal Medicine	0	In state provider	MD	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
257953	Fee-for-Service	1538498340	1538498340	1	1	DUBNER, REBECCA PSYD	5/9/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
257962	Fee-for-Service	1871969972	1871969972	1	1	DUKES, JENNIFER	4/19/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
257981	Fee-for-Service	1306103924	1306103924	1	1	DORSCHNER, ROBERT A MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128567	07	Dermatology	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
257997	Fee-for-Service	1588033773	1588033773	1	1	DR GRACE GUIMEI YAO A PROFES	10/6/2015	193400000X	NA	Other	026	PHYSICIANS	132410	None	None	0	In state provider	SIONAL CORPORATION	22 ODYSSEY	STE155	IRVINE	CA	92618	3194	30	06059	33.66719598	-117.7642461	Orange County
258011	Fee-for-Service	1487732145	1487732145	1	1	DAGHER, EDWARD I MD	4/4/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	81150	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
258025	Fee-for-Service	1235254749	1235254749	1	1	DALY, JOANNE R MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57107	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
258117	Fee-for-Service	1932545035	1932545035	1	1	DEUEL, CHRISTOPHER J MD	8/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149788	01	General Practice	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
258129	Fee-for-Service	1669476578	1669476578	1	1	DUNCAN, CHRISTAL J MD	8/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	68173	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	700 S MAIN ST	STE 2	YREKA	CA	96097	3354	47	06093	41.72616846	-122.6381326	Siskiyou County
258157	Fee-for-Service	1306814918	1306814918	1	4	DELTA PATHOLOGY ASSOC	8/4/2009	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
258204	Fee-for-Service	1144420134	1144420134	1	1	DHINGRA, NEIL MD	12/7/2010	207LP2900X	NA	Other	026	PHYSICIANS	97498	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
258227	Fee-for-Service	1295823797	1295823797	1	1	DENISE V SHUSHAN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
258344	Fee-for-Service	1790750768	1790750768	1	1	DUONG, PAUL L T MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52717	30	Radiology	0	In state provider	None	1211 W LA PALMA AVE	STE 100	ANAHEIM	CA	92801	2809	30	06059	33.84718298	-117.933758	Orange County
258366	Fee-for-Service	1679979512	1679979512	1	1	DEALBA, MARIA LMFT	3/3/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	123745	-	NOT APPLICABLE	0	In state provider	None	222 W VALERIO ST	REAR BUILDING	SANTA BARBARA	CA	93101	2930	42	06083	34.42532284	-119.7137898	Santa Barbara County
258393	Fee-for-Service	1770770257	1770770257	1	1	DHANANI, RIAZ MD	8/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96921	30	Radiology	0	In state provider	None	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
258458	Fee-for-Service	1578925087	1578925087	1	1	DELISSER, MONIQUE A MD	5/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154102	08	Family Practice	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
258476	Fee-for-Service	1699353797	1699353797	1	1	DANG, ALEX MD	9/11/2024	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
258491	Fee-for-Service	1184650921	1184650921	1	1	DREEBEN, SHARON MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67534	01	General Practice	0	In state provider	DISORDERS OF THE FOOT AN	4130 LA JOLLA VILLAGE DR	STE 300	LA JOLLA	CA	92037	1481	37	06073	32.87194345	-117.2173414	San Diego County
258502	Fee-for-Service	1710447925	1710447925	1	1	DOPP, MEENA M MD	9/27/2022	207R00000X	NA	Other	026	PHYSICIANS	177397	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
258508	Fee-for-Service	1043859523	1043859523	1	1	DHILLON, JAGJEET K PT	1/29/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
258567	Fee-for-Service	1033642574	1033642574	1	1	DOVE, KATHERINE M MD	10/16/2023	2084N0402X	NA	Neurology	026	PHYSICIANS	184759	None	None	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
258570	Fee-for-Service	1053401216	1053401216	1	1	DIETRICH, JENNIFER E MD	2/1/2022	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
258575	Fee-for-Service	1679836084	1679836084	1	6	DHP OF CALIFORNIA MEDICAL GR	11/3/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	OUP INC	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
258587	Fee-for-Service	1487785689	1487785689	1	1	DAVIS, ELIZABETH L LMFT	1/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	219 ESTATES DR	106	ROSEVILLE	CA	95678	2391	31	06061	38.74752583	-121.2723377	Placer County
258606	Fee-for-Service	1174021729	1174021729	1	2	DR. RUMANA MANSUR AND ASSOCI	11/5/2021	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ATES, A PROFESSIONAL PSY	4000 MACARTHUR BLVD	600 EAST TOWER	NEWPORT BEACH	CA	92660	2517	30	06059	33.66002304	-117.8629957	Orange County
258611	Fee-for-Service	1295021905	1295021905	1	1	DUMONTIER, STEPHEN A DO	3/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12925	01	General Practice	0	In state provider	None	58471 29 PALMS HWY	STE 303	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
258630	Fee-for-Service	1790750768	1790750768	1	1	DUONG, PAUL L T MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52717	78	Neoplastic Diseases/Oncology	0	In state provider	None	1211 W LA PALMA AVE	STE 100	ANAHEIM	CA	92801	2809	30	06059	33.84718298	-117.933758	Orange County
258753	Fee-for-Service	1164595856	1164595856	1	1	DAHL, GARY V H MD	7/31/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	57968	40	Pediatrics	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
258758	Fee-for-Service	1952302564	1952302564	1	1	DANG, AN Q MD	6/12/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	65421	45	Nephrology (Renal-Kidney)	0	In state provider	None	10495 BOLSA AVE	STE 106	WESTMINSTER	CA	92683	6762	30	06059	33.74509077	-117.9464853	Orange County
258776	Fee-for-Service	1184650921	1184650921	1	1	DREEBEN, SHARON MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67534	66	Emergency Medicine (Urgent Care)	0	In state provider	DISORDERS OF THE FOOT AN	4130 LA JOLLA VILLAGE DR	STE 300	LA JOLLA	CA	92037	1481	37	06073	32.87194345	-117.2173414	San Diego County
258782	Fee-for-Service	1043472871	1043472871	1	1	DEGRAFT-JOHNSON, JOHN MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104894	None	None	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
258831	Fee-for-Service	1467644682	1467644682	1	1	DAVIS, CHRISTY CRNA	10/24/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
258889	Fee-for-Service	1053612168	1053612168	1	1	DUBANSKY, JOSHUA P MD	11/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118968	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
258894	Fee-for-Service	1174021729	1174021729	1	2	DR. RUMANA MANSUR AND ASSOCI	8/8/2020	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ATES, A PROFESSIONAL PSY	4000 MACARTHUR BLVD	600 EAST TOWER	NEWPORT BEACH	CA	92660	2517	30	06059	33.66002304	-117.8629957	Orange County
258921	Fee-for-Service	1790750768	1790750768	1	1	DUONG, PAUL L T MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52717	01	General Practice	0	In state provider	None	1211 W LA PALMA AVE	STE 100	ANAHEIM	CA	92801	2809	30	06059	33.84718298	-117.933758	Orange County
258997	Fee-for-Service	1619061249	1619061249	1	1	DILLON, CHARLES W DC	4/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	DILLON CHIROPRACTIC	114 JOHN ST	None	SALINAS	CA	93901	3321	27	06053	36.67030069	-121.6515141	Monterey County
259040	Fee-for-Service	1215379276	1215379276	1	1	DARAMOLA, OLUWAYEMISI CNP	7/6/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
259043	Fee-for-Service	1164595856	1164595856	1	1	DAHL, GARY V H MD	7/31/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	57968	68	Hematology	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
259046	Fee-for-Service	1952302564	1952302564	1	1	DANG, AN Q MD	6/12/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	65421	41	Internal Medicine	0	In state provider	None	10495 BOLSA AVE	STE 106	WESTMINSTER	CA	92683	6762	30	06059	33.74509077	-117.9464853	Orange County
259057	Fee-for-Service	1013098177	1013098177	1	1	DREIMANE, DIANA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56108	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
259066	Fee-for-Service	1184650921	1184650921	1	1	DREEBEN, SHARON MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67534	20	Orthopedic Surgery	0	In state provider	DISORDERS OF THE FOOT AN	4130 LA JOLLA VILLAGE DR	STE 300	LA JOLLA	CA	92037	1481	37	06073	32.87194345	-117.2173414	San Diego County
259072	Fee-for-Service	1417951443	1417951443	1	1	DORN, DAVID P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 E 28TH ST	None	MINNEAPOLIS	MN	55407	3723	00	None	44.95428	-93.2614155	Hennepin County
259102	Fee-for-Service	1730467887	1730467887	1	1	DEBOER, REBECCA J MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142328	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259114	Fee-for-Service	1790012839	1790012839	1	1	DURR, MEGAN L MD	11/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110299	84	Surgery-Head and Neck	0	In state provider	None	3779 PIEDMONT AVENUE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
259142	Fee-for-Service	1437123643	1437123643	1	1	DVA RENAL HEALTHCARE INC	3/17/2003	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	770 W PINEDALE AVE	None	FRESNO	CA	93711	5744	10	06019	36.84516507	-119.8070803	Fresno County
259225	Fee-for-Service	1962673178	1962673178	1	1	DUFFIN, KATIE LCSW	9/26/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
259244	Fee-for-Service	1518496348	1518496348	1	1	DEL ROSA HOSPICE AND	7/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	2601 DEL ROSA AVE	SUITE 108	SAN BERNARDINO	CA	92404	4413	36	06071	34.13966452	-117.2523752	San Bernardino County
259290	Fee-for-Service	1710404611	1710404611	1	1	DIN, MYLA ANGELA	10/12/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5330 HARTONA WAY	None	SACRAMENTO	CA	95835	1753	34	06067	38.671506	-121.501251	Sacramento County
259335	Fee-for-Service	1861925844	1861925844	1	1	DU, FANNY H MD	7/15/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	159269	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
259345	Fee-for-Service	1013098177	1013098177	1	1	DREIMANE, DIANA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56108	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
259348	Fee-for-Service	1770808388	1770808388	1	1	DOROTHY MADSEN	6/9/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	77 HOSPITAL AVE	STE 302	NORTH ADAMS	MA	01247	2538	00	None	42.706908	-73.1091915	Berkshire County
259370	Fee-for-Service	1316266778	1316266778	1	1	DESAI, KANIKSHA S MD	12/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145417	67	Endocrinology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
259378	Fee-for-Service	1225372063	1225372063	1	1	DUONG, PAUL T MD INC	4/16/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66325	41	Internal Medicine	0	In state provider	None	9433 BOLSA AVE	SUITE A	WESTMINSTER	CA	92683	5964	30	06059	33.74498152	-117.964368	Orange County
259436	Fee-for-Service	1386776961	1386776961	1	1	DANIEL THOMPSON MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
259463	Fee-for-Service	1952544124	1952544124	1	1	DAE YONG LEE MD AMC	7/3/2009	207L00000X	NA	Other	026	PHYSICIANS	31152	05	Anesthesiology	0	In state provider	None	235 N HOOVER ST	None	LOS ANGELES	CA	90004	3627	19	06037	34.07580952	-118.283404	Los Angeles County
259475	Fee-for-Service	1780736918	1780736918	1	1	DOLISLAGER, DONNA M MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35468	40	Pediatrics	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
259502	Fee-for-Service	1831505452	1831505452	1	1	DIAZ, DAMIEN D LMFT	12/5/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
259529	Fee-for-Service	1770516288	1770516288	1	1	DARIN E NEVEN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99205	0000	00	None	47.647989	-117.4112415	Spokane County
259531	Fee-for-Service	1518496348	1518496348	1	1	DEL ROSA HOSPICE AND	7/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	2601 DEL ROSA AVE	SUITE 108	SAN BERNARDINO	CA	92404	4413	36	06071	34.13966452	-117.2523752	San Bernardino County
259533	Fee-for-Service	1710327580	1710327580	1	1	DVIVEDI, MIRA N MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140425	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
259542	Fee-for-Service	1356058952	1356058952	1	1	DOCTORS CHOICE NEMT	7/31/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	26029 CHATEAU CT	None	MORENO VALLEY	CA	92555	1772	33	06065	33.95153612	-117.2083776	Riverside County
259549	Fee-for-Service	1699919647	1699919647	1	1	DINH, VI A MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113517	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE 108	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
259577	Fee-for-Service	1710404611	1710404611	1	1	DIN, MYLA ANGELA	10/12/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5330 HARTONA WAY	None	SACRAMENTO	CA	95835	1753	34	06067	38.671506	-121.501251	Sacramento County
259582	Fee-for-Service	1265046189	1265046189	1	1	DELROSARIO, JANET RCP	2/6/2024	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
259590	Fee-for-Service	1568853547	1568853547	1	1	DILLER, LAUREN A PHD	7/24/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	333 BRADFORD	STE 270	REDWOOD CITY	CA	94063	1571	41	06081	37.48799425	-122.2320157	San Mateo County
259609	Fee-for-Service	1912940594	1912940594	1	1	DOUGLASS, LUCY M MD	10/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	90595	01	General Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
259633	Fee-for-Service	1649699661	1649699661	1	1	DEDENT, ALISON M MD	6/24/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	149343	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
259655	Fee-for-Service	1780657114	1780657114	1	1	DUENCKELMEYER, JOERG MD	7/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
259657	Fee-for-Service	1982711016	1982711016	1	1	DAYANA, ASHA MD	10/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56025	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
259689	Fee-for-Service	1609404136	1609404136	1	1	DELEON, ABIGAIL ANNE DO	12/13/2024	207R00000X	NA	Other	026	PHYSICIANS	21845	41	Internal Medicine	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
259876	Fee-for-Service	1376644955	1376644955	1	1	DAANE, STEPHEN P MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69411	24	Plastic Surgery	0	In state provider	None	2186 GEARY BLVD	STE 212	SAN FRANCISCO	CA	94115	3456	38	06075	37.78343395	-122.4392245	San Francisco County
259896	Fee-for-Service	1023028032	1023028032	1	1	DEBAETS, ELIZABETH A MD	5/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74866	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
259913	Fee-for-Service	1023038130	1023038130	1	1	DE LA FUENTE, LISA R M CNM	10/19/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
259918	Fee-for-Service	1376842898	1376842898	1	1	DARBY, ADAM J MD	5/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136681	13	Neurology (M.D. only)	0	In state provider	None	1801 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5609	19	06037	34.03012232	-118.4848095	Los Angeles County
259941	Fee-for-Service	1013229384	1013229384	1	1	DAVIDOFF, JULIA MD	9/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134646	36	Psychiatry	0	In state provider	None	760 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8631	19	06037	34.07067	-118.4432445	Los Angeles County
259994	Fee-for-Service	1093250748	1093250748	1	1	DU PONT, EDEN H NP	10/24/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
260007	Fee-for-Service	1821004847	1821004847	1	1	DRESSLER, GAIL A MD	10/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	58546	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
260037	Fee-for-Service	1114422938	1114422938	1	1	DAGUANNO, ALEXANDER W MD	11/28/2022	207P00000X	NA	Other	026	PHYSICIANS	166275	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
260051	Fee-for-Service	1124261813	1124261813	1	1	DUNN, WALTER S MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119397	36	Psychiatry	0	In state provider	None	6345 BALBOA BLVD	STE 240	ENCINO	CA	91316	1580	19	06037	34.18620241	-118.5011527	Los Angeles County
260082	Fee-for-Service	1780298455	1780298455	1	1	DOYLE, SARAH CRNA	6/13/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1515 E OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
260144	Fee-for-Service	1043231632	1043231632	1	2	DOAN, DOMINIQUE G G MD	4/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	38598	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	323 W VALLEY BLVD	None	SAN GABRIEL	CA	91776	3726	19	06037	34.07955234	-118.1047349	Los Angeles County
260151	Fee-for-Service	1407599764	1407599764	1	1	DIVINE LIFE PSYCHOLOGY INC	10/17/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	11325 PARK SQUARE DR	K102	BAKERSFIELD	CA	93311	8857	15	06029	35.32232807	-119.1301738	Kern County
260163	Fee-for-Service	1376644955	1376644955	1	1	DAANE, STEPHEN P MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69411	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2186 GEARY BLVD	STE 212	SAN FRANCISCO	CA	94115	3456	38	06075	37.78343395	-122.4392245	San Francisco County
260225	Fee-for-Service	1871526145	1871526145	1	2	DERMATOLOGY MEDICAL GROUP OF	2/21/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OXNARD AND CAMARILLO	2811 N VENTURA RD	None	OXNARD	CA	93036	2213	56	06111	34.24375508	-119.1828168	Ventura County
260243	Fee-for-Service	1164676169	1164676169	1	1	DE MARCO CENTENO, PATRICIA	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114122	36	Psychiatry	0	In state provider	MD	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1864	19	06037	34.07671715	-118.3799413	Los Angeles County
260278	Fee-for-Service	1053894758	1053894758	1	1	DANIELS, DORA LMFT	10/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14390 PARK AVE.	None	VICTORVILLE	CA	92392	2910	36	06071	34.512453	-117.324936	San Bernardino County
260334	Fee-for-Service	1326136151	1326136151	1	1	DREW, BRENDON G DO	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11092	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
260346	Fee-for-Service	1881957694	1881957694	1	1	DAVIDSON, ANDERS J MD	12/15/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	128374	None	None	0	In state provider	None	530 W ACACIA ST	None	STOCKTON	CA	95203	2454	39	06077	37.96109625	-121.3011471	San Joaquin County
260354	Fee-for-Service	1427878636	1427878636	1	1	DE MESA, MOLLY Q	3/5/2025	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 7TH AVE	STE 135	SANTA CRUZ	CA	95062	4670	44	06087	36.96438797	-121.998448	Santa Cruz County
260374	Fee-for-Service	1518385905	1518385905	1	1	DANIEL GELLER PODIATRY	8/31/2015	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	11600 WILSHIRE BLVD	STE 205	LOS ANGELES	CA	90025	1704	19	06037	34.05055194	-118.4594619	Los Angeles County
260404	Fee-for-Service	1609037472	1609037472	1	1	DAVARPANAH, ROMINA MD	10/12/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	113433	08	Family Practice	0	In state provider	None	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	43	06085	37.39572142	-122.1051204	Santa Clara County
260416	Fee-for-Service	1144242140	1144242140	1	1	DOCKWEILER, DAVID W MD	8/31/1984	207L00000X	NA	Other	026	PHYSICIANS	45731	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
260452	Fee-for-Service	1770524795	1770524795	1	1	DAVID ANDERSON MD	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	750 W 800 N	None	OREM	UT	84057	3660	00	None	40.31373134	-111.7150045	Utah County
260461	Fee-for-Service	1457439176	1457439176	1	1	DONG, ROBERT F MD	8/19/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	78408	05	Anesthesiology	0	In state provider	None	7500 HOSPITAL DR	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
260473	Fee-for-Service	1932632429	1932632429	1	1	DASGUPTA, ADITI MD	4/24/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160739	40	Pediatrics	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
260488	Fee-for-Service	1922003961	1922003961	1	1	DYSON, REBECCA L MD	6/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79894	30	Radiology	0	In state provider	None	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
260492	Fee-for-Service	1730158460	1730158460	1	1	DEGUZMAN, RODNEY D MD	10/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
260512	Fee-for-Service	1114165453	1114165453	1	1	DISSANAYAKE, VINODINEE L MD	7/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111409	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
260556	Fee-for-Service	1578723151	1578723151	1	1	DOMBROWSKY, JOSEPH MD	4/16/2024	207QS1201X	NA	Adult Primary Care	026	PHYSICIANS	172392	08	Family Practice	0	In state provider	None	5471 KEARNY VILLA RD	STE 202	SAN DIEGO	CA	92123	1105	37	06073	32.83480543	-117.138158	San Diego County
260684	Fee-for-Service	1306171350	1306171350	1	1	DIAMOND, MICHELLE K PT	6/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
260689	Fee-for-Service	1841222999	1841222999	1	1	DONALD GARVER, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	19701 VERNIER RD	STE 150	HARPER WOODS	MI	48225	1422	00	None	42.44889434	-82.92825884	Wayne County
260714	Fee-for-Service	1780299289	1780299289	1	1	DORONIO, RACHEL NP	6/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4070 JURAPA AVE	None	RIVERSIDE	CA	92506	2234	33	06065	33.96087652	-117.3960765	Riverside County
260717	Fee-for-Service	1083392302	1083392302	1	1	DISRUPTIVE THERAPY COLLECTIV	8/2/2024	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	E	1769 PARK AVE	STE 250	SAN JOSE	CA	95126	2029	43	06085	37.33457692	-121.9248572	Santa Clara County
260790	Fee-for-Service	1336154160	1336154160	1	1	DIOP, ABDOULAYE MD	3/10/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33986	40	Pediatrics	0	In state provider	None	2710 W MANCHESTER BLVD	STE A	INGLEWOOD	CA	90305	2436	19	06037	33.9598587	-118.3237499	Los Angeles County
260842	Fee-for-Service	1992853766	1992853766	1	1	DO, JENNIFER H MD	2/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95341	40	Pediatrics	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
260845	Fee-for-Service	1255692976	1255692976	1	1	DHANOTA, AMRIT K MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136202	01	General Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
260909	Fee-for-Service	1467967547	1467967547	1	1	DOSS, STEPHANIE B LCSW	1/7/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2490 W SHAW AVE	STE 101	FRESNO	CA	93711	3305	10	06019	36.80841598	-119.8371594	Fresno County
260946	Fee-for-Service	1548312507	1548312507	1	1	DIABLO P & O INC	8/16/2007	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	4479 STONERIDGE DR	STE A	PLEASANTON	CA	94588	8447	01	06001	37.68796252	-121.8761775	Alameda County
260993	Fee-for-Service	1447894043	1447894043	1	1	DURANT, VICTORIA E LMFT	5/28/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1010 N CENTRAL AVE	SUITE 310	GLENDALE	CA	91202	2937	19	06037	34.16012317	-118.2571026	Los Angeles County
261004	Fee-for-Service	1356758833	1356758833	1	1	DALRYMPLE, ITHA DO	3/19/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
261021	Fee-for-Service	1568789725	1568789725	1	2	DESERT MEDICAL SPECIALISTS	12/15/2010	207R00000X	NA	Other	026	PHYSICIANS	10642	41	Internal Medicine	0	In state provider	None	1169 W RAMSEY STREET	None	BANNING	CA	92220	4443	33	06065	33.92545045	-116.8894845	Riverside County
261077	Fee-for-Service	1316062128	1316062128	1	1	DESERT HEART PHYSICIANS	1/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP INC	41120 WASHINGTON ST	STE 220	BERMUDA DUNES	CA	92203	9596	33	06065	33.75029437	-116.3037097	Riverside County
261142	Fee-for-Service	1811718844	1811718844	1	1	DELAROSA, AUBRIE CCC-SLP	3/14/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR	STE B	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
261152	Fee-for-Service	1679836084	1679836084	1	7	DHP OF CALIFORNIA MEDICAL GR	11/6/2020	193200000X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	OUP INC	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
261207	Fee-for-Service	1750342622	1750342622	1	1	DUDEJA, DEEP R MD	6/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83764	18	Ophthalmology	0	In state provider	SOUTHERN CALIFORNIA EYEC	731 N BEACH BLVD	STE 120	LA HABRA	CA	90631	3657	30	06059	33.93812202	-117.9680337	Orange County
261230	Fee-for-Service	1750451688	1750451688	1	1	DOSANJH, SANDEEP K MD	12/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86466	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
261236	Fee-for-Service	1306343421	1306343421	1	1	DOSCAS, MICHELLE E MD	7/21/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163633	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
261238	Fee-for-Service	1467608885	1467608885	1	1	DHILLON, NAVJOT MD	8/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137248	78	Neoplastic Diseases/Oncology	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
261258	Fee-for-Service	1427230838	1427230838	1	1	DAO, KHIEM D M D INC	9/13/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83781	46	Hand Surgery	0	In state provider	None	2314 NEWPORT BLVD	None	COSTA MESA	CA	92627	1548	30	06059	33.65498541	-117.9048415	Orange County
261352	Fee-for-Service	1083077440	1083077440	1	1	DARBY, ANNA M MD	10/23/2020	207P00000X	NA	Other	026	PHYSICIANS	153602	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
261354	Fee-for-Service	1053599647	1053599647	1	1	DOSTZADA, GHULAM Y MD INC	6/5/2009	193400000X	NA	Other	026	PHYSICIANS	76019	41	Internal Medicine	0	In state provider	None	3801 KATELLA AVE	STE 321	LOS ALAMITOS	CA	90720	3369	30	06059	33.80318951	-118.066068	Orange County
261441	Fee-for-Service	1679836084	1679836084	1	7	DHP OF CALIFORNIA MEDICAL GR	11/6/2020	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	OUP INC	1600 WEST AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
261487	Fee-for-Service	1326135377	1326135377	1	1	DA SILVEIRA, EDUARDO MD	6/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51904	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
261489	Fee-for-Service	1518305630	1518305630	1	1	DALY, JENNIE C MD	3/22/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	139111	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
261548	Fee-for-Service	1427230838	1427230838	1	1	DAO, KHIEM D M D INC	9/13/2012	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	83781	20	Orthopedic Surgery	0	In state provider	None	2314 NEWPORT BLVD	None	COSTA MESA	CA	92627	1548	30	06059	33.65498541	-117.9048415	Orange County
261579	Fee-for-Service	1700901212	1700901212	1	1	DUNN, GREGORY Y MD	4/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81958	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
261590	Fee-for-Service	1497080568	1497080568	1	1	DOHERTY, AMANDA R MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100266	22	Pathology (M.D. only)	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
261601	Fee-for-Service	1912056888	1912056888	1	1	DEVELOPMENTAL CLIENT	12/15/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	24576 ORMISTA DR	None	MORENO VALLEY	CA	92553	5325	33	06065	33.92170999	-117.2335716	Riverside County
261669	Fee-for-Service	1841545563	1841545563	1	1	DOHMEIER, KEELEY M MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141984	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
261687	Fee-for-Service	1063543718	1063543718	1	1	DANIELS, PARVIZ MD	3/12/2008	208600000X	NA	General Surgery	026	PHYSICIANS	36510	02	General Surgery	0	In state provider	None	5901 W OLYMPIC BLVD	STE 507	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
261717	Fee-for-Service	1245291723	1245291723	1	1	DRACHENBERG, MILTON R MD	2/8/2015	207ZP0102X	NA	Other	026	PHYSICIANS	77738	22	Pathology (M.D. only)	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
261734	Fee-for-Service	1013634005	1013634005	1	1	DELGADO MAGANA, HUGO PT	11/30/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
261757	Fee-for-Service	1548985153	1548985153	1	1	DELGADO, KARINA OD	7/11/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15923 BEAR VALLEY ROAD	SUITE B-100	HESPERIA	CA	92345	1762	36	06071	34.47065953	-117.316035	San Bernardino County
261770	Fee-for-Service	1386089415	1386089415	1	1	DIPTI DOSHI MD, INC.	5/5/2019	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	ATOLOGY CENTER	17100 NORWALK BLVD	STE 101	CERRITOS	CA	90703	2750	19	06037	33.87557796	-118.0725386	Los Angeles County
261822	Fee-for-Service	1851678585	1851678585	1	2	DHHS IHS PHOENIX AREA	2/26/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	12033 AGENCY ROAD	None	PARKER	AZ	85344	7718	00	None	34.14638102	-114.3057195	La Paz County
261828	Fee-for-Service	1659799153	1659799153	1	1	DEWHIRST, SCOTT M MD	2/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	155178	36	Psychiatry	0	In state provider	None	3916 STATE ST	SUITE 300	SANTA BARBARA	CA	93105	3137	42	06083	34.44050378	-119.7522529	Santa Barbara County
261873	Fee-for-Service	1457858110	1457858110	1	1	DUMITRIU, BOGDAN G MD	7/16/2021	207P00000X	NA	Other	026	PHYSICIANS	163446	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
261915	Fee-for-Service	1346326246	1346326246	1	1	DESTA, TADDESE T MD	4/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49164	66	Emergency Medicine (Urgent Care)	0	In state provider	DESTA DIGESTIVE DISEASE	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
261923	Fee-for-Service	1477676047	1477676047	1	1	DEMERS, ARIANA M	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10879	20	Orthopedic Surgery	0	In state provider	None	940 SYLVA LANE	SUITE E	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
261966	Fee-for-Service	1952358988	1952358988	1	1	DESERT CARDIO CONSULTANT	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL GROUP	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
262124	Fee-for-Service	1497826176	1497826176	1	1	DO, THINH T MD	5/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85251	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
262125	Fee-for-Service	1043735756	1043735756	1	1	DOWNEY, MATTHEW B	10/12/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
262135	Fee-for-Service	1659301620	1659301620	1	1	DEMETRIADES, DEMETRIOS	2/17/1999	208600000X	NA	General Surgery	026	PHYSICIANS	53404	02	General Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
262138	Fee-for-Service	1841580321	1841580321	1	1	DESAI, HIRAL V MD	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125697	45	Nephrology (Renal-Kidney)	0	In state provider	None	1801 EAST MARCH LANE	SUITE B265	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
262175	Fee-for-Service	1568131811	1568131811	1	1	DHILLON, GURPREET S NP	1/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
262183	Fee-for-Service	1477596617	1477596617	1	1	DOUGHER, JAMES W	10/29/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72803	01	General Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
262190	Fee-for-Service	1326233800	1326233800	1	1	DEANS, PAMELA A PSYD	2/11/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
262203	Fee-for-Service	1346326246	1346326246	1	1	DESTA, TADDESE T MD	4/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49164	41	Internal Medicine	0	In state provider	DESTA DIGESTIVE DISEASE	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
262206	Fee-for-Service	1093223901	1093223901	1	1	DANIEL M. VILLAROSA, M.D., A	8/17/2020	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PROFESSIONAL CORPORATIO	18064 WIKA RD STE	102	APPLE VALLEY	CA	92307	2182	36	06071	34.54065092	-117.2698167	San Bernardino County
262230	Fee-for-Service	1952376535	1952376535	2	1	DIABLO INFECTIOUS DISEASE	3/29/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1447 CEDARWOOD LANE	STE A	PLEASANTON	CA	94566	6175	01	06001	37.67102566	-121.8742221	Alameda County
262265	Fee-for-Service	1457859407	1457859407	1	1	DR. J. MICHAIL INC.	1/8/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	38	Geriatrics	0	In state provider	None	10605 BALBOA BLVD	STE 260	GRANADA HILLS	CA	91344	6353	19	06037	34.263378	-118.5022965	Los Angeles County
262279	Fee-for-Service	1114993540	1114993540	1	1	DECKER, PATRICIA L MD	2/1/1999	207L00000X	NA	Other	026	PHYSICIANS	77402	05	Anesthesiology	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
262327	Fee-for-Service	1235660796	1235660796	1	1	DEVLIN, GABRIEL P MD	3/26/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	158347	40	Pediatrics	0	In state provider	None	1001 POTRERO AVE	6E/6D37	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
262367	Fee-for-Service	1851365845	1851365845	1	1	DS PHARMACEUTICALS CO IN	6/6/1986	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	LINH'S PHARMACY	9191 BOLSA AVE	STE 102	WESTMINSTER	CA	92683	5502	30	06059	33.74494947	-117.969093	Orange County
262369	Fee-for-Service	1932563533	1932563533	1	1	DALL, TANYA M MD	11/26/2019	207P00000X	NA	Other	026	PHYSICIANS	151283	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
262392	Fee-for-Service	1437505815	1437505815	1	1	DAHILL, DAVID L DO	2/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18523	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
262431	Fee-for-Service	1093882367	1093882367	1	1	DEGUTES, SUSAN NP	2/22/2025	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
262471	Fee-for-Service	1477596617	1477596617	1	1	DOUGHER, JAMES W	10/29/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72803	08	Family Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
262491	Fee-for-Service	1346326246	1346326246	1	1	DESTA, TADDESE T MD	4/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	49164	10	Gastroenterology (M.D. only)	0	In state provider	DESTA DIGESTIVE DISEASE	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
262507	Fee-for-Service	1134454788	1134454788	1	1	DE LA TORRE, HILDA N LMFT	11/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	282 LANDIS AVENUE	None	CHULA VISTA	CA	91910	2627	37	06073	32.64168665	-117.0812298	San Diego County
262509	Fee-for-Service	1205865763	1205865763	1	1	DACH, DEBORAH L CRNA	4/6/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
262582	Fee-for-Service	1154436707	1154436707	1	1	DUA, RENEE MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78217	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
262601	Fee-for-Service	1821109349	1821109349	1	1	DAVID A CLARK, MD, MEDIC	10/10/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	880 CASS STREET	SUITE 108	MONTEREY	CA	93940	2948	27	06053	36.59354661	-121.8957685	Monterey County
262626	Fee-for-Service	1154920205	1154920205	1	1	DOEPPE, KATELYNN S NP	6/15/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
262700	Fee-for-Service	1285775437	1285775437	1	1	DE LEON, MARIA LOURDES	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73468	40	Pediatrics	0	In state provider	MD	220 N MACLAY AVE	STE 2	SAN FERNANDO	CA	91340	2909	19	06037	34.28545456	-118.4382977	Los Angeles County
262761	Fee-for-Service	1689244477	1689244477	1	1	DIAZ, PORSCHA A LMFT	3/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
262832	Fee-for-Service	1609604354	1609604354	1	1	DANIEL, JASON PT	1/9/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
262837	Fee-for-Service	1801099676	1801099676	1	1	DOSHI, AMI P MD	6/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95217	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
262876	Fee-for-Service	1790988426	1790988426	1	1	DROCTON, PETER MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98631	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
262919	Fee-for-Service	1164537452	1164537452	1	1	DIABETES MANAGEMENT &	1/27/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	SUPPLIES	2 COMMERCE CT	None	NEW ORLEANS	LA	70123	3225	00	None	29.94910392	-90.1873497	Jefferson Parish
262936	Fee-for-Service	1316496334	1316496334	1	1	DE LIMA, KATHY J LCSW	9/1/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	355 ABBOTT STREET	200	SALINAS	CA	93901	4483	27	06053	36.66552031	-121.6439174	Monterey County
262942	Fee-for-Service	1295794964	1295794964	1	1	DUNLAP, JANET MD	8/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	63785	01	General Practice	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
262978	Fee-for-Service	1962125278	1962125278	1	1	DALY, KATHLEEN F OT	5/24/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
262981	Fee-for-Service	1821174541	1821174541	1	1	DELLIT, TIMOTHY H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	HARBORVIEW MED CENTRE	325 9TH AVE	C/O UWP 359110	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
263024	Fee-for-Service	1114243375	1114243375	1	1	DAS, TRACY O MD	9/29/2020	2084P0804X	NA	Psychiatry	026	PHYSICIANS	168094	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
263028	Fee-for-Service	1598128670	1598128670	1	1	DURRANCE, RICHARD MD	3/6/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
263029	Fee-for-Service	1356710388	1356710388	1	1	DELGADO, ASHLEY C LMFT	10/27/2020	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	770 E SHAW AVE	STE 230	FRESNO	CA	93710	7708	10	06019	36.80886739	-119.7731624	Fresno County
263118	Fee-for-Service	1093841140	1093841140	1	1	DOMINGUEZ, JESSICA LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
263127	Fee-for-Service	1700322500	1700322500	1	1	DIAGNOSTIX PREMIUM PATHOLOGY	7/18/2019	207ZP0102X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	PARTNERS, INC	77734 COUNTRY CLUB DRIVE	STE L-2	PALM DESERT	CA	92211	0455	33	06065	33.75832278	-116.3087629	Riverside County
263180	Fee-for-Service	1568974137	1568974137	1	1	DONALDSON, CHRISTINA M	9/20/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
263194	Fee-for-Service	1043456106	1043456106	1	6	DIGNITY HEALTH MEDICAL FOUND	1/6/2017	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	150 CATHERINE LANE	STE F	GRASS VALLEY	CA	95945	5719	29	06057	39.22894557	-121.0489578	Nevada County
263245	Fee-for-Service	1467584326	1467584326	1	1	DIEKMANN, GLENN R MD	9/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95215	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
263261	Fee-for-Service	1174996789	1174996789	1	1	DIAZ, ESMERALDA LMFT	6/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
263297	Fee-for-Service	1831583723	1831583723	1	1	DANIEL ASH	8/27/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60637	1443	00	None	41.788431	-87.60489252	Cook County
263318	Fee-for-Service	1598128670	1598128670	1	1	DURRANCE, RICHARD MD	3/6/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
263324	Fee-for-Service	1619455086	1619455086	1	1	DICKERSON, CAMEDA T LPCC	11/26/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
263326	Fee-for-Service	1457439366	1457439366	1	1	DEOL, AMARDEEP S MD	1/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82367	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
263351	Fee-for-Service	1871929760	1871929760	1	1	DOSHI, DARSHANA S LMFT	7/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
263354	Fee-for-Service	1003278037	1003278037	1	1	DESAI, JITEN MD	7/15/2024	207R00000X	NA	Other	026	PHYSICIANS	190138	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
263374	Fee-for-Service	1902039555	1902039555	1	1	DUARTE, NICHOLE A PHD	2/13/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
263395	Fee-for-Service	1902660152	1902660152	1	1	DAVIS, DINAH L	2/9/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2087 GRAND CANAL BLVD	SUITE 9	STOCKTON	CA	95207	6651	39	06077	37.98552607	-121.3315122	San Joaquin County
263425	Fee-for-Service	1144255878	1144255878	1	1	DUBINETT, STEVEN M MD	6/11/1998	207RP1001X	NA	Pulmonology	026	PHYSICIANS	45998	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
263451	Fee-for-Service	1285655126	1285655126	1	1	DURAN, MARIA C H MD	11/24/2008	207R00000X	NA	Other	026	PHYSICIANS	95219	41	Internal Medicine	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
263473	Fee-for-Service	1053499145	1053499145	1	1	DASARI,RAJ V MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64949	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
263484	Fee-for-Service	1588081814	1588081814	1	1	DAVE, SHRAVAN MD	7/21/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	139385	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
263563	Fee-for-Service	1912055849	1912055849	1	1	DAVIS, JEFFREY A MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73938	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
263569	Fee-for-Service	1164049847	1164049847	1	1	DIAZ, ASHLEY A NP	1/6/2021	363LN0005X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
263571	Fee-for-Service	1770535692	1770535692	1	1	DAVIS, GARTH G MD	9/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73018	41	Internal Medicine	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
263660	Fee-for-Service	1154869956	1154869956	1	1	DHALIWAL, SUKHDEEP KAUR	1/10/2025	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1538 RED RIBBONS LANE	None	MANTECA	CA	95337	7926	39	06077	37.77923119	-121.2418602	San Joaquin County
263706	Fee-for-Service	1043416613	1043416613	1	1	DOSHI-WILCOX, RUPAL LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
263714	Fee-for-Service	1063684850	1063684850	1	1	DULDULAO III, MARJUN PHILIP	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109414	02	General Surgery	0	In state provider	N MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
263719	Fee-for-Service	1609825421	1609825421	1	1	DIAMOND, MARK H MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67025	30	Radiology	0	In state provider	None	824 E CARSON ST	STE 104	CARSON	CA	90745	2262	19	06037	33.83159904	-118.2605506	Los Angeles County
263739	Fee-for-Service	1285655126	1285655126	1	1	DURAN, MARIA C H MD	11/24/2008	207R00000X	NA	Other	026	PHYSICIANS	95219	08	Family Practice	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
263797	Fee-for-Service	1710090055	1710090055	1	1	DAVID B STANTON MD &	6/23/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	ASSOCIATES, A MED GRP	1140 W LA VETA AVE	STE 555	ORANGE	CA	92868	4214	30	06059	33.7802984	-117.8651669	Orange County
263805	Fee-for-Service	1225290554	1225290554	1	1	DICKEY, MICAH J DO	6/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11572	01	General Practice	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
263806	Fee-for-Service	1528549854	1528549854	1	2	DOLLARHIDE, LAUREN N LMFT	1/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5151 N PALM AVE	STE 200	FRESNO	CA	93704	2221	10	06019	36.81119879	-119.808555	Fresno County
263833	Fee-for-Service	1558901967	1558901967	1	1	DELPASAND, NICOLE A	1/18/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
263837	Fee-for-Service	1962728238	1962728238	1	1	DOST, ADAM M DO	4/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11931	None	None	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
263874	Fee-for-Service	1801187398	1801187398	1	1	DILLER, DAVID S MD	4/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140729	66	Emergency Medicine (Urgent Care)	0	In state provider	None	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
263882	Fee-for-Service	1356981393	1356981393	1	1	DMS SERVICES, INC.	11/9/2020	101Y00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	601 S HARBOR BLVD	None	ANAHEIM	CA	92805	4527	30	06059	33.82736368	-117.9174159	Orange County
263892	Fee-for-Service	1306559208	1306559208	1	1	DYSE, MYSTI A DOULA	1/13/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
263926	Fee-for-Service	1205870748	1205870748	1	1	DAVIDSON, JOHN L MD	1/31/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	71316	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA RM 1-340	None	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
263948	Fee-for-Service	1154869956	1154869956	1	1	DHALIWAL, SUKHDEEP KAUR	1/10/2025	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1538 RED RIBBONS LANE	None	MANTECA	CA	95337	7926	39	06077	37.77923119	-121.2418602	San Joaquin County
263992	Fee-for-Service	1295958494	1295958494	1	1	DE BETTIGNIES, JEAN LPT	2/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
264047	Fee-for-Service	1407353311	1407353311	1	1	DELROSARIO, GLYNIS NP	1/2/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	81709 DR CARREON BLVD	STE C3	INDIO	CA	92201	5577	33	06065	33.70733082	-116.2400326	Riverside County
264085	Fee-for-Service	1710090055	1710090055	1	1	DAVID B STANTON MD &	5/18/1999	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, A MED GRP	1140 W LA VETA AVE	STE 555	ORANGE	CA	92868	4214	30	06059	33.7802984	-117.8651669	Orange County
264097	Fee-for-Service	1497951313	1497951313	1	1	DUBER, HERBERT C MD	4/15/2008	207P00000X	NA	Other	026	PHYSICIANS	97499	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1937	19	06037	33.808185	-118.1850575	Los Angeles County
264122	Fee-for-Service	1679894836	1679894836	1	1	DONG, FEI MD	6/22/2023	207ZP0101X	NA	Other	026	PHYSICIANS	186365	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
264159	Fee-for-Service	1790010452	1790010452	1	1	DUNBAR, BERNADETTE M LCSW	11/24/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	270 DOUGLAS AVE	# 4	EL CAJON	CA	92020	4514	37	06073	32.7938777	-116.9592516	San Diego County
264174	Fee-for-Service	1740625201	1740625201	1	1	DILLON, CHRISTY A MD	12/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138754	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
264178	Fee-for-Service	1790592939	1790592939	1	1	DOUGHERTY, DESIREE DOULA	2/14/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
264228	Fee-for-Service	1679065536	1679065536	1	1	DARMAL, BORHAN MD	8/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	30	06059	33.67783408	-117.8720921	Orange County
264274	Fee-for-Service	1184914681	1184914681	1	1	DUNN, HEATHER R LCSW	8/26/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1008 5TH ST	None	SANTA ROSA	CA	95404	4307	49	06097	38.443941	-122.708187	Sonoma County
264278	Fee-for-Service	1992001655	1992001655	1	1	DUNCAN, SARAH R DO	9/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12366	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN STREET	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
264329	Fee-for-Service	1336119676	1336119676	1	1	DAAR, ERIC S MD	10/31/1989	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	58472	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
264337	Fee-for-Service	1407931173	1407931173	1	1	DESLER, MARGARET MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	8125	40	Pediatrics	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
264340	Fee-for-Service	1891923298	1891923298	1	1	DATU, SHIRLEY G DO	7/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11626	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
264412	Fee-for-Service	1457316150	1457316150	1	1	DANG, PHUC C MD	6/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67799	41	Internal Medicine	0	In state provider	None	1692 TULLY RD	STE 10	SAN JOSE	CA	95122	2550	43	06085	37.3212391	-121.8273245	Santa Clara County
264434	Fee-for-Service	1073610960	1073610960	1	1	DOWNEY, JAY FLETCHER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	73327	08	Family Practice	0	In state provider	None	650 S ZEDIKER AVE	None	PARLIER	CA	93648	2639	10	06019	36.60500164	-119.5210273	Fresno County
264526	Fee-for-Service	1447274972	1447274972	1	1	DARAKJIAN, HRAIR E MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	55678	20	Orthopedic Surgery	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
264530	Fee-for-Service	1942252978	1942252978	1	1	DUNCAN, JACQUE L MD	7/1/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	60776	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264616	Fee-for-Service	1982644894	1982644894	1	1	DANE, JOSEPH MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	59463	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
264619	Fee-for-Service	1447678560	1447678560	1	1	DIETRICH, AUGUST R MD	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148003	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264672	Fee-for-Service	1316955024	1316955024	1	1	DAWSON, JOHN M DPM	8/11/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
264694	Fee-for-Service	1104835396	1104835396	1	1	DEWOSKIN, PATTI J LCSW	6/21/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15708 POMERADO RD	SUITE 201	POWAY	CA	92064	2036	37	06073	32.99948815	-117.0580342	San Diego County
264706	Fee-for-Service	1972298180	1972298180	1	1	DOMINADOR MANSAT JR, A PROFE	5/11/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	SSIONAL NURSING CORP	1910 S ARCHIBALD AVE	STE D	ONTARIO	CA	91761	8503	36	06071	34.038603	-117.5935995	San Bernardino County
264714	Fee-for-Service	1104808823	1104808823	1	1	DWYRE, DENIS M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60373	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
264736	Fee-for-Service	1811972375	1811972375	1	1	DHILLON, HARKEERAT S MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51026	20	Orthopedic Surgery	0	In state provider	None	6405 DAY ST	None	RIVERSIDE	CA	92507	0901	33	06065	33.934059	-117.2789475	Riverside County
264744	Fee-for-Service	1083825947	1083825947	1	1	DERMATOLOGY CONSULTANTS	7/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	OF SACRAMENTO	5340 ELVAS AVE	STE 600	SACRAMENTO	CA	95819	2385	34	06067	38.574819	-121.434867	Sacramento County
264782	Fee-for-Service	1376578591	1376578591	1	1	DELGADO JR, MIGUEL A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62309	28	Proctology (colon and rectal)	0	In state provider	None	165 ROWLAND WAY	STE 300	NOVATO	CA	94945	5055	21	06041	38.09824386	-122.559872	Marin County
264802	Fee-for-Service	1316336753	1316336753	1	1	DAWSON DIALYSIS LLC	4/6/2017	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	587 N MOUNTAIN AVE	None	UPLAND	CA	91786	5016	36	06071	34.10115423	-117.6702497	San Bernardino County
264813	Fee-for-Service	1053358457	1053358457	1	1	DASHTIPOUR, KHASHAYAR MD	7/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85250	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE 2400	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
264840	Fee-for-Service	1578239711	1578239711	1	1	DEOL, ELIZABETH LCSW	7/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
264872	Fee-for-Service	1265796346	1265796346	1	1	DAY, RYAN W MD	7/14/2020	2086X0206X	NA	General Surgery	026	PHYSICIANS	168421	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
264892	Fee-for-Service	1609018944	1609018944	1	1	DODEN, MICHAEL J MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118151	05	Anesthesiology	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
264894	Fee-for-Service	1457409427	1457409427	1	1	DAVIS, FREDERICK A MD	7/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82120	25	Physical Medicine and Rehabilitation	0	In state provider	MGA OFFICE	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
264932	Fee-for-Service	1245232578	1245232578	2	2	DICHMANN, ROBERT A MD	1/27/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	54341	None	None	0	In state provider	None	1325 E CHURCH ST	STE. 301	SANTA MARIA	CA	93454	4806	42	06083	34.95209265	-120.4147348	Santa Barbara County
264933	Fee-for-Service	1659335701	1659335701	1	1	DELAROSA, JOSE L	7/19/2002	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	43518	None	None	0	In state provider	None	16415 COLORADO AVE	STE 103	PARAMOUNT	CA	90723	5051	19	06037	33.8853075	-118.1614695	Los Angeles County
264961	Fee-for-Service	1912165440	1912165440	1	1	DIXIT, NIHARIKA MD	8/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117064	68	Hematology	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
264992	Fee-for-Service	1174942130	1174942130	1	1	DER, AARON G MD	1/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138897	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
265004	Fee-for-Service	1104808823	1104808823	1	1	DWYRE, DENIS M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60373	68	Hematology	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
265012	Fee-for-Service	1417087784	1417087784	1	1	DOUGLAS, VANJA C MD	3/6/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	94749	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
265042	Fee-for-Service	1578666186	1578666186	1	1	DOVICHI, JENNIFER H MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66114	40	Pediatrics	0	In state provider	None	4 COUNTRY CLUB PLAZA	None	ORINDA	CA	94563	2308	07	06013	37.88568235	-122.1926427	Contra Costa County
265084	Fee-for-Service	1295489086	1295489086	1	1	DOYLE, MICHAEL LMFT	8/6/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
265089	Fee-for-Service	1063509404	1063509404	1	1	DAVID LEE SOMMERFELD	5/21/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1235 E CHEROKEE ST	None	SPRINGFIELD	MO	65804	2203	00	None	37.17834049	-93.2753205	Greene County
265128	Fee-for-Service	1699706812	1699706812	1	1	DAUD, ADIL I MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53245	68	Hematology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
265136	Fee-for-Service	1740845346	1740845346	1	1	DIRECT HOSPICE CARE, INC	1/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4701 PATRICK HENRY DRIVE	BUILDING 6 SUITE M	SANTA CLARA	CA	95054	1863	43	06085	37.397709	-121.984972	Santa Clara County
265155	Fee-for-Service	1427740828	1427740828	1	1	DIANA LEE MD, PC	1/15/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	2226 N STATE COLLEGE BLV	None	FULLERTON	CA	92831	1361	30	06059	33.89628141	-117.8917615	Orange County
265183	Fee-for-Service	1023217718	1023217718	1	1	DAUGHTERS, HEATHER L MD	8/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107834	05	Anesthesiology	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
265190	Fee-for-Service	1740330554	1740330554	1	1	DAOOD, MOHAMMAD MD INC	12/26/2008	174400000X	NA	Other	026	PHYSICIANS	25816	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2601 W ALAMEDA AVE	STE 202	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
265203	Fee-for-Service	1043502941	1043502941	1	1	DOWNING, NORMAN L MD	8/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122051	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
265215	Fee-for-Service	1235792391	1235792391	1	1	DESERT VIEW HOSPICE INC	5/30/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14338 PARK AVE	STE 4	VICTORVILLE	CA	92392	2341	36	06071	34.511319	-117.3249365	San Bernardino County
265239	Fee-for-Service	1528231727	1528231727	1	1	DUA, AMAN MD	1/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109452	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
265275	Fee-for-Service	1104438928	1104438928	1	1	DURAN, ALLEN MD	4/23/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
265287	Fee-for-Service	1104808823	1104808823	1	1	DWYRE, DENIS M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60373	22	Pathology (M.D. only)	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
265292	Fee-for-Service	1356300222	1356300222	1	1	DUBIN, JONATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8600 LIBERTY RD	None	RANDALLSTOWN	MD	21133	4707	00	None	39.36143885	-76.778834	Baltimore County
265309	Fee-for-Service	1780976324	1780976324	1	1	DOSKOCIL, BRANDON J MD	6/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123344	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
265318	Fee-for-Service	1457336729	1457336729	1	1	DANIEL G TURNER	7/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5444 S GREEN ST	None	MURRAY	UT	84123	5632	00	None	40.651605	-111.90357	Salt Lake County
265360	Fee-for-Service	1275057283	1275057283	1	1	DOUGHER, AMELIA J PT	2/26/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5648 LAKE MURRAY BLVD	None	LA MESA	CA	91942	1929	37	06073	32.78184153	-117.03104	San Diego County
265375	Fee-for-Service	1568789725	1568789725	1	1	DESERT MEDICAL SPECIALISTS	9/23/2010	207R00000X	NA	Other	026	PHYSICIANS	106425	41	Internal Medicine	0	In state provider	INC	81833 DOCTOR CARREON BLV	SUITE 8	INDIO	CA	92201	5590	33	06065	33.70737252	-116.2365255	Riverside County
265414	Fee-for-Service	1699706812	1699706812	1	1	DAUD, ADIL I MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53245	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
265423	Fee-for-Service	1740845346	1740845346	1	1	DIRECT HOSPICE CARE, INC	1/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4701 PATRICK HENRY DRIVE	BUILDING 6 SUITE M	SANTA CLARA	CA	95054	1863	43	06085	37.397709	-121.984972	Santa Clara County
265426	Fee-for-Service	1104067339	1104067339	1	1	DHAMIJA, NITIN MD	8/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109997	05	Anesthesiology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
265470	Fee-for-Service	1023335957	1023335957	1	1	DARDASHTI, SIMON MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117883	05	Anesthesiology	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
265488	Fee-for-Service	1194898882	1194898882	1	1	DANIEL, BRUCE LEWIS MD	4/12/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	80973	30	Radiology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
265501	Fee-for-Service	1235792391	1235792391	1	1	DESERT VIEW HOSPICE INC	5/30/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14338 PARK AVE	STE 4	VICTORVILLE	CA	92392	2341	36	06071	34.511319	-117.3249365	San Bernardino County
265511	Fee-for-Service	1659666014	1659666014	1	1	DO, NICHOLAS T MD	6/2/2023	2086S0122X	NA	General Surgery	026	PHYSICIANS	168046	None	None	0	In state provider	None	1000 W CARSON ST	BLDG 1 EAST	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
265571	Fee-for-Service	1457349524	1457349524	1	1	DELEON, JOSE F MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5939 HARRY HINES BLVD	STE 945	DALLAS	TX	75235	6243	00	None	32.81731011	-96.84421654	Dallas County
265591	Fee-for-Service	1194755363	1194755363	1	2	DICKSON, KIMBERLY K S MD	3/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	7995	01	General Practice	0	In state provider	None	1628 PALM AVE	None	SAN DIEGO	CA	92154	1027	37	06073	32.58396546	-117.098649	San Diego County
265697	Fee-for-Service	1245656339	1245656339	1	1	DICKSON, ERICA L MD	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14162	None	None	0	In state provider	None	1729 W AVE J	None	LANCASTER	CA	93534	2707	19	06037	34.68944953	-118.162287	Los Angeles County
265733	Fee-for-Service	1871519934	1871519934	1	1	DAVE, RAVI H MD	6/8/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53150	None	None	0	In state provider	None	1245 16TH ST	STE 303	SANTA MONICA	CA	90404	1239	19	06037	34.02726451	-118.4857138	Los Angeles County
265757	Fee-for-Service	1114088796	1114088796	1	1	DISALVO, PETR J OD	1/31/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8105 EDGEWATER DR	STE 1	OAKLAND	CA	94621	2019	01	06001	37.7394611	-122.2011944	Alameda County
265820	Fee-for-Service	1639341969	1639341969	1	1	DOQUI, ANN M LCSW	12/17/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
265831	Fee-for-Service	1518435379	1518435379	1	1	DYTHAVON, NOOR A CNP	8/16/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1675 ALHAMBRA	STE B	SACRAMENTO	CA	95816	7047	34	06067	38.563983	-121.4679915	Sacramento County
265844	Fee-for-Service	1952493413	1952493413	1	1	DIOGO, MARY J CNM	1/23/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
265872	Fee-for-Service	1699270595	1699270595	1	1	DUARTE, MARIA J MD	8/26/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	166857	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
265881	Fee-for-Service	1477574200	1477574200	2	1	DO, CUONG-DUNG T MD	4/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83887	18	Ophthalmology	0	In state provider	None	9061 BOLSA AVENUE	SUITE 105	WESTMINSTER	CA	92683	5558	30	06059	33.74494462	-117.9711164	Orange County
265887	Fee-for-Service	1124605902	1124605902	1	1	DOAN, JOHN MD	1/27/2024	207R00000X	NA	Other	026	PHYSICIANS	190311	None	None	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
265954	Fee-for-Service	1023469335	1023469335	1	1	DEAN, CHELSEA L MD	7/2/2019	390200000X	NA	Other	026	PHYSICIANS	158203	41	Internal Medicine	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
265990	Fee-for-Service	1265605042	1265605042	1	1	DANG, PATRICIA P DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11052	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
266039	Fee-for-Service	1902287709	1902287709	1	1	DE LIMA, FABIANE S MD	2/16/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	170552	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266044	Fee-for-Service	1437579893	1437579893	1	1	DONOHOE, STEVEN MD	6/14/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	140859	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
266084	Fee-for-Service	1184838880	1184838880	1	1	DODDS, STEVEN J MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71780	40	Pediatrics	0	In state provider	SAINT PHILOMENA INFANT	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
266101	Fee-for-Service	1780678300	1780678300	1	1	DHAM, SANDEEP K MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111075	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
266112	Fee-for-Service	1982809315	1982809315	1	1	DENNIS JAMES TANNER	4/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
266131	Fee-for-Service	1447779343	1447779343	1	1	DORTEN ENTERPRISES INC	3/19/2019	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	26933 CORNELL STREET	None	HEMET	CA	92544	7458	33	06065	33.730623	-116.9411775	Riverside County
266179	Fee-for-Service	1144874694	1144874694	1	1	DEBSKI, LAUREN NP	11/25/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
266196	Fee-for-Service	1134578156	1134578156	1	1	DARROW, LUSIJAH S	5/14/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2715 PORTER ST	STE 204	SOQUEL	CA	95073	2458	44	06087	36.986121	-121.9574065	Santa Cruz County
266199	Fee-for-Service	1447240171	1447240171	1	1	DAVIS, CHARLES M MD	6/1/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	152187	30	Radiology	0	In state provider	None	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
266216	Fee-for-Service	1134170681	1134170681	3	1	DYNAMIC MEDICAL SYSTEMS LLC	8/7/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7935 DUNBROOK RD	STE H	SAN DIEGO	CA	92126	6322	37	06073	32.89257508	-117.1502477	San Diego County
266232	Fee-for-Service	1336156728	1336156728	1	1	DHILLON, GURMEJ S MD	10/24/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	62402	41	Internal Medicine	0	In state provider	None	6069 N 1ST ST	STE 103	FRESNO	CA	93710	5467	10	06019	36.824463	-119.7723855	Fresno County
266236	Fee-for-Service	1255794467	1255794467	1	1	DAVIS, KENDRA D LCSW	3/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ICES	1007 LIVE OAK BLVD	STE B-1	YUBA CITY	CA	95991	3454	51	06101	39.14368281	-121.6207923	Sutter County
266244	Fee-for-Service	1013054584	1013054584	1	1	DIMEGLIO, PAUL J OT	2/3/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
266283	Fee-for-Service	1821619271	1821619271	1	1	DIB PHARMACEUTICAL INC	9/8/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	528 E MAIN ST	None	EL CAJON	CA	92020	4008	37	06073	32.7950043	-116.9557672	San Diego County
266306	Fee-for-Service	1053979591	1053979591	1	1	DUARTE, SIENA M MD	6/12/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	185323	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
266310	Fee-for-Service	1134303597	1134303597	1	1	DONG, MAMIE H MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99372	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
266337	Fee-for-Service	1326205568	1326205568	1	1	DR CARMELA LARINO OD INC	9/22/1995	332H00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	18800 E AMAR RD	SUITE A5	WALNUT	CA	91789	7100	19	06037	34.02857448	-117.8910187	Los Angeles County
266342	Fee-for-Service	1154497758	1154497758	1	1	DRS COOPER & LINK	3/11/2011	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRISTS, APC	3241 CHURN CREEK ROAD	None	REDDING	CA	96002	2516	45	06089	40.560309	-122.3530415	Shasta County
266370	Fee-for-Service	1013928589	1013928589	1	1	DAVIES, JEFFREY W DO	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
266371	Fee-for-Service	1184838880	1184838880	1	1	DODDS, STEVEN J MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	71780	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SAINT PHILOMENA INFANT	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
266387	Fee-for-Service	1376006114	1376006114	1	1	DEVOTED HOSPICE INC	10/27/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2910 W. BURBANK BLVD	SUITE B	BURBANK	CA	91505	2309	19	06037	34.17720132	-118.3426301	Los Angeles County
266394	Fee-for-Service	1871989038	1871989038	1	1	DUFRESNE, WHITNEY E MD	11/7/2018	207P00000X	NA	Other	026	PHYSICIANS	144781	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
266418	Fee-for-Service	1548245541	1548245541	1	1	DON, BURL MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45171	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
266427	Fee-for-Service	1003293093	1003293093	1	1	DENTONE, PETER MD	5/7/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161470	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
266454	Fee-for-Service	1750651006	1750651006	1	1	DIAMOND, JOSHUA W H MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126510	41	Internal Medicine	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
266468	Fee-for-Service	1962432138	1962432138	1	1	DUONG, TAO H MD INC	8/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68522	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10301 BOLSA AVE	STE 209	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
266470	Fee-for-Service	1467626408	1467626408	1	1	DESHIELDS, SCOTT S MD	2/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	101755	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
266527	Fee-for-Service	1235223009	1235223009	1	1	DEUTSCH, ROBERT I MD	3/3/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30023	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2059 CLINTON AVE	STE 5	ALAMEDA	CA	94501	4379	01	06001	37.76321262	-122.2534547	Alameda County
266582	Fee-for-Service	1720110083	1720110083	1	1	DUVVURI, RAMANA V MD	4/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89866	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
266620	Fee-for-Service	1346324613	1346324613	2	1	DANG, LONG P MD	5/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	80593	41	Internal Medicine	0	In state provider	None	10161 BOLSA AVENUE	STE 206-C	WESTMINSTER	CA	92683	6775	30	06059	33.74508538	-117.9521356	Orange County
266621	Fee-for-Service	1053302257	1053302257	1	1	DEFILIPPI, VINCENT J MD	10/21/2008	174400000X	NA	Other	026	PHYSICIANS	88362	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	212 SAN JOSE ST	#301	SALINAS	CA	93901	3928	27	06053	36.65853377	-121.6476066	Monterey County
266643	Fee-for-Service	1629289152	1629289152	1	1	DRUG ABUSE ALTERNATIVES	9/30/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	2403 PROFESSIONAL DRIVE	SUITE 103	SANTA ROSA	CA	95403	3007	49	06097	38.463642	-122.7245175	Sonoma County
266650	Fee-for-Service	1417301987	1417301987	1	1	DOSHI, NIVEDITA MD	7/14/2020	207R00000X	NA	Other	026	PHYSICIANS	161032	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
266672	Fee-for-Service	1376006114	1376006114	1	1	DEVOTED HOSPICE INC	10/27/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2910 W. BURBANK BLVD	SUITE B	BURBANK	CA	91505	2309	19	06037	34.17720132	-118.3426301	Los Angeles County
266682	Fee-for-Service	1588618599	1588618599	1	1	DOWELL,STANLEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1325 EASTMORELAND AVE	STE #245	MEMPHIS	TN	38104	0000	00	None	35.13560673	-90.01728839	Shelby County
266690	Fee-for-Service	1972045615	1972045615	1	1	DAVID KAMRAVA MD INC	8/13/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
266699	Fee-for-Service	1144357377	1144357377	1	1	DURKEE, WENDY L LMFT	6/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	36	06071	34.51210263	-117.3272335	San Bernardino County
266703	Fee-for-Service	1548245541	1548245541	1	1	DON, BURL MD	5/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	45171	45	Nephrology (Renal-Kidney)	0	In state provider	None	1001 POTRERO AVE	# 5H	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
266711	Fee-for-Service	1558406736	1558406736	1	1	DAMMANN, GRACE M	4/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	63041	08	Family Practice	0	In state provider	None	2111 UNIVERSITY AVE	None	PALO ALTO	CA	94303	1715	41	06081	37.463436	-122.1418585	San Mateo County
266729	Fee-for-Service	1811944010	1811944010	1	1	DORNHOFER, PETER L MD	7/30/1989	207P00000X	NA	Other	026	PHYSICIANS	69683	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
266753	Fee-for-Service	1962432138	1962432138	1	1	DUONG, TAO H MD INC	8/16/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	68522	41	Internal Medicine	0	In state provider	None	10301 BOLSA AVE	STE 209	WESTMINSTER	CA	92683	6784	30	06059	33.74508782	-117.9495976	Orange County
266783	Fee-for-Service	1659750032	1659750032	1	1	DEEDAS, CHRISTINA DO	10/10/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15469	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
266811	Fee-for-Service	1235223009	1235223009	1	1	DEUTSCH, ROBERT I MD	3/3/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30023	41	Internal Medicine	0	In state provider	None	2059 CLINTON AVE	STE 5	ALAMEDA	CA	94501	4379	01	06001	37.76321262	-122.2534547	Alameda County
266834	Fee-for-Service	1609478189	1609478189	1	1	DINUBA OPTOMETRIC CENTER INC	3/1/2020	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	119 S L ST	None	DINUBA	CA	93618	2324	54	06107	36.54055651	-119.3899159	Tulare County
266857	Fee-for-Service	1245291335	1245291335	1	1	DARR,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3580 W 9000 S	None	WEST JORDAN	UT	84088	8899	00	None	40.590153	-111.974634	Salt Lake County
266866	Fee-for-Service	1396708418	1396708418	1	1	DOUGLAS BERGLUND	4/2/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
266880	Fee-for-Service	1437737368	1437737368	1	1	DUAN, MICHAEL MD	8/4/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
266892	Fee-for-Service	1063480978	1063480978	1	1	DAS, PHILLIP K MD	2/1/2002	207L00000X	NA	Other	026	PHYSICIANS	42288	05	Anesthesiology	0	In state provider	None	17101 ARMSTRONG AVE	STE 201	IRVINE	CA	92614	5742	30	06059	33.69524989	-117.8444582	Orange County
266901	Fee-for-Service	1831180587	1831180587	1	1	DAGDAGAN, MARK	4/30/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42621	08	Family Practice	0	In state provider	None	1120 KENSINGTON ST	None	DELANO	CA	93215	2212	15	06029	35.77149567	-119.2434424	Kern County
266906	Fee-for-Service	1053302257	1053302257	1	1	DEFILIPPI, VINCENT J MD	10/21/2008	174400000X	NA	Other	026	PHYSICIANS	88362	02	General Surgery	0	In state provider	None	212 SAN JOSE ST	#301	SALINAS	CA	93901	3928	27	06053	36.65853377	-121.6476066	Monterey County
266907	Fee-for-Service	1346324613	1346324613	2	1	DANG, LONG P MD	5/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	80593	10	Gastroenterology (M.D. only)	0	In state provider	None	10161 BOLSA AVENUE	STE 206-C	WESTMINSTER	CA	92683	6775	30	06059	33.74508538	-117.9521356	Orange County
266911	Fee-for-Service	1417089350	1417089350	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
266913	Fee-for-Service	1205824521	1205824521	1	1	DAMAR MED INDUSTRIES INC	8/20/2004	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	DAMAR MEDICAL INDUSTRIES	12460 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2806	19	06037	33.9186799	-118.1252595	Los Angeles County
266923	Fee-for-Service	1528036464	1528036464	1	1	DAHL, LESLI PSYD	7/4/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	565 CASTRO STREET	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38903016	-122.0819046	Santa Clara County
266945	Fee-for-Service	1295501708	1295501708	1	1	DLR FAMILY MEDICINE MEDICAL	5/16/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	11985 4TH ST STE 102	None	YUCAIPA	CA	92399	2727	36	06071	34.035525	-117.0518615	San Bernardino County
266948	Fee-for-Service	1326587155	1326587155	1	1	DOBLE, KRISTINA CLARISSE M N	2/21/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	P	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
266958	Fee-for-Service	1134200165	1134200165	1	1	DAO, NINA H OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 E 4TH ST	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
266985	Fee-for-Service	1851599179	1851599179	1	1	DR. BASSEM SROUR M.D.	11/6/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 MACARTHUR BLVD	None	MUNSTER	IN	46321	2901	00	None	41.550678	-87.506217	Lake County
267006	Fee-for-Service	1376819276	1376819276	1	1	DUFF, ERIC T CSW	9/5/2019	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2355 CENTRAL AVE	STE 124	MCKINLEYVILLE	CA	95519	3684	12	06023	40.947939	-124.1009125	Humboldt County
267014	Fee-for-Service	1659322071	1659322071	1	1	DESERT PAIN CARE MEDICINE GR	5/21/2019	174400000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	36915 COOK ST	SUITE 102	PALM DESERT	CA	92211	6067	33	06065	33.77987071	-116.3558569	Riverside County
267065	Fee-for-Service	1568465466	1568465466	1	2	DOCTORS ON DUTY MEDICAL GROU	4/25/2023	261QU0200X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	558 ABBOTT ST	A	SALINAS	CA	93901	4326	27	06053	36.66276002	-121.6420145	Monterey County
267128	Fee-for-Service	1144365891	1144365891	1	1	DREADON, RITA S NP	10/5/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	238207	-	NOT APPLICABLE	0	In state provider	None	1310 M STREET	None	FRESNO	CA	93721	1808	10	06019	36.73926478	-119.7905188	Fresno County
267136	Fee-for-Service	1023062320	1023062320	1	1	DICKERSON, RUSSELL W MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	32003	30	Radiology	0	In state provider	None	355 PLACENTIA AVE	None	NEWPORT BEACH	CA	92663	3311	30	06059	33.62672719	-117.9312941	Orange County
267193	Fee-for-Service	1417089350	1417089350	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
267200	Fee-for-Service	1356500656	1356500656	1	1	DASGUPTA, TINA MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111029	30	Radiology	0	In state provider	None	7301 MEDICAL CENTER DR	STE 100	WEST HILLS	CA	91307	2000	19	06037	34.20285756	-118.6294575	Los Angeles County
267202	Fee-for-Service	1194736884	1194736884	1	2	DERENONCOURT, FRANTZ MD	12/15/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54662	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
267232	Fee-for-Service	1295501708	1295501708	1	1	DLR FAMILY MEDICINE MEDICAL	11/6/2024	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP	11985 4TH ST STE 102	None	YUCAIPA	CA	92399	2727	36	06071	34.035525	-117.0518615	San Bernardino County
267297	Fee-for-Service	1548330947	1548330947	1	2	DUTIL, BRIGITTE G LMFT	3/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AND MEDIATION	4433 E VILLAGE RD	SUITE L	LONG BEACH	CA	90808	1538	19	06037	33.83397238	-118.1408189	Los Angeles County
267350	Fee-for-Service	1568465466	1568465466	1	2	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	558 ABBOTT ST	A	SALINAS	CA	93901	4326	27	06053	36.66276002	-121.6420145	Monterey County
267379	Fee-for-Service	1861256182	1861256182	1	1	DINES, MERCEDES DOULA	4/18/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	36	06071	0	0	None
267436	Fee-for-Service	1295100063	1295100063	1	1	DAY LIGHT HOME HEALTH INC	10/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3100 W BURBANK BLVD	#102	BURBANK	CA	91505	2348	19	06037	34.17660763	-118.3444514	Los Angeles County
267444	Fee-for-Service	1356109581	1356109581	1	1	DOULA ADVOKIT LLC	4/8/2024	193200000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
267457	Fee-for-Service	1619087764	1619087764	1	1	DORIA, THOMAS R MD	4/27/2006	207L00000X	NA	Other	026	PHYSICIANS	55337	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
267468	Fee-for-Service	1861509341	1861509341	1	1	DELGADO, SHARON L LMFT	7/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30131 TOWN CENTER DR	STE 280	LAGUNA NIGUEL	CA	92677	2086	30	06059	33.52530096	-117.7148334	Orange County
267476	Fee-for-Service	1417089350	1417089350	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
267477	Fee-for-Service	1356500656	1356500656	1	1	DASGUPTA, TINA MD	10/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111029	78	Neoplastic Diseases/Oncology	0	In state provider	None	7301 MEDICAL CENTER DR	STE 100	WEST HILLS	CA	91307	2000	19	06037	34.20285756	-118.6294575	Los Angeles County
267488	Fee-for-Service	1194736884	1194736884	1	2	DERENONCOURT, FRANTZ MD	12/15/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54662	33	Thoracic Surgery	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
267507	Fee-for-Service	1366744856	1366744856	1	1	DEMIRJIAN, MARY OD INC	2/1/2011	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2915 W MAGNOLIA BLVD	None	BURBANK	CA	91505	3039	19	06037	34.17040349	-118.3395219	Los Angeles County
267538	Fee-for-Service	1467413450	1467413450	1	1	DANISA, OLUMIDE A MD	1/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89015	20	Orthopedic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1500	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
267570	Fee-for-Service	1578947313	1578947313	1	1	DHILLON, AMREEP DPM	10/17/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
267571	Fee-for-Service	1013005636	1013005636	1	1	DEVILLENA, ELAINIE O MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70842	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
267593	Fee-for-Service	1790733400	1790733400	1	1	DEGUCHI, MARIO MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	72150	30	Radiology	0	In state provider	None	457 GREENFIELD AVE	STE 150	HANFORD	CA	93230	3586	16	06031	36.32951016	-119.6581355	Kings County
267617	Fee-for-Service	1730685801	1730685801	1	1	DAWLEY, DIANE T MD	8/15/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
267629	Fee-for-Service	1194380212	1194380212	1	1	DEBLAUW, MICHELLE K AU	11/8/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267632	Fee-for-Service	1568465466	1568465466	1	2	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	558 ABBOTT ST	A	SALINAS	CA	93901	4326	27	06053	36.66276002	-121.6420145	Monterey County
267649	Fee-for-Service	1831900224	1831900224	1	1	DR XINGE HU MD PC	3/11/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	39243 LIBERTY ST	None	FREMONT	CA	94538	1501	01	06001	37.55043899	-121.9813016	Alameda County
267668	Fee-for-Service	1104429570	1104429570	1	1	DR. JAVIER RIOS, A MEDICAL C	11/4/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	LIAR	27625 JEFFERSON AVE	STE. 101	TEMECULA	CA	92590	2619	33	06065	33.51653601	-117.1610206	Riverside County
267691	Fee-for-Service	1366489965	1366489965	1	1	DR. JOCELYN YU ANG MD	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3901 BEAUBIEN ST	None	DETROIT	MI	48201	2119	00	None	42.35164453	-83.05377946	Wayne County
267702	Fee-for-Service	1538272356	1538272356	1	1	DOVER, ARTHUR S MD	6/1/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	243 GREEN VALLEY RD	STE B	FREEDOM	CA	95019	3133	44	06087	36.93890175	-121.7705457	Santa Cruz County
267710	Fee-for-Service	1649310707	1649310707	1	1	DVT DIAGNOSTIC SERVICES INC	7/20/2012	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	9400 BURNET AVE	SUITE 127	NORTH HILLS	CA	91343	7099	19	06037	34.241346	-118.4631445	Los Angeles County
267712	Fee-for-Service	1811573785	1811573785	1	1	DA VINCI HOSPICE CARE INC	6/29/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	107 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2081	19	06037	34.14383611	-118.1504823	Los Angeles County
267727	Fee-for-Service	1346206083	1346206083	1	1	DEEPSHIKHA DATTA	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13103 E MANSFIELD AVE	None	SPOKANE VLY	WA	99216	1642	00	None	47.67755045	-117.228357	Spokane County
267775	Fee-for-Service	1194736884	1194736884	1	2	DERENONCOURT, FRANTZ MD	12/15/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54662	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
267827	Fee-for-Service	1659844934	1659844934	1	1	DIAZ, RITA LPCC	1/31/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
267852	Fee-for-Service	1013005636	1013005636	1	1	DEVILLENA, ELAINIE O MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70842	40	Pediatrics	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
267914	Fee-for-Service	1568465466	1568465466	1	2	DOCTORS ON DUTY MEDICAL GROU	10/1/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	558 ABBOTT ST	A	SALINAS	CA	93901	4326	27	06053	36.66276002	-121.6420145	Monterey County
267930	Fee-for-Service	1831900224	1831900224	1	1	DR XINGE HU MD PC	3/11/2025	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	39243 LIBERTY ST	None	FREMONT	CA	94538	1501	01	06001	37.55043899	-121.9813016	Alameda County
267997	Fee-for-Service	1811573785	1811573785	1	1	DA VINCI HOSPICE CARE INC	6/29/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	107 S FAIR OAKS AVE	STE 215	PASADENA	CA	91105	2081	19	06037	34.14383611	-118.1504823	Los Angeles County
268002	Fee-for-Service	1104988898	1104988898	1	1	DOMINGO FORASTE, DESIREE MD	2/9/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55127	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
268009	Fee-for-Service	1043300536	1043300536	1	1	DAJANI, NAFISA K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIV OF AR MED SVCS	3915 WEST 8TH STREET	None	LITTLE ROCK	AR	72204	0000	00	None	34.743474	-92.317248	Pulaski County
268025	Fee-for-Service	1538377528	1538377528	1	1	DAVIS, JENNIFER L MD	12/2/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	147072	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
268060	Fee-for-Service	1669903738	1669903738	1	1	DOROSHENKO, MAKSYM MD	5/11/2023	207L00000X	NA	Other	026	PHYSICIANS	184466	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
268072	Fee-for-Service	1346603826	1346603826	1	1	DOYLE, MATTHEW DPM	6/27/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
268103	Fee-for-Service	1871571554	1871571554	1	1	DESHA,KELLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20010 CENTURY BLVD	None	GERMANTOWN	MD	20874	1115	00	None	39.18560725	-77.25950536	Montgomery County
268105	Fee-for-Service	1306361605	1306361605	1	1	DHITAL, RASHMI	6/23/2023	207RR0500X	NA	Other	026	PHYSICIANS	172635	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268124	Fee-for-Service	1962814947	1962814947	1	1	DEPPE, NICOLE R MD	5/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140202	08	Family Practice	0	In state provider	None	441 N LAKEVIEW BLVD	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
268149	Fee-for-Service	1639951981	1639951981	1	1	DIEAL, KARIELLE G DOULA	11/29/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
268169	Fee-for-Service	1336187210	1336187210	1	1	DESJARDINS, TOBIAS D LCSW	9/4/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON STREET	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
268201	Fee-for-Service	1982616439	1982616439	1	1	DESA, WATSON A MD INC	11/16/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32717	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3851 KATELLA AVE	STE 305	LOS ALAMITOS	CA	90720	3349	30	06059	33.80319053	-118.0657305	Orange County
268202	Fee-for-Service	1235864539	1235864539	1	1	DHILLON, SUKHMANDER S AU	8/24/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4300 ASHE ROAD	# 111	BAKERSFIELD	CA	93313	2033	15	06029	35.314974	-119.074423	Kern County
268264	Fee-for-Service	1861458721	1861458721	1	1	DAFTARY, ASHOK V MD	5/4/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30233	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
268279	Fee-for-Service	1427069368	1427069368	1	1	DESERT HEMATOLOGY-ONCOLOGY M	12/1/2000	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC.	34490 BOB HOPE	None	RANCHO MIRAGE	CA	92270	1713	33	06065	33.79844194	-116.40586	Riverside County
268346	Fee-for-Service	1720015597	1720015597	1	1	DOUGLAS PETERSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	900 E BROADWAY AVE	None	BISMARCK	ND	58501	4520	00	None	46.807119	-100.7778375	Burleigh County
268373	Fee-for-Service	1871796276	1871796276	1	1	DEITZ, LUKE MC	6/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112512	18	Ophthalmology	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
268395	Fee-for-Service	1053736678	1053736678	1	1	DAWSON, JEREMIAH RH MD	8/25/2014	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	126985	20	Orthopedic Surgery	0	In state provider	MEDICAL CORP	1196 SOUTH MAIN STREET	None	WILLITS	CA	95490	4304	23	06045	39.3999805	-123.3497005	Mendocino County
268444	Fee-for-Service	1588622906	1588622906	1	1	DONABEDIAN, MARAL H MD	5/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54188	41	Internal Medicine	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
268484	Fee-for-Service	1982616439	1982616439	1	1	DESA, WATSON A MD INC	11/16/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	32717	41	Internal Medicine	0	In state provider	None	3851 KATELLA AVE	STE 305	LOS ALAMITOS	CA	90720	3349	30	06059	33.80319053	-118.0657305	Orange County
268517	Fee-for-Service	1164262887	1164262887	1	1	DECHANT, THOMAS J CRNA	6/24/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
268546	Fee-for-Service	1861458721	1861458721	1	1	DAFTARY, ASHOK V MD	5/4/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30233	38	Geriatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
268563	Fee-for-Service	1427069368	1427069368	1	1	DESERT HEMATOLOGY-ONCOLOGY M	4/29/2010	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP, INC.	34490 BOB HOPE	None	RANCHO MIRAGE	CA	92270	1713	33	06065	33.79844194	-116.40586	Riverside County
268582	Fee-for-Service	1447357330	1447357330	1	1	DYNER, TOBY S MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	51900	41	Internal Medicine	0	In state provider	None	45 CASTRO ST	STE 332	SAN FRANCISCO	CA	94114	1019	38	06075	37.76829732	-122.4357056	San Francisco County
268603	Fee-for-Service	1134474158	1134474158	1	1	DURAN, DIANA V LMFT	5/25/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4701 VON KARMAN AVE	STE 323	NEWPORT BEACH	CA	92660	8145	30	06059	33.66894215	-117.8600003	Orange County
268650	Fee-for-Service	1063769883	1063769883	1	1	DUTTON, PASCUAL H MD	1/2/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	129631	None	None	0	In state provider	None	6719 ALVARADO ROAD	SUITE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
268658	Fee-for-Service	1245338185	1245338185	1	1	DELMONACO, BRIAN L MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
268684	Fee-for-Service	1063830271	1063830271	1	1	DAVIS, GRAHAM W DO	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
268690	Fee-for-Service	1881222636	1881222636	1	1	DAO, TUNG V DPM	7/11/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
268705	Fee-for-Service	1972596062	1972596062	1	1	DO, THI KIM TOAN	1/14/1988	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TANA PHARMACY	10512 BOLSA AVE	None	WESTMINSTER	CA	92683	6727	30	06059	33.74498451	-117.94581	Orange County
268750	Fee-for-Service	1104802503	1104802503	1	1	DAWSON, DAVID LEE MD	10/4/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86663	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
268755	Fee-for-Service	1376642769	1376642769	1	1	DIGIOVANNI, ANTHONY P MD	2/3/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	87688	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
268757	Fee-for-Service	1053979096	1053979096	1	1	DUNN, JOY L	5/19/2023	225700000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
268841	Fee-for-Service	1588116974	1588116974	1	1	DAY, KAYLA LCSW	3/7/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
268879	Fee-for-Service	1154385409	1154385409	1	1	DELOGE, JON A CRNA	9/4/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
268911	Fee-for-Service	1962579854	1962579854	1	1	DARAKJIAN, ANI B MD	9/19/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	51260	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
268916	Fee-for-Service	1194878926	1194878926	1	1	DOAN, PHI	1/2/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13916 BROOKHURST ST	STE F	GARDEN GROVE	CA	92843	4331	30	06059	33.761034	-117.954832	Orange County
269005	Fee-for-Service	1649311838	1649311838	1	1	DUBEY, ARCHANA MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69049	08	Family Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
269021	Fee-for-Service	1841339868	1841339868	1	1	DELEA, SUZANNE L MD	2/18/2025	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
269025	Fee-for-Service	1952695694	1952695694	1	1	DE LEON, ANNE MICHELLE	10/7/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
269068	Fee-for-Service	1659599538	1659599538	1	1	DEMPSEY, BRETT MD	11/27/2023	208600000X	NA	General Surgery	026	PHYSICIANS	188588	None	None	0	In state provider	None	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
269100	Fee-for-Service	1720306756	1720306756	1	1	DORAM, KEITH R MD	1/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52927	41	Internal Medicine	0	In state provider	None	75 N 13TH STREET	None	SAN JOSE	CA	95112	3439	43	06085	37.34299596	-121.8788519	Santa Clara County
269128	Fee-for-Service	1639514441	1639514441	1	1	DELGADO, ISAMAR LMFT	10/6/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
269151	Fee-for-Service	1457643751	1457643751	1	1	DAI, TIANE MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114216	45	Nephrology (Renal-Kidney)	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
269172	Fee-for-Service	1386655413	1386655413	1	1	DONG, TAMMY M MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66903	40	Pediatrics	0	In state provider	None	1400 S GRAND AVE	None	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
269185	Fee-for-Service	1679782387	1679782387	1	1	DIDOMENICO, PAUL J MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106339	30	Radiology	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
269196	Fee-for-Service	1245439983	1245439983	1	1	DE HAAS, ADRIENNE R LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
269211	Fee-for-Service	1194878926	1194878926	1	1	DOAN, PHI	7/29/2011	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13916 BROOKHURST ST	STE F	GARDEN GROVE	CA	92843	4331	30	06059	33.761034	-117.954832	Orange County
269237	Fee-for-Service	1770066375	1770066375	1	1	DAVIS, DEBORAH	12/14/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1261 TRAVIS BLVD	SUITE 140	FAIRFIELD	CA	94533	4897	48	06095	38.25812361	-122.0495417	Solano County
269256	Fee-for-Service	1437321932	1437321932	1	1	DAO, MICHAEL M MD	11/7/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	51334	None	None	0	In state provider	None	9191 WESTMINSTER AVE	None	GARDEN GROVE	CA	92844	2751	30	06059	33.75946879	-117.9688437	Orange County
269268	Fee-for-Service	1396303236	1396303236	1	1	D'OTO, ALEXANDRA D MD	6/14/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
269278	Fee-for-Service	1639331630	1639331630	1	1	DAUGHARTHY, JENNIFER L MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
269279	Fee-for-Service	1285826248	1285826248	1	1	DELVALLEBLOGG, ANTOINETTE M	3/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	7063	40	Pediatrics	0	In state provider	None	1401 AVOCADO AVE	STE 802	NEWPORT BEACH	CA	92660	7720	30	06059	33.61235015	-117.8704573	Orange County
269378	Fee-for-Service	1285056903	1285056903	1	1	DELANEY, SEAN W MD	6/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128403	04	Otology, Laryngology, Rhinology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
269396	Fee-for-Service	1932542396	1932542396	1	1	DANAKIAN, LUSINE MD	7/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134484	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
269405	Fee-for-Service	1902669765	1902669765	1	1	DEL SOLAR, KARIE V LCSW	3/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
269427	Fee-for-Service	1457643751	1457643751	1	1	DAI, TIANE MD	6/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114216	41	Internal Medicine	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
269456	Fee-for-Service	1053632877	1053632877	1	1	DEI ROSSI, ELIZABETH R MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4053 LONE TREE WAY	STE 101	ANTIOCH	CA	94531	6210	07	06013	37.97569499	-121.800733	Contra Costa County
269489	Fee-for-Service	1558382242	1558382242	1	1	DAVENPORT, ELAINE E MD	1/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77450	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
269503	Fee-for-Service	1639221435	1639221435	1	1	DOS SANTOS, PAULO A L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30720	42	Nuclear Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
269532	Fee-for-Service	1548641418	1548641418	1	1	DICHIACCHIO, LAURA N MD	8/23/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
269620	Fee-for-Service	1770594699	1770594699	1	1	DENEAU, DAVID G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	21972	07	Dermatology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
269633	Fee-for-Service	1790756211	1790756211	1	1	DAHL, KAREN M MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	83801	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
269678	Fee-for-Service	1386675452	1386675452	1	1	DEGUZMAN, ROSALIE A MD	3/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	39804	40	Pediatrics	0	In state provider	INC	823 S MAIN ST	# 100	CORONA	CA	92882	3421	33	06065	33.87244032	-117.5668207	Riverside County
269694	Fee-for-Service	1104905835	1104905835	1	1	DAVIS, LAWRENCE G MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	76884	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
269743	Fee-for-Service	1932137486	1932137486	1	1	DUANE LAMBERT MD	5/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
269750	Fee-for-Service	1578611406	1578611406	1	1	DEWAR, MELANIE S MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86464	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
269769	Fee-for-Service	1376521005	1376521005	2	1	DORIA, ROBERT MD	11/12/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54180	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1941 JOHNSON AVE	STE 101	SAN LUIS OBISPO	CA	93401	4154	40	06079	35.27804785	-120.649711	San Luis Obispo County
269780	Fee-for-Service	1639221435	1639221435	1	1	DOS SANTOS, PAULO A L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30720	30	Radiology	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
269846	Fee-for-Service	1982174660	1982174660	1	1	DEUTSCH, MONICA PT	8/4/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
269912	Fee-for-Service	1629001383	1629001383	1	1	DANESHVAR, HOMAYOUN H MD	3/6/1996	207L00000X	NA	Other	026	PHYSICIANS	39623	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
269944	Fee-for-Service	1982726865	1982726865	1	1	DALTON, CATHERINE I MD	5/4/2020	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	162908	25	Physical Medicine and Rehabilitation	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
270053	Fee-for-Service	1386643856	1386643856	2	1	DYNASPLINT SYSTEMS INC	4/8/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	770 RITCHIE HIGHWAY	SUITE W-21	SEVERNA PARK	MD	21146	4152	00	None	39.06681444	-76.53635827	Anne Arundel County
270058	Fee-for-Service	1639221435	1639221435	1	1	DOS SANTOS, PAULO A L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30720	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
270072	Fee-for-Service	1831457589	1831457589	1	1	DJOKAKLIAN, JULIANA S MD	1/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13180	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
270091	Fee-for-Service	1841721867	1841721867	1	2	DAVIDOWITZ, ANDREW MD	2/12/2025	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	162264	-	NOT APPLICABLE	0	In state provider	None	2330 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2220	19	06037	34.0681396	-118.2738016	Los Angeles County
270104	Fee-for-Service	1811437304	1811437304	1	1	D'ANNIBALE, NATALIE C LMFT	6/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	28616 FARRIER DR	None	VALENCIA	CA	91354	4503	19	06037	34.45609981	-118.5736692	Los Angeles County
270110	Fee-for-Service	1710931910	1710931910	1	1	DIAGNOSTIC RADIOLOGICAL	9/24/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	IMAGING MEDICAL GROUP	79 SCRIPPS DR	STE 100	SACRAMENTO	CA	95825	6208	34	06067	38.572911	-121.4105085	Sacramento County
270122	Fee-for-Service	1346535960	1346535960	1	1	DEZURE, CHANDANI P MD	2/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159923	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
270145	Fee-for-Service	1700825171	1700825171	1	1	DOUER, DAN MD	4/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	36194	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
270155	Fee-for-Service	1912160185	1912160185	1	1	DE LEON, TATE A MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	115841	01	General Practice	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
270211	Fee-for-Service	1083756027	1083756027	1	1	DIBLASI, ROBERT J MD	1/1/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	30478	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
270247	Fee-for-Service	1801984596	1801984596	2	1	DAO, LE MD	11/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	44435	40	Pediatrics	0	In state provider	None	14554 BROOKHURST STREET	None	WESTMINSTER	CA	92683	5750	30	06059	33.7515705	-117.9548401	Orange County
270285	Fee-for-Service	1205996469	1205996469	1	1	DUCKETT, MATTHEW I LMFT	7/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
270299	Fee-for-Service	1639125578	1639125578	1	1	DASIG, ALEXIS L MD	2/28/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	32516	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
270378	Fee-for-Service	1063808947	1063808947	1	1	DAVIDOFF, LORI M LMFT	9/11/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	822 G STREET	SUITE 6	ARCATA	CA	95521	6224	12	06023	40.86821305	-124.0859305	Humboldt County
270391	Fee-for-Service	1447436266	1447436266	1	1	DIERCKMAN, BRIAN D MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115842	20	Orthopedic Surgery	0	In state provider	None	6815 NOBLE AVENUE	None	VAN NUYS	CA	91405	3730	19	06037	34.19440435	-118.461871	Los Angeles County
270438	Fee-for-Service	1730198193	1730198193	1	1	DAUG, ROY P D MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54311	40	Pediatrics	0	In state provider	None	8787 HALL RD	None	LAMONT	CA	93241	1953	15	06029	35.25969451	-118.908099	Kern County
270445	Fee-for-Service	1225851371	1225851371	1	1	DOCTOR VOLODARSKAYA FAMILY P	3/26/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	RACTICE	5346 MADISON AVE	SUITE D AND E	SACRAMENTO	CA	95841	3166	34	06067	38.660319	-121.3393905	Sacramento County
270446	Fee-for-Service	1861926669	1861926669	1	1	DAVID KAGAN MD INC	5/29/2020	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1340 15TH STREET	None	SANTA MONICA	CA	90404	1802	19	06037	34.02545225	-118.4855666	Los Angeles County
270447	Fee-for-Service	1750375218	1750375218	1	1	DINGEMAN, ROBERT S MD	11/12/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88075	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
270453	Fee-for-Service	1700101383	1700101383	1	1	DE FOUR, AMANDA R MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118058	41	Internal Medicine	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
270457	Fee-for-Service	1598824211	1598824211	1	1	DOMINGO, NOEL M NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
270476	Fee-for-Service	1487331484	1487331484	1	1	DEPENDABLE DIAMOND TRANSPORT	9/19/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ATION	12440 FIRESTONE BLVD	SUITE# 3025, OFFICE J	NORWALK	CA	90650	9331	19	06037	33.90523023	-118.0681168	Los Angeles County
270495	Fee-for-Service	1043415888	1043415888	1	1	DEER, MELISSA E MD	9/30/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	107921	-	NOT APPLICABLE	0	In state provider	None	10159 MISSION GORGE RD.	C, D, E, F, G	SANTEE	CA	92071	3857	37	06073	32.83844151	-116.976096	San Diego County
270511	Fee-for-Service	1033650478	1033650478	1	1	DIAZ, CELSO L MD	4/28/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	170157	None	None	0	In state provider	None	3500 LOMITA BLVD	300, 302, M100	TORRANCE	CA	90505	5038	19	06037	33.81384593	-118.3465974	Los Angeles County
270649	Fee-for-Service	1013467216	1013467216	1	1	DINKLER, SARAH CNM	3/28/2018	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	200 SOUTH WELLS ROAD	100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
270707	Fee-for-Service	1225505738	1225505738	1	1	DE GUIA, DEMI VICTORIA P PT	4/1/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
270729	Fee-for-Service	1487674693	1487674693	1	1	DASZKO, JAROM A MD	7/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	72860	None	None	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
270731	Fee-for-Service	1356534994	1356534994	1	1	DAVIS, CEDRIC MD	7/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
270747	Fee-for-Service	1013909225	1013909225	1	1	DAVIS, WILLIAM F MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	69230	02	General Surgery	0	In state provider	None	2010 E FIRST ST	STE 270	SANTA ANA	CA	92705	4083	30	06059	33.74554507	-117.8387522	Orange County
270779	Fee-for-Service	1225197213	1225197213	1	1	DALY, MICHAEL JAMES	2/8/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2305 COURT ST	None	REDDING	CA	96001	2527	45	06089	40.57550148	-122.3926024	Shasta County
270782	Fee-for-Service	1508812926	1508812926	1	1	DOYLE, WILLIAM L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 WESTWOOD DR	None	HAMILTON	MT	59840	2345	00	None	46.248102	-114.1718175	Ravalli County
270784	Fee-for-Service	1659979433	1659979433	1	1	DIVERSITY HOME HEALTH INC	1/31/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	229 N CENTRAL AVE	STE 402	GLENDALE	CA	91203	3542	19	06037	34.14910181	-118.2579537	Los Angeles County
270788	Fee-for-Service	1396780763	1396780763	1	1	DIKRANIAN, HAGOP A MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	37794	34	Urology and Urological Surgery	0	In state provider	None	901 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08588	-118.123089	Los Angeles County
270815	Fee-for-Service	1467529313	1467529313	1	1	DANIELS, JEEVAN S DO	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	7697	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
270878	Fee-for-Service	1407914757	1407914757	1	1	DEMANES, DAVID J MD	6/1/1993	174400000X	NA	Other	026	PHYSICIANS	29678	47	Miscellaneous	0	In state provider	None	365 34TH ST	None	OAKLAND	CA	94609	2814	01	06001	37.82206763	-122.2621954	Alameda County
270909	Fee-for-Service	1255399960	1255399960	1	1	DESHPANDE, SATISH K MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56174	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
270956	Fee-for-Service	1477843373	1477843373	1	1	DIRDA, TYLER R MD	1/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145904	05	Anesthesiology	0	In state provider	None	616 E CHAPEL ST	None	SANTA MARIA	CA	93456	6406	42	06083	34.95426953	-120.427596	Santa Barbara County
271004	Fee-for-Service	1508073057	1508073057	1	1	DIXIT, RAHUL MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126290	10	Gastroenterology (M.D. only)	0	In state provider	None	1301 20TH ST	STE 280	SANTA MONICA	CA	90404	2087	19	06037	34.02976782	-118.4812493	Los Angeles County
271009	Fee-for-Service	1851734388	1851734388	1	1	DESLOOVER, TANYA S LMFT	2/12/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
271019	Fee-for-Service	1366062069	1366062069	1	1	DAVIS, JOSHUA B MD	1/17/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192258	None	None	0	In state provider	None	7600 OLD DOMINION CT	None	APTOS	CA	95003	3821	44	06087	36.97913818	-121.9099818	Santa Cruz County
271039	Fee-for-Service	1740230333	1740230333	1	2	DHANUKA, PIYUSH K MD	1/4/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	94647	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
271054	Fee-for-Service	1184962565	1184962565	1	1	DIAZ DE GIMENEZ, LIZMER MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131242	41	Internal Medicine	0	In state provider	None	2601 E MAIN ST	SUITE 104	VENTURA	CA	93003	2801	56	06111	34.27443821	-119.2609368	Ventura County
271108	Fee-for-Service	1578568432	1578568432	1	1	DEEMER, ANDREW MD DBA	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66191	01	General Practice	0	In state provider	COASTAL SURGN MED OFFICE	3998 VISTA WAY	STE C200	OCEANSIDE	CA	92056	4519	37	06073	33.18370179	-117.292963	San Diego County
271131	Fee-for-Service	1992839377	1992839377	1	1	DENURE HARNDEN, TARRAH S LMF	8/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LEY FAMILY THERAPY	585 B COLLIER WAY	None	ETNA	CA	96027	9998	47	06093	41.46280474	-122.8966109	Siskiyou County
271176	Fee-for-Service	1093911760	1093911760	1	1	DR ROBYN CHACE	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
271181	Fee-for-Service	1972828085	1972828085	1	1	DURFEE FAMILY CARE MEDICAL	6/25/1996	193400000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	GROUP, APC	2006 DURFEE AVE	None	EL MONTE	CA	91733	3713	19	06037	34.04578162	-118.0297235	Los Angeles County
271212	Fee-for-Service	1417485392	1417485392	1	1	DOWD, SUSAN M NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
271229	Fee-for-Service	1053517177	1053517177	1	1	DEWEESE, DIANE E PT	10/19/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
271293	Fee-for-Service	1255313565	1255313565	1	1	DAVID, FREDERICK M MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28035	01	General Practice	0	In state provider	None	1555 EAST ST	STE 210	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
271324	Fee-for-Service	1609948983	1609948983	1	1	DIAGNOSTIC PATHOLOGY MEDICAL	10/7/2013	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP	11815 EDUCATION STREET	None	AUBURN	CA	95602	2410	31	06061	38.94431878	-121.1009419	Placer County
271339	Fee-for-Service	1336157445	1336157445	1	1	DREW, DENIS W MD	5/25/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23367	41	Internal Medicine	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
271350	Fee-for-Service	1972037349	1972037349	1	1	DOO, FLORENCE X MD	6/21/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175198	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
271401	Fee-for-Service	1558476663	1558476663	1	1	DAMANIA, ZUBIN R MD	4/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72951	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
271434	Fee-for-Service	1346326394	1346326394	1	1	DELALOZA, DAVID MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	82210	None	None	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
271488	Fee-for-Service	1538371752	1538371752	1	1	DINARTE, BETTY M MD	5/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55019	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
271512	Fee-for-Service	1568689040	1568689040	1	1	DANDEKAR, APARNA A DO	2/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8789	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
271528	Fee-for-Service	1649917931	1649917931	1	1	DR EMELLINE CHEN OD OPTOMETR	9/22/2022	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	Y	36330 HIDDEN SPRINGS RD	STE A	WILDOMAR	CA	92595	5804	33	06065	33.59339735	-117.2454691	Riverside County
271541	Fee-for-Service	1659437291	1659437291	1	1	DOLGOFF, ROBERT K MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21844	36	Psychiatry	0	In state provider	None	1080 EMELINE AVE	None	SANTA CRUZ	CA	95060	1966	44	06087	36.99191102	-122.0176744	Santa Cruz County
271572	Fee-for-Service	1255313565	1255313565	1	1	DAVID, FREDERICK M MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	28035	41	Internal Medicine	0	In state provider	None	1555 EAST ST	STE 210	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
271574	Fee-for-Service	1750926176	1750926176	1	1	DELOS REYES, LIZA MARIE G PT	4/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
271615	Fee-for-Service	1336157445	1336157445	1	1	DREW, DENIS W MD	5/25/1979	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	23367	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4320	01	06001	37.76333626	-122.253868	Alameda County
271760	Fee-for-Service	1558689786	1558689786	1	1	DARR, JASON M LMFT	1/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 W F ST	None	ONTARIO	CA	91762	3205	36	06071	34.06932	-117.6542865	San Bernardino County
271798	Fee-for-Service	1457713505	1457713505	1	1	DAVTYAN, ARPINE MD	7/14/2023	390200000X	NA	Other	026	PHYSICIANS	153435	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
271807	Fee-for-Service	1518674126	1518674126	1	1	DAVIS, SHANICA CD	6/15/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
271842	Fee-for-Service	1609151125	1609151125	1	1	DESAI, ARPITA MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133686	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
271888	Fee-for-Service	1033370499	1033370499	1	1	DOTSON,JENNIFER	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
271918	Fee-for-Service	1346326394	1346326394	1	3	DE LA LOZA, DAVID MD	4/28/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82210	-	NOT APPLICABLE	0	In state provider	None	5232 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5710	19	06037	34.09810648	-118.304811	Los Angeles County
271950	Fee-for-Service	1023205002	1023205002	1	1	DAVID SOSNOFF	3/1/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
272017	Fee-for-Service	1942261904	1942261904	2	1	DUBER, ROGER D DO	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	4904	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	685 N 13TH AVENUE	#9	UPLAND	CA	91786	4165	36	06071	34.10202219	-117.6339091	San Bernardino County
272143	Fee-for-Service	1932391885	1932391885	1	1	DANCZ, CHRISTINA E MD	6/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	93957	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500 SAN PABLO	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
272157	Fee-for-Service	1003841735	1003841735	1	1	DEMARA, STEPHANIE	5/31/1994	207L00000X	NA	Other	026	PHYSICIANS	78772	05	Anesthesiology	0	In state provider	None	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
272207	Fee-for-Service	1215055884	1215055884	1	1	DAVE, MARION A LMFT	3/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3510 TORRANCE BLVD	SUITE 216	TORRANCE	CA	90503	4823	19	06037	33.83756756	-118.3469036	Los Angeles County
272377	Fee-for-Service	1992250948	1992250948	1	1	DO, NGUYEN T DO INC	5/10/2016	207T00000X	NA	General Surgery	026	PHYSICIANS	9031	14	Neurological Surgery	0	In state provider	None	2301 CAMINO RAMON	STE 140	SAN RAMON	CA	94583	2000	07	06013	37.77574883	-121.9663326	Contra Costa County
272382	Fee-for-Service	1447247853	1447247853	1	1	DHAWAN, PUNEET MD INC	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66066	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	1310 W STEWART DRIVE	SUITE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
272404	Fee-for-Service	1053317362	1053317362	1	1	DAY SURGERY AT RENAISSAN	7/14/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	5501 S MCCOLL RD	None	EDINBURG	TX	78539	9152	00	None	26.25257119	-98.20410216	Hidalgo County
272419	Fee-for-Service	1801901749	1801901749	1	1	DARTEY, MAXWELL A MD INC	12/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	33447	None	None	0	In state provider	None	1360 W 6TH STREET	SUITE 220	SAN PEDRO	CA	90732	3514	19	06037	33.73886546	-118.3075065	Los Angeles County
272459	Fee-for-Service	1750443198	1750443198	1	1	DOOLITTLE, SAMUEL W MD	6/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	27746	01	General Practice	0	In state provider	None	1480 S HARBOR BLVD	STE 12	LA HABRA	CA	90631	7569	30	06059	33.91276851	-117.931697	Orange County
272483	Fee-for-Service	1497826523	1497826523	1	1	DENG, BAI QING	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	22 ROSS ALY	None	SAN FRANCISCO	CA	94108	1204	38	06075	37.79560208	-122.407356	San Francisco County
272601	Fee-for-Service	1699988113	1699988113	1	1	DUNNE, DIANE L PHD	10/31/1991	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1226 BAYPOINTE DR	None	NEWPORT BEACH	CA	92660	8514	30	06059	33.64979475	-117.8656472	Orange County
272611	Fee-for-Service	1881699346	1881699346	1	1	DUZ-MOR DIAGNOSTIC LAB	1/20/1978	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2700 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2436	19	06037	33.95989254	-118.323693	Los Angeles County
272651	Fee-for-Service	1447247853	1447247853	1	1	DHAWAN, PUNEET MD INC	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66066	33	Thoracic Surgery	0	In state provider	None	1310 W STEWART DRIVE	SUITE 503	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
272675	Fee-for-Service	1053317362	1053317362	1	1	DAY SURGERY AT RENAISSAN	7/14/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	LLC	5501 S MCCOLL RD	None	EDINBURG	TX	78539	9152	00	None	26.25257119	-98.20410216	Hidalgo County
272804	Fee-for-Service	1992762496	1992762496	1	1	DUH, QUAN-YANG MD	12/31/1993	208600000X	NA	General Surgery	026	PHYSICIANS	48212	02	General Surgery	0	In state provider	BOX 7921	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
272814	Fee-for-Service	1497759096	1497759096	1	1	DINNEL, MICHAEL L DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	986 VISTA VILLAGE DR	None	VISTA	CA	92084	6064	37	06073	33.20531924	-117.2371821	San Diego County
272844	Fee-for-Service	1417212564	1417212564	1	1	DEREKA, NATALIE PT	12/14/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12411 POWAY RD	STE 202B	POWAY	CA	92064	4302	37	06073	32.95170468	-117.0621893	San Diego County
272867	Fee-for-Service	1720849946	1720849946	1	1	DAABOUL, MAYA PT	1/30/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2221 WANKEL WAY	None	OXNARD	CA	93030	0192	56	06111	34.21677352	-119.1475125	Ventura County
272878	Fee-for-Service	1639327315	1639327315	1	1	DESAI, HEALTHY J MD	4/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114098	None	None	0	In state provider	None	1041 N CHINA LAKE BLVD	STE B	RIDGECREST	CA	93555	3130	15	06029	35.63953945	-117.669891	Kern County
272889	Fee-for-Service	1669937686	1669937686	1	1	DE LA MORA, NAOMI LCSW	1/5/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
272947	Fee-for-Service	1366621567	1366621567	1	1	DIRKSEN, TAMMY L	10/8/2003	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2039 N FINE AVE	None	FRESNO	CA	93727	1512	10	06019	36.76905227	-119.7285775	Fresno County
273057	Fee-for-Service	1679836084	1679836084	1	9	DHP OF CALIFORNIA MEDICAL GR	6/8/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	OUP INC	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
273152	Fee-for-Service	1801830211	1801830211	1	1	DIGIAMARINO, EDWARD MD	8/31/1985	207L00000X	NA	Other	026	PHYSICIANS	53341	05	Anesthesiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
273165	Fee-for-Service	1881280519	1881280519	1	1	DESENA, MICHAEL LCSW	10/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41880 KALMIA STREET	UNIT 115	MURRIETA	CA	92562	1297	33	06065	33.55740114	-117.2157733	Riverside County
273234	Fee-for-Service	1699100289	1699100289	1	1	DEMOSS, SONIA D CA	8/7/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
273284	Fee-for-Service	1467450155	1467450155	1	1	DACUS, JAMES D III MD	7/31/1984	207R00000X	NA	Other	026	PHYSICIANS	39808	41	Internal Medicine	0	In state provider	None	230 SAN JOSE ST	None	SALINAS	CA	93901	3901	27	06053	36.65837657	-121.6469645	Monterey County
273328	Fee-for-Service	1679836084	1679836084	1	9	DHP OF CALIFORNIA MEDICAL GR	10/4/2022	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	OUP INC	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
273355	Fee-for-Service	1518043033	1518043033	1	1	DEBREZION, TEKIE T MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91247	08	Family Practice	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
273416	Fee-for-Service	1003436692	1003436692	1	1	DALY, JAMES DO	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	20905	None	None	0	In state provider	None	147 N BRENT STREET	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
273417	Fee-for-Service	1831399229	1831399229	1	1	DHILLON, GURPREET S MD	7/13/2010	208200000X	NA	General Surgery	026	PHYSICIANS	104754	24	Plastic Surgery	0	In state provider	None	317 ROSECRANS AVE	None	MANHATTAN BEACH	CA	90266	3241	19	06037	33.90124824	-118.4173142	Los Angeles County
273432	Fee-for-Service	1275943193	1275943193	1	1	DELSHAD, REBECCA M OD	6/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 NORTH BRAND BLVD	SUITE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
273440	Fee-for-Service	1174695977	1174695977	1	1	DAWSON, JIAN C MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65155	22	Pathology (M.D. only)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
273534	Fee-for-Service	1477584902	1477584902	1	1	DAVIS CHIROPRACTIC	12/11/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	100 E ROMIE LN	STE 4	SALINAS	CA	93901	3167	27	06053	36.66197644	-121.6550581	Monterey County
273564	Fee-for-Service	1447320569	1447320569	1	1	DABRAL, MUDIT MD	11/2/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1505 SHEPARD DR	STE 105	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
273595	Fee-for-Service	1578743894	1578743894	1	1	DOBALIAN, DANIEL D MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	41926	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
273612	Fee-for-Service	1346339884	1346339884	1	1	DESERT VALLEY ORTHOPEDIC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51163	20	Orthopedic Surgery	0	In state provider	SURGERY	1669 W AVENUE J	STE 201	LANCASTER	CA	93534	2869	19	06037	34.68944746	-118.1608785	Los Angeles County
273663	Fee-for-Service	1477873784	1477873784	1	1	DURAN-GHEORGHE, HILCIAS MD	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148252	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
273699	Fee-for-Service	1427084722	1427084722	1	1	DREYFUS, EVE MD	6/24/2024	2084P0804X	NA	Psychiatry	026	PHYSICIANS	46447	36	Psychiatry	0	In state provider	None	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
273732	Fee-for-Service	1902139900	1902139900	1	1	D'AVELLA, JUSTIN M PSYD	6/15/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	409 13TH	STE 1900	OAKLAND	CA	94612	2605	01	06001	37.80326679	-122.2707988	Alameda County
273784	Fee-for-Service	1114973914	1114973914	1	1	DESERT VALLEY MEDICAL	11/1/1995	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP INC	17450 MAIN ST	None	HESPERIA	CA	92345	6298	36	06071	34.41871211	-117.2821748	San Bernardino County
273831	Fee-for-Service	1447320569	1447320569	1	1	DABRAL, MUDIT MD	11/2/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1505 SHEPARD DR	STE 105	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
273869	Fee-for-Service	1801524723	1801524723	1	1	DESERT PRIMARY QUALITY HEALT	11/15/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	HCARE INC	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
273885	Fee-for-Service	1255362802	1255362802	1	1	DESAI, VASUDEVA R MD	11/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	29486	None	None	0	In state provider	None	2001 ZINFANDEL DR	STE A1	RANCHO CORDOVA	CA	95670	4265	34	06067	38.611782	-121.271499	Sacramento County
273970	Fee-for-Service	1295737401	1295737401	1	1	DOS PALOS MEMORIAL HOSP	4/8/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	2118 MARGUERITE ST	None	DOS PALOS	CA	93620	2339	24	06047	36.98679421	-120.6293768	Merced County
274046	Fee-for-Service	1174148027	1174148027	1	1	DICENZO, NATALIE MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
274070	Fee-for-Service	1891036364	1891036364	1	1	DEL VALLE, JANINE N	6/5/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
274121	Fee-for-Service	1558424440	1558424440	1	1	D'AUGUSTINE, STEPHANIE L	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72885	40	Pediatrics	0	In state provider	MD	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
274125	Fee-for-Service	1134466493	1134466493	1	1	DELA CUESTA, SUZANNE M MD	5/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	145439	08	Family Practice	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
274134	Fee-for-Service	1013981984	1013981984	1	1	DVA RENAL HEALTHCARE INC	1/20/1999	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES DOWNTOWN	2021 S FLOWER ST	None	LOS ANGELES	CA	90007	1342	19	06037	34.03195972	-118.2720571	Los Angeles County
274153	Fee-for-Service	1275382178	1275382178	1	1	DORY, KYLE M LMFT	11/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
274337	Fee-for-Service	1700032729	1700032729	1	1	DALAL, APARNA R MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	103842	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
274349	Fee-for-Service	1790879369	1790879369	1	2	DEL PIERO, ERIC J MD	1/31/1985	207W00000X	NA	Ophthalmology	026	PHYSICIANS	46085	18	Ophthalmology	0	In state provider	None	871 CASS ST	STE 200	MONTEREY	CA	93940	2917	27	06053	36.59360797	-121.8956769	Monterey County
274381	Fee-for-Service	1912012824	1912012824	1	1	DUWE, BEAU V MD	8/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	98194	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
274420	Fee-for-Service	1841557477	1841557477	1	1	DHILLON, ROBINDER J MD	4/16/2018	207RR0500X	NA	Other	026	PHYSICIANS	150689	83	Rheumatology	0	In state provider	None	10390 COLOMA AVENUE	B	RANCHO CORDOVA	CA	95670	2152	34	06067	38.596176	-121.3042725	Sacramento County
274491	Fee-for-Service	1023038411	1023038411	1	1	DIAZ, IAN B MD	12/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	128213	08	Family Practice	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
274520	Fee-for-Service	1962260208	1962260208	1	1	DERM LOUNGE PC	7/10/2024	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	1713 W KATELLA AVE	None	ANAHEIM	CA	92804	6450	30	06059	33.8033013	-117.9419025	Orange County
274540	Fee-for-Service	1962509109	1962509109	1	1	DERMATOLOGY SURGICAL &	2/28/1992	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	MEDICAL GROUP	1661 SOQUEL DR	STE E	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
274548	Fee-for-Service	1740489178	1740489178	1	1	DUNNE, WENDY L LMFT	9/13/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1368 LINCOLN AVE	STE 108	SAN RAFAEL	CA	94901	2122	21	06041	37.97742613	-122.5223006	Marin County
274596	Fee-for-Service	1982860664	1982860664	1	1	DOVE, JANET H NP	6/9/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
274616	Fee-for-Service	1316031917	1316031917	1	1	DONALD, FIONA A MD	4/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53312	01	General Practice	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
274629	Fee-for-Service	1164811568	1164811568	1	2	DAO, JASMIN MD	8/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132098	79	Neurology-Child	0	In state provider	None	2880 ATLANTIC AVE	SUITE 260	LOS ANGELES	CA	90806	1714	19	06037	33.809382	-118.185001	Los Angeles
274643	Fee-for-Service	1881801405	1881801405	1	1	DR CHRISTINA MORCH	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST LUKES REGIONAL MD	3101 E STATE ST	None	EAGLE	ID	83616	0000	00	None	43.68295931	-116.315383	Ada County
274654	Fee-for-Service	1821636598	1821636598	1	1	DEVINE, SARA M CNP	3/25/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
274657	Fee-for-Service	1396914792	1396914792	1	1	DIABETIC MEDIC, LLC	10/20/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	DIABETIC MEDIC, LLC	2265 ROSWELL RD	STE 100	MARIETTA	GA	30062	2980	00	None	33.97365488	-84.48514552	Cobb County
274667	Fee-for-Service	1639198666	1639198666	1	1	DE SANTI, MARK A MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77300	05	Anesthesiology	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
274798	Fee-for-Service	1336588870	1336588870	1	2	DIGNITY HEALTH	12/12/2014	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
274863	Fee-for-Service	1811956063	1811956063	1	1	DARZYNKIEWICZ, ROBERT J	12/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
274891	Fee-for-Service	1699157321	1699157321	1	1	DUMAIS, CANDICE OT	9/1/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
274908	Fee-for-Service	1033673140	1033673140	1	1	DEFRAN, ZACHARY P LMFT	11/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
274918	Fee-for-Service	1114956273	1114956273	1	1	DAN CAPAMPANGAN MD	10/17/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1955 W FRYE RD	None	CHANDLER	AZ	85224	6282	00	None	33.297705	-111.8736495	Maricopa County
274932	Fee-for-Service	1174538755	1174538755	2	1	D&R PHARMACY INC	1/22/2016	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1273 S UNION AVE	None	LOS ANGELES	CA	90015	2043	19	06037	34.0451151	-118.2767455	Los Angeles County
274955	Fee-for-Service	1568911972	1568911972	1	1	DE LEON, VAN N	5/29/2018	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
274985	Fee-for-Service	1942413976	1942413976	1	1	DEPEW, ARON J MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93461	02	General Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
275008	Fee-for-Service	1154728434	1154728434	1	1	DA AND AR HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	STE 206	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
275020	Fee-for-Service	1073174686	1073174686	1	1	DOMINGO, ALLISON L LCSW	3/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
275055	Fee-for-Service	1588825327	1588825327	1	1	DOM, MIROU P MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104280	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
275067	Fee-for-Service	1235660424	1235660424	1	1	DONDERO, TRENT J MD	5/22/2020	390200000X	NA	Other	026	PHYSICIANS	157412	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
275126	Fee-for-Service	1336283621	1336283621	1	1	DENNY, MATTHEW R MD	10/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99994	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
275145	Fee-for-Service	1215717343	1215717343	1	1	DAMKO, CHAEHYEON CNP	1/19/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 BAKER ST	None	COSTA MESA	CA	92626	4111	30	06059	33.68015852	-117.906831	Orange County
275161	Fee-for-Service	1396896809	1396896809	2	1	DAILY CARE INC	10/22/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	19330 VENTURA BLVD	None	TARZANA	CA	91356	3093	19	06037	34.17264181	-118.5543603	Los Angeles County
275190	Fee-for-Service	1699723148	1699723148	1	1	DOBBS, RYAN E MD	3/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4724	00	None	39.53124039	-119.8188498	Washoe County
275200	Fee-for-Service	1487604989	1487604989	1	1	DAVIS, DENNISE A.	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68194	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
275237	Fee-for-Service	1871563692	1871563692	1	1	DRIES, CHARLES P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N. CENTRAL AVE.	SUITE 500	PHOENIX	AZ	85067	3219	00	None	33.480666	-112.0729905	Maricopa County
275241	Fee-for-Service	1750968186	1750968186	1	1	DORZIA, DORE MD	9/5/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
275263	Fee-for-Service	1154728434	1154728434	1	1	DA AND AR HOSPICE CARE INC	7/26/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	STE 206	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
275270	Fee-for-Service	1063437507	1063437507	1	1	DOMINGUEZ, CHARLES E OD	10/10/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	RM 1-340	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
275279	Fee-for-Service	1598126468	1598126468	1	1	DE GUZMAN, JOEL A	7/14/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
275290	Fee-for-Service	1770200982	1770200982	1	1	DAVIS, NORA LCSW	12/20/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
275309	Fee-for-Service	1083431357	1083431357	1	1	DEOL, GABRIEL H PT	10/3/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
275319	Fee-for-Service	1831498195	1831498195	1	1	DARUKHANAVALA, JENNIFER P MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128163	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
275326	Fee-for-Service	1760866297	1760866297	1	1	DADANI, FARHAN MD	2/8/2024	207R00000X	NA	Other	026	PHYSICIANS	191877	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
275365	Fee-for-Service	1316119399	1316119399	1	1	DUSADEE SARANGARM M.D.	11/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
275404	Fee-for-Service	1518427608	1518427608	1	1	DE ARAUJO, MONIQUE B MD	7/14/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	179445	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
275458	Fee-for-Service	1396206868	1396206868	1	1	DE RUYTER, MATTHEW MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
275488	Fee-for-Service	1427068865	1427068865	1	1	DIAMOND, PHILIP J MD	5/31/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75431	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
275508	Fee-for-Service	1699806059	1699806059	1	1	DELL, PETER A MD	7/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100801	36	Psychiatry	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
275510	Fee-for-Service	1255642633	1255642633	1	1	DELGADO, MIGUEL OD	4/1/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
275542	Fee-for-Service	1003907338	1003907338	2	1	DO, HANH-NGUYEN MD	6/30/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	65840	15	Obstetrics (D.O. only)	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
275551	Fee-for-Service	1033643606	1033643606	1	1	DE SOUZA, BRADLEY MD	6/2/2021	207LC0200X	NA	Other	026	PHYSICIANS	169202	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
275588	Fee-for-Service	1275168726	1275168726	1	1	DAUGHERTY, MARTHA LMFT	3/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	505 S VILLA REAL DRIVE	STE 117	ANAHEIM	CA	92807	3441	30	06059	33.83712262	-117.8220203	Orange County
275688	Fee-for-Service	1447755350	1447755350	1	1	DELENA, REIGNER P	9/14/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
275730	Fee-for-Service	1457309361	1457309361	1	1	DAY,MICHAEL L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1255 HILYARD STREET	None	EUGENE	OR	97401	0000	00	None	44.04647879	-123.0820996	Lane County
275736	Fee-for-Service	1285061168	1285061168	1	1	DAO, NAM	12/7/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1621 S ALAMEDA ST	None	COMPTON	CA	90220	4973	19	06037	33.88019638	-118.2180632	Los Angeles County
275737	Fee-for-Service	1093947376	1093947376	1	1	DUPREE, ANGELUS T LCSW	1/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8976 NEPONSET DR	None	ELK GROVE	CA	95624	3580	34	06067	38.422512	-121.366287	Sacramento County
275742	Fee-for-Service	1366519886	1366519886	1	1	DORMAN JR, ROY L MD	11/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87218	30	Radiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
275745	Fee-for-Service	1427068865	1427068865	1	1	DIAMOND, PHILIP J MD	5/31/1994	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75431	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
275797	Fee-for-Service	1003907338	1003907338	2	1	DO, HANH-NGUYEN MD	6/30/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	65840	09	Gynecology (D.O. only)	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
275808	Fee-for-Service	1841014420	1841014420	1	1	DOAN, ALINA PT	3/3/2025	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2595	43	06085	37.323639	-122.014123	Santa Clara County
275812	Fee-for-Service	1730256561	1730256561	1	1	DRINVILLE, JAMIE S MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87601	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
275842	Fee-for-Service	1346372075	1346372075	1	1	DAVIDSON, CANDI L LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
275866	Fee-for-Service	1831221555	1831221555	1	1	DYMOTT, JEAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4040 N CENTRAL EXPY	STE 600	DALLAS	TX	75204	3147	00	None	32.81262242	-96.79058739	Dallas County
275893	Fee-for-Service	1033340252	1033340252	1	1	DIMAILIG-DAVID, ANNA B MD	4/8/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	106072	40	Pediatrics	0	In state provider	None	2651 HIGHLAND AVE	None	SELMA	CA	93662	3392	10	06019	36.57182292	-119.6287694	Fresno County
275985	Fee-for-Service	1972674943	1972674943	1	1	DITO, CATHERINE N MD	11/6/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65254	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
276026	Fee-for-Service	1245319805	1245319805	1	1	DEL MUNDO, NOEL G MD	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78724	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 OLD RIVER ROAD	STE 200	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
276034	Fee-for-Service	1194755363	1194755363	1	4	DICKSON, KIMBERLY K S MD	11/8/2017	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	7995	02	General Surgery	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
276143	Fee-for-Service	1376953240	1376953240	1	1	DESAI, AYUSHI MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142394	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
276146	Fee-for-Service	1013136423	1013136423	1	1	DUTTON, JULIE L NP	4/23/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND STREET WEST	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
276182	Fee-for-Service	1851424345	1851424345	1	2	D'AGOSTIN, MICHAEL U PSYD	12/15/2018	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	RVICES	12520 MAGNOLIA BLVD	206	VALLEY VILLAGE	CA	91607	2336	19	06037	34.16485451	-118.406106	Los Angeles County
276185	Fee-for-Service	1497141485	1497141485	1	1	DR. HANI JAMAL TURKMANI MD	5/9/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 SPRINGHILL DR	None	N LITTLE ROCK	AR	72117	2922	00	None	34.783704	-92.2230765	Pulaski County
276193	Fee-for-Service	1245203447	1245203447	1	1	DEL AMO HOSPITAL INC	9/21/1992	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5000	19	06037	33.8102385	-118.3441185	Los Angeles County
276209	Fee-for-Service	1730703604	1730703604	1	1	DOWELL, RUSSELL DO	10/14/2024	207P00000X	NA	Other	026	PHYSICIANS	22460	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
276240	Fee-for-Service	1861093791	1861093791	1	1	DE LEON, MICHELLE HAYAG PT	9/30/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2100 SOLAR DRIVE	204	OXNARD	CA	93036	2602	56	06111	34.22156515	-119.14488	Ventura County
276282	Fee-for-Service	1124657523	1124657523	1	1	DOSTER, BRYAN LMFT	11/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
276332	Fee-for-Service	1790889814	1790889814	1	1	DELZOPP0, GREGORY J MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	47388	68	Hematology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
276336	Fee-for-Service	1528112786	1528112786	1	1	DUNGAN-FONG, ELISABETH OD	12/1/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
276338	Fee-for-Service	1073763447	1073763447	1	1	DUFFY, STEPHEN D MD	7/16/2020	208200000X	NA	General Surgery	026	PHYSICIANS	161184	24	Plastic Surgery	0	In state provider	None	1044 S FAIR OAKS AVE	STE 101	PASADENA	CA	91105	2622	19	06037	34.12819088	-118.1502923	Los Angeles County
276377	Fee-for-Service	1841721867	1841721867	1	1	DAVIDOWITZ, ANDREW MD	2/11/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	162264	-	NOT APPLICABLE	0	In state provider	None	2330 BEVERLY BLVD	None	LOS ANGELES	CA	90057	2220	19	06037	34.0681396	-118.2738016	Los Angeles County
276403	Fee-for-Service	1992176788	1992176788	1	1	DOBAK, MARIANNA LCSW	12/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
276447	Fee-for-Service	1245203447	1245203447	1	1	DEL AMO HOSPITAL INC	1/1/1995	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5000	19	06037	33.8102385	-118.3441185	Los Angeles County
276453	Fee-for-Service	1407943392	1407943392	1	1	DYCHIAO, GLADYS G MD	12/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	82522	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
276485	Fee-for-Service	1467542175	1467542175	1	1	DAO, MARC K MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142559	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
276506	Fee-for-Service	1265574818	1265574818	1	1	DITCHEY, ROY V MD INC	9/1/1996	193400000X	NA	Other	026	PHYSICIANS	37783	41	Internal Medicine	0	In state provider	None	2638 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57129583	-122.3975042	Shasta County
276515	Fee-for-Service	1588050934	1588050934	1	1	DITTMAR, WALDO J MD	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	155351	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
276525	Fee-for-Service	1003860479	1003860479	1	1	DANG, BICH N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56918	05	Anesthesiology	0	In state provider	None	26816 VISTA TER	None	LAKE FOREST	CA	92630	8115	30	06059	33.6649298	-117.6631024	Orange County
276527	Fee-for-Service	1275022303	1275022303	1	1	DESAI, ARPAN J MD	7/13/2021	390200000X	NA	Other	026	PHYSICIANS	164546	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
276541	Fee-for-Service	1588650741	1588650741	1	1	DOAK, GREGORY A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1712 S LAFAYETTE AVE	None	SEDALIA	MO	65301	7542	00	None	38.69623148	-93.22407694	Pettis County
276604	Fee-for-Service	1174695795	1174695795	1	1	DE LA ROSA, IVONNE E MD	1/31/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49734	40	Pediatrics	0	In state provider	None	480 4TH AVE	# S306	CHULA VISTA	CA	91910	4410	37	06073	32.63411298	-117.0816772	San Diego County
276644	Fee-for-Service	1336588870	1336588870	1	1	DIGNITY HEALTH	6/20/2014	261QX0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	310 HARTNELL AVE	None	REDDING	CA	96002	1800	45	06089	40.56670901	-122.3688887	Shasta County
276661	Fee-for-Service	1861595886	1861595886	1	1	DAVID BRONSTEIN MD	3/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1035 116TH AVE NE	None	BELLEVUE	WA	98004	4604	00	None	47.620296	-122.1856955	King County
276694	Fee-for-Service	1245203447	1245203447	1	1	DEL AMO HOSPITAL INC	9/21/1992	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5000	19	06037	33.8102385	-118.3441185	Los Angeles County
276753	Fee-for-Service	1265574818	1265574818	1	1	DITCHEY, ROY V MD INC	9/1/1996	193400000X	NA	Other	026	PHYSICIANS	37783	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2638 EDITH AVE	None	REDDING	CA	96001	3043	45	06089	40.57129583	-122.3975042	Shasta County
276840	Fee-for-Service	1538573894	1538573894	1	1	DIXON, JORDAN E DO	10/24/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	23028	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
276856	Fee-for-Service	1518018191	1518018191	5	2	DIGNITY HEALTH	3/2/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2740 M ST	None	MERCED	CA	95340	6211	24	06047	37.31239905	-120.478839	Merced County
276895	Fee-for-Service	1194278085	1194278085	1	1	DONATO, IMELDA LPCC	10/25/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	3108 W. HAMMER LANE	SUITE B	STOCKTON	CA	95209	2752	39	06077	38.02107693	-121.3555583	San Joaquin County
276915	Fee-for-Service	1437439262	1437439262	1	1	DERN, RACHEL MD	10/10/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
276922	Fee-for-Service	1073960845	1073960845	1	1	DSI APPLE VALLEY HOME	2/8/2018	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS LLC	17125 SILICA RD	STE 102	VICTORVILLE	CA	92395	7715	36	06071	34.47817265	-117.2886194	San Bernardino County
276997	Fee-for-Service	1639264054	1639264054	1	1	DAYTON, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTIVEW BLVD	None	AURORA	CO	80045	1719	00	None	39.748041	-104.834673	Adams County
277045	Fee-for-Service	1407008634	1407008634	1	1	DALISAY, TRISTAN B PT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
277117	Fee-for-Service	1902268394	1902268394	1	1	DUNCAN, EMMA C NP	6/8/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
277163	Fee-for-Service	1437439262	1437439262	1	1	DERN, RACHEL MD	10/10/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
277234	Fee-for-Service	1356769855	1356769855	1	1	DYKAN, ANDREY V MD	4/27/2020	207L00000X	NA	Other	026	PHYSICIANS	142465	05	Anesthesiology	0	In state provider	None	5530 BIRDCAGE ST	STE 145	CITRUS HEIGHTS	CA	95610	7690	34	06067	38.667744	-121.273758	Sacramento County
277240	Fee-for-Service	1154300978	1154300978	1	1	DAVIS, STEVEN E	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5217	30	Radiology	0	In state provider	None	1125 VIA VERDE	None	SAN DIMAS	CA	91773	4400	19	06037	34.07402699	-117.829182	Los Angeles County
277290	Fee-for-Service	1043222623	1043222623	1	1	DUNNETT, CHERYL L MD	6/30/1988	174400000X	NA	Other	026	PHYSICIANS	59130	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
277311	Fee-for-Service	1629283841	1629283841	1	1	DAROUI, PARIMA MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117435	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
277313	Fee-for-Service	1972180172	1972180172	1	1	DAGGUBATI, SUSMITHA MD	8/23/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
277354	Fee-for-Service	1437181369	1437181369	1	1	DUONG, THINH H MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65006	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	19	06037	34.07274763	-118.2804096	Los Angeles County
277404	Fee-for-Service	1982165007	1982165007	1	1	DUSSAQ, ALEX M MD	3/4/2025	207ZP0102X	NA	Other	026	PHYSICIANS	179458	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
277485	Fee-for-Service	1154300978	1154300978	1	1	DAVIS, STEVEN E	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	5217	08	Family Practice	0	In state provider	None	1125 VIA VERDE	None	SAN DIMAS	CA	91773	4400	19	06037	34.07402699	-117.829182	Los Angeles County
277520	Fee-for-Service	1063596021	1063596021	1	1	DESOTO, ANA MARIE PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	353 E PARK AVE	STE 4	EL CAJON	CA	92020	3944	37	06073	32.79775963	-116.9580754	San Diego County
277521	Fee-for-Service	1578538583	1578538583	1	1	DIVERSIFIED MED EQUIP &	1/11/2005	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES, INC	15472 CHEMICAL LN	None	HUNTINGTON BEACH	CA	92649	1220	30	06059	33.73743603	-118.0366231	Orange County
277645	Fee-for-Service	1053754689	1053754689	1	1	DAHODWALA, MUFADDAL Q MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133734	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITES 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
277677	Fee-for-Service	1427710979	1427710979	1	1	DONOGHUE, ELIZABETH T NP	9/8/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
277714	Fee-for-Service	1902010937	1902010937	1	1	DAVIDI, FARAMARZ MD	4/24/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	51024	18	Ophthalmology	0	In state provider	None	16260 VENTURA BLVD	STE 711	ENCINO	CA	91436	2256	19	06037	34.15687678	-118.4876342	Los Angeles County
277725	Fee-for-Service	1477169399	1477169399	1	1	DISCOVERY MARRIAGE & FAMILY	3/15/2022	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1672 W AVENUE J	202	LANCASTER	CA	93534	2861	19	06037	34.68938947	-118.1609775	Los Angeles County
277788	Fee-for-Service	1770921140	1770921140	1	1	DIXIT, ANANT MD	9/12/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	162606	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
277820	Fee-for-Service	1104314616	1104314616	1	1	DISALVO, LAUREN E DO	6/29/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	20997	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
277841	Fee-for-Service	1245224344	1245224344	1	1	DANIEL BRADLEY LORD MD	4/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	721 WELLNESS WAY	STE 100	LAWRENCEVILLE	GA	30046	3304	00	None	33.96307761	-84.01125126	Gwinnett County
277889	Fee-for-Service	1558366047	1558366047	1	1	DREYFUSS, BRUCE J MD	10/4/1995	207RR0500X	NA	Other	026	PHYSICIANS	64297	41	Internal Medicine	0	In state provider	None	25 N 14TH ST	STE 890	SAN JOSE	CA	95112	6216	43	06085	37.34293357	-121.8775187	Santa Clara County
277958	Fee-for-Service	1922470608	1922470608	1	1	DESERT OCCUPATIONAL THERAPY	9/23/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	FOR KIDS INC	77564 COUNTRY CLUB DR.	SUITE 401B	PALM DESERT	CA	92211	6246	33	06065	33.75833451	-116.3114325	Riverside County
277967	Fee-for-Service	1639752553	1639752553	1	5	DISPATCHHEALTH-CA, PC	9/28/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	5735 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	7623	34	06067	38.670597	-121.2722235	Sacramento County
277969	Fee-for-Service	1477169399	1477169399	1	1	DISCOVERY MARRIAGE & FAMILY	10/25/2021	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1672 W AVENUE J	202	LANCASTER	CA	93534	2861	19	06037	34.68938947	-118.1609775	Los Angeles County
277985	Fee-for-Service	1285419317	1285419317	1	1	DE HOYOS, CAITLIN	10/10/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
277992	Fee-for-Service	1992725063	1992725063	1	1	DOTY, GAIL A	12/1/1998	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	866 PLUMAS ST	STE F	YUBA CITY	CA	95991	4022	51	06101	39.14154171	-121.6177237	Sutter County
278003	Fee-for-Service	1972566602	1972566602	1	1	DELEMOS, JAMES A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
278035	Fee-for-Service	1750708772	1750708772	1	1	DUHE, JESSICA M MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138678	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
278037	Fee-for-Service	1689258048	1689258048	1	1	DELFAVERO, NATALIE MD	1/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182881	None	None	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
278039	Fee-for-Service	1346216652	1346216652	1	1	DAVID, RAYMUND R MD	12/29/2008	2084N0402X	NA	Neurology	026	PHYSICIANS	106007	78	Neoplastic Diseases/Oncology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
278054	Fee-for-Service	1366479438	1366479438	1	1	DAVIS, RANDALL K MD	5/27/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	7930 FLOYD CURL DR	None	SAN ANTONIO	TX	78229	3925	00	None	29.51157346	-98.57548112	Bexar County
278055	Fee-for-Service	1710390513	1710390513	1	1	DESTEFANO, LAUREN	8/7/2019	208600000X	NA	General Surgery	026	PHYSICIANS	161692	02	General Surgery	0	In state provider	None	8670 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	2930	19	06037	34.06629779	-118.3807407	Los Angeles County
278091	Fee-for-Service	1821370941	1821370941	1	1	DALE, MARIAN E PHD	11/14/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
278135	Fee-for-Service	1558366047	1558366047	1	1	DREYFUSS, BRUCE J MD	10/4/1995	207RR0500X	NA	Other	026	PHYSICIANS	64297	83	Rheumatology	0	In state provider	None	25 N 14TH ST	STE 890	SAN JOSE	CA	95112	6216	43	06085	37.34293357	-121.8775187	Santa Clara County
278140	Fee-for-Service	1881637106	1881637106	1	1	DASYAM,ANIL K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 FIFTH AVE	STE 3950	PITTSBURGH	PA	15213	0000	00	None	40.44154544	-79.95885126	Allegheny County
278190	Fee-for-Service	1174500607	1174500607	1	1	DALAL, BANKIM H MD	5/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	51130	10	Gastroenterology (M.D. only)	0	In state provider	None	1622 S COURT ST	None	VISALIA	CA	93277	4962	54	06107	36.315963	-119.291661	Tulare County
278205	Fee-for-Service	1174791883	1174791883	1	1	DAVITA RIVERSIDE LLC	2/1/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3050 W FLORIDA AVE	None	HEMET	CA	92545	3619	33	06065	33.7474465	-117.0040995	Riverside County
278210	Fee-for-Service	1639752553	1639752553	1	5	DISPATCHHEALTH-CA, PC	9/28/2023	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5735 SUNRISE BLVD	None	CITRUS HEIGHTS	CA	95610	7623	34	06067	38.670597	-121.2722235	Sacramento County
278221	Fee-for-Service	1194757443	1194757443	1	1	DAWSON, TIMOTHY C MD	3/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89902	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
278230	Fee-for-Service	1770058570	1770058570	1	1	DOCKERY, DOLLYE LMFT	1/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1833 W MARCH LN	SUITE 6	STOCKTON	CA	95207	6415	39	06077	37.9875446	-121.3283031	San Joaquin County
278236	Fee-for-Service	1295501708	1295501708	1	2	DLR FAMILY MEDICINE MEDICAL	11/6/2024	207R00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	GROUP PC	802 W COLTON AVENUE	SUITE E	REDLANDS	CA	92374	2905	36	06071	34.06290649	-117.1918845	San Bernardino County
278244	Fee-for-Service	1144248410	1144248410	1	2	DE JESUS, VIOLETA M MD	12/14/2021	207R00000X	NA	Other	026	PHYSICIANS	48057	None	None	0	In state provider	None	15791 BEAR VALLEY RD.	None	HESPERIA	CA	92345	1746	36	06071	34.47063553	-117.3190095	San Bernardino County
278293	Fee-for-Service	1912438631	1912438631	1	1	DAVIES, MICHAEL R MD	8/26/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	159733	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
278343	Fee-for-Service	1356710388	1356710388	1	2	DELGADO, ASHLEY C LMFT	4/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	22489	8050 N. PALM AVE.	300	FRESNO	CA	93711	5510	10	06019	36.85231752	-119.8052619	Fresno County
278345	Fee-for-Service	1104867555	1104867555	1	1	DHANDA, LAKNBINDER P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54446	41	Internal Medicine	0	In state provider	None	23928 LYONS AVE	STE 110	NEWHALL	CA	91321	2454	19	06037	34.37895689	-118.5532505	Los Angeles County
278454	Fee-for-Service	1366437410	1366437410	1	1	DYKSTRA, THOMAS P. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11115 PARKVIEW PLAZA DR	None	FORT WAYNE	IN	46845	1701	00	None	41.1874757	-85.09943567	Allen County
278477	Fee-for-Service	1295501708	1295501708	1	2	DLR FAMILY MEDICINE MEDICAL	5/16/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP PC	802 W COLTON AVENUE	SUITE E	REDLANDS	CA	92374	2905	36	06071	34.06290649	-117.1918845	San Bernardino County
278500	Fee-for-Service	1366463366	1366463366	1	1	DE JESUS, MANUEL F MD	8/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86981	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
278561	Fee-for-Service	1649305517	1649305517	1	1	DAVIS, ALEXIS S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72842	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
278687	Fee-for-Service	1649472317	1649472317	1	1	DAVOUDI, MOHSEN MD	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86885	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
278703	Fee-for-Service	1801858873	1801858873	1	1	DUTERTE, BRENDAN O MD	2/10/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32639	40	Pediatrics	0	In state provider	None	6500 HIGHWAY 9	STE C	FELTON	CA	95018	9757	44	06087	37.05562952	-122.0748701	Santa Cruz County
278728	Fee-for-Service	1609004399	1609004399	1	1	DAVIS, BRANDON A CRNA	10/25/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
278739	Fee-for-Service	1790911352	1790911352	1	1	DESAI, NIRAV N MD	6/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	107922	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3838 SAN DIMAS ST	STE B201	BAKERSFIELD	CA	93301	1496	15	06029	35.3946385	-119.008203	Kern County
278748	Fee-for-Service	1073681722	1073681722	1	1	DIAMOND, DIANE	9/11/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
278749	Fee-for-Service	1649530791	1649530791	1	1	DAO, JACKELYNN	6/14/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	520 WEST I ST	None	LOS BANOS	CA	95616	6201	24	06047	37.06346603	-120.8593647	Merced County
278751	Fee-for-Service	1285715417	1285715417	1	1	DAINES, CORI LYNN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
278810	Fee-for-Service	1982674628	1982674628	1	1	DUNCAN, TIMOTHY D MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78777	30	Radiology	0	In state provider	MGA OFFICE	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
278817	Fee-for-Service	1013005503	1013005503	1	1	DEA, DANIEL K MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64208	41	Internal Medicine	0	In state provider	None	2701 W ALAMEDA AVE	STE 601	BURBANK	CA	91505	4411	19	06037	34.15751343	-118.3303715	Los Angeles County
278905	Fee-for-Service	1326055237	1326055237	1	1	DOWBAK, JOHN M MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	39616	20	Orthopedic Surgery	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
278974	Fee-for-Service	1679836084	1679836084	1	8	DHP OF CALIFORNIA MEDICAL GR	5/25/2021	193200000X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	OUP INC	44105 15TH	STE 301	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
278977	Fee-for-Service	1346433711	1346433711	1	1	DEBIASI, GREGORY J MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109236	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
278981	Fee-for-Service	1710344452	1710344452	1	1	DOSHI, SONA K MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138395	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
278986	Fee-for-Service	1376955781	1376955781	1	1	DORAN PHARMACY INC	4/28/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	525 N GLENDALE AVE	None	GLENDALE	CA	91206	3307	19	06037	34.15378014	-118.2435369	Los Angeles County
279051	Fee-for-Service	1013005503	1013005503	1	1	DEA, DANIEL K MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64208	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2701 W ALAMEDA AVE	STE 601	BURBANK	CA	91505	4411	19	06037	34.15751343	-118.3303715	Los Angeles County
279078	Fee-for-Service	1891055729	1891055729	1	1	DANIEL GIOIA, M.D.	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
279087	Fee-for-Service	1699201004	1699201004	1	1	DIEBOLD, BRITTNEY DO	7/20/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	17484	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
279139	Fee-for-Service	1356412324	1356412324	1	1	DEGNER, TIMOTHY L MD	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50867	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
279208	Fee-for-Service	1679836084	1679836084	1	8	DHP OF CALIFORNIA MEDICAL GR	5/25/2021	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	OUP INC	44105 15TH	STE 301	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
279210	Fee-for-Service	1013942713	1013942713	1	1	DARDASHTI, SIAMAK MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	80392	30	Radiology	0	In state provider	None	17065 CAMINO SAN BERNARD	# 400	SAN DIEGO	CA	92127	5709	37	06073	33.02106138	-117.1014226	San Diego County
279221	Fee-for-Service	1346231750	1346231750	1	2	DESAI, PRAKASH K MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	1901 PORT LANE	None	AMARILLO	TX	79106	2430	00	None	35.19394499	-101.9134555	Potter County
279284	Fee-for-Service	1891868535	1891868535	1	1	DOWD, MICHAEL T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18702 N CREEK PKWY	STE 212	BOTHELL	WA	98011	8019	00	None	47.76340307	-122.1829504	King County
279368	Fee-for-Service	1154594240	1154594240	1	1	DREWNIAK, BART PT	10/22/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
279371	Fee-for-Service	1356412324	1356412324	1	1	DEGNER, TIMOTHY L MD	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	50867	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
279383	Fee-for-Service	1679921084	1679921084	1	1	DESROSIERS, GARRETT R PT	8/17/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
279389	Fee-for-Service	1053435685	1053435685	1	1	DADRES, SALUMEH N MD	9/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106071	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
279489	Fee-for-Service	1609926765	1609926765	1	1	DIGNITY HEALTH	1/15/2002	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	MERCY MEMORIAL HOME HLTH	1600 D ST	STE 202	BAKERSFIELD	CA	93301	0000	15	06029	35.372664	-119.0258325	Kern County
279494	Fee-for-Service	1992025332	1992025332	1	1	DUTTER, DARYL R MD INC	11/19/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	57233	08	Family Practice	0	In state provider	None	150 VERA AVE	None	RIPON	CA	95366	2343	39	06077	37.7389707	-121.133029	San Joaquin County
279502	Fee-for-Service	1164992004	1164992004	1	1	DOMINO, SCOTT F RCP	9/7/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	450 6TH AVE	None	SAN FRANCISCO	CA	94118	3010	38	06075	37.7802547	-122.4642049	San Francisco County
279527	Fee-for-Service	1902235146	1902235146	1	1	DAVIS, KELLY N	7/27/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	35023 MISSION HILLS DR	BLDG A	RANCHO MIRAGE	CA	92270	1317	33	06065	33.79890054	-116.4319423	Riverside County
279533	Fee-for-Service	1710944426	1710944426	1	1	DIETRICH, ROSALIND B MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	36811	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
279546	Fee-for-Service	1952377913	1952377913	1	1	DREISBACH, ELVA L MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74704	41	Internal Medicine	0	In state provider	None	2232 SEPULVEDA BLVD	None	TORRANCE	CA	90501	5301	19	06037	33.8203219	-118.3209025	Los Angeles County
279619	Fee-for-Service	1881723864	1881723864	1	1	DANGELO, ERNANI J MD	3/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	48830	36	Psychiatry	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
279689	Fee-for-Service	1619689023	1619689023	1	1	DEVANE, AMANDA PSYD	3/27/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	520 CHADBOURNE RD	None	FAIRFIELD	CA	94534	0000	48	06095	38.235248	-122.0817079	Solano County
279702	Fee-for-Service	1134139546	1134139546	1	1	DANSKY, JAYNE E CNMW	3/16/2004	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
279765	Fee-for-Service	1124592084	1124592084	1	1	DUDZIK, LORETTA NP	8/16/2023	2278C0205X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
279861	Fee-for-Service	1164522546	1164522546	1	1	DE LA CRUZ, MANUEL R MD	10/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	50064	40	Pediatrics	0	In state provider	None	518 W EATON AVE	None	TRACY	CA	95376	3422	39	06077	37.74328555	-121.433589	San Joaquin County
279881	Fee-for-Service	1821083171	1821083171	1	1	DEKKERS, ROBERT J MD	1/20/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40656	41	Internal Medicine	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
279912	Fee-for-Service	1760435655	1760435655	1	1	DEVIREN, SIBEL MD	3/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89756	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
279974	Fee-for-Service	1225114747	1225114747	1	1	DERROUGH, JOSEPH F MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	68897	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
279998	Fee-for-Service	1235780404	1235780404	1	1	DEAN, ERICA A LMFT	3/29/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
280057	Fee-for-Service	1275064958	1275064958	1	1	DHALIWAL, JASMEET MD	7/20/2021	207R00000X	NA	Other	026	PHYSICIANS	171335	None	None	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
280084	Fee-for-Service	1497067862	1497067862	1	1	DILLMAN, ARIANA N MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
280106	Fee-for-Service	1821083171	1821083171	1	1	DEKKERS, ROBERT J MD	1/20/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40656	40	Pediatrics	0	In state provider	None	243 MARCH ST	None	SANTA PAULA	CA	93060	2511	56	06111	34.34932722	-119.0780965	Ventura County
280134	Fee-for-Service	1760614366	1760614366	1	1	DAWN, JENNIFER P LCSW	12/21/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
280263	Fee-for-Service	1871975557	1871975557	1	1	DUNLAP, NEKA MD INC	6/4/2018	207L00000X	NA	Other	026	PHYSICIANS	101400	05	Anesthesiology	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
280295	Fee-for-Service	1619596426	1619596426	1	1	DE LA CRUZ MAYHUA, JUAN C MD	6/8/2023	207R00000X	NA	Other	026	PHYSICIANS	183754	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
280304	Fee-for-Service	1942534060	1942534060	1	1	DANESHVARI, ALI R MD	7/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119359	41	Internal Medicine	0	In state provider	None	215 WEST JANSS ROAD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
280345	Fee-for-Service	1538178785	1538178785	1	1	DURAN, MICHELLE A OD	4/10/2010	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1131 W 6TH ST	STE 150	ONTARIO	CA	91762	1116	36	06071	34.084404	-117.6717015	San Bernardino County
280416	Fee-for-Service	1487784658	1487784658	1	1	DIAZ-BONALES, FRANCIS I LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
280441	Fee-for-Service	1033183322	1033183322	1	1	DANHS PHARMACY	11/7/1978	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9182 BOLSA AVE	None	WESTMINSTER	CA	92683	5588	30	06059	33.74470697	-117.9687788	Orange County
280448	Fee-for-Service	1619472503	1619472503	1	1	DIALLO, ISMAEL MD	9/12/2023	208600000X	NA	General Surgery	026	PHYSICIANS	185815	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
280514	Fee-for-Service	1407099138	1407099138	1	1	DOLGNER, STEPHEN J MD	10/1/2020	207RA0002X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
280584	Fee-for-Service	1194796250	1194796250	1	1	DAWSON, SHANNON M MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83288	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 112	SAN DIEGO	CA	92123	4226	37	06073	32.798889	-117.150826	San Diego County
280630	Fee-for-Service	1073953568	1073953568	1	1	DONNELLY, LUKE B MD	12/18/2019	207P00000X	NA	Other	026	PHYSICIANS	153831	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
280631	Fee-for-Service	1710034970	1710034970	1	1	DEXTER, JOHN MD	2/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	38860	25	Physical Medicine and Rehabilitation	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
280634	Fee-for-Service	1316980618	1316980618	1	1	DONALDSON, NIKKI A DO	5/31/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6698	08	Family Practice	0	In state provider	None	4770 W HERNDON AVE	None	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
280636	Fee-for-Service	1790024487	1790024487	1	1	DMI TRANSPORTATION INC	12/13/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1110 N BRAND BLVD	STE 101-A	GLENDALE	CA	91202	2567	19	06037	34.161876	-118.255033	Los Angeles County
280639	Fee-for-Service	1275543670	1275543670	1	1	DANG, TRUNG Q MD	9/16/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78009	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
280652	Fee-for-Service	1235588260	1235588260	1	1	DYMKOSKI, ROMANA P DO	8/13/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	16100	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
280683	Fee-for-Service	1972118263	1972118263	1	1	DALING, MITOS RACHEL NP	12/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
280704	Fee-for-Service	1366510364	1366510364	1	1	DEGUIA, LECILLE G	1/28/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
280739	Fee-for-Service	1851424345	1851424345	1	1	DAGOSTIN, MICHAEL U PSYD	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24187	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
280767	Fee-for-Service	1982164521	1982164521	1	1	DAVANI, ARIEA J MD	8/16/2024	207L00000X	NA	Other	026	PHYSICIANS	181808	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
280791	Fee-for-Service	1689069296	1689069296	1	1	DEMARIS, DARRYL G MD	5/12/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172277	None	None	0	In state provider	None	2020 COURT STREET	None	REDDING	CA	96001	1822	45	06089	40.57825667	-122.3936821	Shasta County
280828	Fee-for-Service	1740621515	1740621515	1	1	DAVIS, AMANDA E NP	8/14/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
280843	Fee-for-Service	1457714099	1457714099	1	1	DAS, DRUV MD	12/7/2022	207R00000X	NA	Other	026	PHYSICIANS	180861	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
280850	Fee-for-Service	1710034970	1710034970	1	1	DEXTER, JOHN MD	2/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	38860	13	Neurology (M.D. only)	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
280897	Fee-for-Service	1629131545	1629131545	1	1	DIAL, LANYARD K MD	6/30/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48637	08	Family Practice	0	In state provider	VENTURA COUNTY MED CTR	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
280909	Fee-for-Service	1114488210	1114488210	1	1	DASARI, SUMANA MD	4/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
280916	Fee-for-Service	1942616040	1942616040	1	1	DANG, VIRGINIE F OD	7/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5300 LENNOX AVE	STE 101	BAKERSFIELD	CA	93309	1662	15	06029	35.35899025	-119.0625824	Kern County
280922	Fee-for-Service	1578842415	1578842415	1	1	DAWSON, ELAINE W PSYD	3/16/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
280989	Fee-for-Service	1447509450	1447509450	1	1	DIAZ, ADRIANA M LCSW	7/15/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
281051	Fee-for-Service	1497788426	1497788426	1	1	DIGERONIMO, ROBERT J MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
281076	Fee-for-Service	1851678585	1851678585	1	1	DHHS IHS PHOENIX AREA	2/26/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	12033 AGENCY ROAD	None	PARKER	AZ	85344	7718	00	None	34.14638102	-114.3057195	La Paz County
281127	Fee-for-Service	1104810712	1104810712	1	1	DETRICH, LESLIE ANDREWS	6/30/1985	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51253	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
281153	Fee-for-Service	1669524468	1669524468	1	1	DAVIS, JOETTA MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54875	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
281154	Fee-for-Service	1063579720	1063579720	1	1	DAO, LEILANIE OT	11/23/2022	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1251 E DYER RD	SUITE 150	SANTA ANA	CA	92705	5662	30	06059	33.70870351	-117.8551005	Orange County
281196	Fee-for-Service	1467590240	1467590240	1	1	DANFORTH, PALLAVI A DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8287	15	Obstetrics (D.O. only)	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
281198	Fee-for-Service	1730446527	1730446527	1	1	DANIELS, SARAH R MD	7/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130872	40	Pediatrics	0	In state provider	None	3605 VISTA WAY	BLDG B	OCEANSIDE	CA	92056	4565	37	06073	33.1818929	-117.3104591	San Diego County
281233	Fee-for-Service	1740724962	1740724962	1	1	DO, JOCELYN NP	5/28/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2097 COMPTON AVE	BLDG 1, SUITE 103	CORONA	CA	92881	7282	33	06065	33.847776	-117.536173	Riverside County
281242	Fee-for-Service	1356557763	1356557763	1	1	DULAI, HARJOT S MD	5/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118970	30	Radiology	0	In state provider	None	6121 N THESTA RD	SUITE 207	FRESNO	CA	93710	5294	10	06019	36.82493955	-119.783139	Fresno County
281268	Fee-for-Service	1497788426	1497788426	1	1	DIGERONIMO, ROBERT J MD	7/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
281283	Fee-for-Service	1184373797	1184373797	1	1	DOAN, VINH DO	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	21490	41	Internal Medicine	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
281294	Fee-for-Service	1851678585	1851678585	1	1	DHHS IHS PHOENIX AREA	2/26/2013	No Taxonomy Provided	NA	None	075	INDIAN HEALTH SERVICES/MEMORANDUM OF AGREEMENT	-	-	NOT APPLICABLE	1	Border provider	None	12033 AGENCY ROAD	None	PARKER	AZ	85344	7718	00	None	34.14638102	-114.3057195	La Paz County
281300	Fee-for-Service	1275681090	1275681090	1	1	DEGUZMAN, SARA R MD	5/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49162	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
281349	Fee-for-Service	1649353574	1649353574	1	1	DEOL, INDERJIT MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	47800	22	Pathology (M.D. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
281411	Fee-for-Service	1467590240	1467590240	1	1	DANFORTH, PALLAVI A DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8287	09	Gynecology (D.O. only)	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
281468	Fee-for-Service	1841453735	1841453735	1	1	DEHDASHTIAN, SHAGHAYEGH MD	10/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117785	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
281506	Fee-for-Service	1851678585	1851678585	1	1	DHHS IHS PHOENIX AREA	2/26/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	1	Border provider	None	12033 AGENCY ROAD	None	PARKER	AZ	85344	7718	00	None	34.14638102	-114.3057195	La Paz County
281510	Fee-for-Service	1942289491	1942289491	1	1	DHUPAR, SCOTT K MD	6/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	6200 W 9TH STREET	UNIT 1B	GREELEY	CO	80634	4462	00	None	40.42242519	-104.7818208	Weld County
281522	Fee-for-Service	1851818181	1851818181	1	1	DELGADO-JIMENEZ, JANA LCSW	3/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14420 CIVIC DR	4	VICTORVILLE	CA	92392	2928	36	06071	34.51268102	-117.3236867	San Bernardino County
281545	Fee-for-Service	1164451688	1164451688	1	1	DONOVAN, JOHN A MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55128	41	Internal Medicine	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281556	Fee-for-Service	1497204226	1497204226	1	1	DI GREGORIO, KARINA M LMFT	11/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
281587	Fee-for-Service	1326198722	1326198722	1	1	DE LUNA, MARY W LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
281605	Fee-for-Service	1700328127	1700328127	1	1	DICKEY, JONATHAN T	10/2/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
281610	Fee-for-Service	1710931910	1710931910	1	2	DIAGNOSTIC RADIOLOGICAL	9/14/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
281652	Fee-for-Service	1972102259	1972102259	1	1	DO, CINTHIA Y	10/25/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
281680	Fee-for-Service	1578616553	1578616553	1	1	DAVTYAN, ARAM V MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	115648	01	General Practice	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
281699	Fee-for-Service	1053980615	1053980615	1	1	DUNCAN, GOLNAR A PSYD	11/1/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
281757	Fee-for-Service	1164451688	1164451688	1	1	DONOVAN, JOHN A MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55128	10	Gastroenterology (M.D. only)	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
281768	Fee-for-Service	1215150040	1215150040	1	1	DEFIRMIAN, BARBARA L MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	71605	01	General Practice	0	In state provider	None	35 CASA STREET	SUITE 320	SAN LUIS OBISPO	CA	93405	1894	40	06079	35.29359615	-120.6654304	San Luis Obispo County
281776	Fee-for-Service	1932390747	1932390747	1	1	DE LA TORRE, NINIVET LMFT	2/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11455 PARAMOUNT BLVD	SUITE F	DOWNEY	CA	90241	4550	19	06037	33.94022241	-118.1398143	Los Angeles County
281806	Fee-for-Service	1932787884	1932787884	1	1	DWEIK, NOOR MD	9/16/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
281842	Fee-for-Service	1922300599	1922300599	1	1	DAHOV, ANNA MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114728	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
281862	Fee-for-Service	1053815167	1053815167	1	1	DEY, JOEL P MD	6/12/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177008	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
281871	Fee-for-Service	1336198902	1336198902	1	1	DUONG, T ROBERT	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	RADIOLOGY ASSOCIATION IN	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
281889	Fee-for-Service	1124388384	1124388384	1	1	DESTEFANO, CHRISTIN B MD	1/8/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	161927	68	Hematology	0	In state provider	None	1480 64TH ST	STE 100, 125, 175	EMERYVILLE	CA	94608	2038	01	06001	37.84431239	-122.2926758	Alameda County
281905	Fee-for-Service	1891908869	1891908869	1	1	DELBAKHSH, PARVANEH MD	1/30/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63341	40	Pediatrics	0	In state provider	None	2007 WILSHIRE BLVD FL 3	None	LOS ANGELES	CA	90057	3519	19	06037	34.05752718	-118.2749855	Los Angeles County
281908	Fee-for-Service	1629706106	1629706106	1	1	DEATON-LAMPLEY, TRICIA N NP	12/12/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	34	06067	38.570805	-121.4696385	Sacramento County
281944	Fee-for-Service	1245531524	1245531524	1	1	DONKOR, JIMMY A MD	3/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118853	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
281946	Fee-for-Service	1386729549	1386729549	1	1	DIAGNOSTIC PATHOLOGY MED	2/28/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP INC	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
281987	Fee-for-Service	1356429161	1356429161	1	1	DHUGGA, GURPREET MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63219	41	Internal Medicine	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
282009	Fee-for-Service	1437461670	1437461670	1	1	DASGUPTA, SHOM MD	7/2/2019	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	121018	44	Public Health	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
282043	Fee-for-Service	1174985451	1174985451	1	1	DEGNER, NICHOLAS R MD	9/28/2020	207R00000X	NA	Other	026	PHYSICIANS	150947	77	Infectious Disease	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
282050	Fee-for-Service	1922300599	1922300599	1	1	DAHOV, ANNA MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114728	77	Infectious Disease	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
282058	Fee-for-Service	1932272986	1932272986	1	1	DOUGLAS, TROY S DPM	6/24/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
282190	Fee-for-Service	1356347207	1356347207	1	1	DARON MERRYMAN	3/8/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 SCHNEIDER DR	None	MALVERN	AR	72104	4811	00	None	34.358751	-92.785941	Hot Spring County
282214	Fee-for-Service	1437461670	1437461670	1	1	DASGUPTA, SHOM MD	7/2/2019	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	121018	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
282224	Fee-for-Service	1568442986	1568442986	1	1	DJODEIR, MASOOMEH MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	53648	01	General Practice	0	In state provider	None	4910 AIRPORT PLAZA DRIVE	STE 100	LONG BEACH	CA	90815	1264	19	06037	33.80854316	-118.1359209	Los Angeles County
282241	Fee-for-Service	1447668462	1447668462	1	1	DANNYS HOME HEALTH CARE INC	8/15/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2667 CAMINO DEL RIO	SUITE 308	SAN DIEGO	CA	92108	3765	37	06073	32.76979794	-117.1355701	San Diego County
282272	Fee-for-Service	1174887897	1174887897	1	1	DEOL, NAVJOT K NP	1/22/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY STE 2800	None	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
282291	Fee-for-Service	1316147085	1316147085	1	1	DOLNAK, DOUGLAS R DO	9/21/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	6059	None	None	0	In state provider	None	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	37	06073	32.68419388	-117.0829524	San Diego County
282295	Fee-for-Service	1831307651	1831307651	1	1	DV URGENT CARE MEDICAL GROUP	9/25/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6930	None	None	0	In state provider	INC	7777-A MILLIKEN AVE	None	RANCHO CUCAMONGA	CA	91730	6780	36	06071	34.10843256	-117.5570865	San Bernardino County
282299	Fee-for-Service	1275395576	1275395576	1	1	DOULA ALEX KING LLC	1/23/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
282306	Fee-for-Service	1639490402	1639490402	1	1	DJURDJULOV, ADAM V MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118099	05	Anesthesiology	0	In state provider	None	ONE HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
282374	Fee-for-Service	1396939526	1396939526	1	1	DO, KHAI MD	3/19/2018	207R00000X	NA	Other	026	PHYSICIANS	42932	41	Internal Medicine	0	In state provider	None	10362 BOLSA AVENUE	None	WESTMINSTER	CA	92683	6763	30	06059	33.74488248	-117.94806	Orange County
282376	Fee-for-Service	1780787234	1780787234	1	1	DANG, CATHERINE M MD	9/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71205	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
282378	Fee-for-Service	1508025339	1508025339	1	1	DANHAIVE, OLIVIER MD	10/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53232	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
282389	Fee-for-Service	1336221506	1336221506	1	1	DYNAMIC LIFE HEALTH SVS	5/20/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ADVANCED ADULT DAY HLTH	2315 KUEHNER DR	STE 121-126	SIMI VALLEY	CA	93063	3900	56	06111	34.277805	-118.662169	Ventura County
282390	Fee-for-Service	1861557977	1861557977	1	1	DR. PENNY MARIE WILKIE M.D.	9/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	715 E BROADWAY AVE	None	BISMARCK	ND	58501	4451	00	None	46.80603	-100.78074	Burleigh County
282416	Fee-for-Service	1437461670	1437461670	1	1	DASGUPTA, SHOM MD	7/2/2019	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	121018	77	Infectious Disease	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
282418	Fee-for-Service	1932463114	1932463114	1	1	DURAND, RACHELLE E DO	8/21/2020	2085P0229X	NA	Other	026	PHYSICIANS	18444	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
282434	Fee-for-Service	1730685793	1730685793	1	1	DENG, LISA X MD	10/11/2021	207R00000X	NA	Other	026	PHYSICIANS	165369	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
282543	Fee-for-Service	1558695395	1558695395	1	1	DOMINION, DONNA S LCSW	3/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
282593	Fee-for-Service	1942562491	1942562491	1	1	DMITRIY SCHERBAK	10/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
282662	Fee-for-Service	1356818504	1356818504	1	1	DENTON, JOHN M MD	12/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
282703	Fee-for-Service	1386973691	1386973691	1	1	DEWS, JILL	2/8/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7 MERRIWEATHER PLACE	None	LADERA RANCH	CA	92694	0822	30	06059	33.54564783	-117.6377312	Orange County
282749	Fee-for-Service	1760541387	1760541387	1	1	DINH, QUYNH MD	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	83482	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
282765	Fee-for-Service	1811972946	1811972946	1	1	DAVID M HUCHTON, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4450 SUNSET DR	None	SAN ANGELO	TX	76901	5611	00	None	31.43603188	-100.501883	Tom Green County
282783	Fee-for-Service	1871512111	1871512111	1	1	DUNN, WILLIAM M MD	10/7/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41082	None	None	0	In state provider	None	3535 SAN DIMAS ST	STE 2	BAKERSFIELD	CA	93301	1688	15	06029	35.39123916	-119.008246	Kern County
282863	Fee-for-Service	1194001958	1194001958	1	1	DIAZ, ANNA M LCSW	5/3/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
282900	Fee-for-Service	1578861613	1578861613	1	1	DR. PATRICIA'S HEALTH CLUB,	9/6/2016	252Y00000X	NA	Other	026	PHYSICIANS	72318	40	Pediatrics	0	In state provider	None	2100 W. ALTON AVE.	#2	SANTA ANA	CA	92704	7170	30	06059	33.70176	-117.9001845	Orange County
282940	Fee-for-Service	1124291844	1124291844	1	1	DUBOSE, CANDICE N MD	10/1/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	168477	20	Orthopedic Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE 200	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
282942	Fee-for-Service	1417951997	1417951997	1	1	DORSETT, JOHN A MD	6/30/1991	225400000X	NA	Other	026	PHYSICIANS	67624	25	Physical Medicine and Rehabilitation	0	In state provider	None	1135 WHISKEYTOWN CT	None	REDDING	CA	96001	0227	45	06089	40.58505078	-122.4126253	Shasta County
282999	Fee-for-Service	1346327673	1346327673	2	1	DECARLO, MICHAEL P OD	1/26/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5724 E 7TH STREET	None	LONG BEACH	CA	90803	2002	19	06037	33.77520877	-118.1203907	Los Angeles County
283019	Fee-for-Service	1649376229	1649376229	1	2	DANESH, REZA MD	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	7128 PACIFIC BLVD	SUITE D	HUNTINGTON PARK	CA	90255	4776	19	06037	33.97494243	-118.2251099	Los Angeles County
283058	Fee-for-Service	1538236302	1538236302	1	1	DEVINE, GRETCHEN NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3460 E LA PALMA AVE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
283085	Fee-for-Service	1356908099	1356908099	1	1	DANG, LIZA Q LCSW	9/14/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
283132	Fee-for-Service	1639890627	1639890627	1	1	DEL ORO LLC	4/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4301 GOLDEN CENTER DRIVE	None	PLACERVILLE	CA	95667	6260	09	06017	38.7068134	-120.8276855	El Dorado County
283147	Fee-for-Service	1639116882	1639116882	1	1	DALIEH, SADI D MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130369	None	None	0	In state provider	None	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
283186	Fee-for-Service	1700402112	1700402112	1	1	DAHLEN, BRITTNEY A CRNA	9/11/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
283210	Fee-for-Service	1649376229	1649376229	1	2	DANESH, REZA MD	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	7128 PACIFIC BLVD	SUITE D	HUNTINGTON PARK	CA	90255	4776	19	06037	33.97494243	-118.2251099	Los Angeles County
283255	Fee-for-Service	1033465547	1033465547	1	1	DANIEL HUTCHENS MD	4/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
283261	Fee-for-Service	1336457902	1336457902	1	1	DOMINGUEZ, MONIQUE A W DO	11/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11372	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
283274	Fee-for-Service	1396364782	1396364782	1	1	DOCTER, TAYLOR MD	4/23/2024	207P00000X	NA	Other	026	PHYSICIANS	184080	66	Emergency Medicine (Urgent Care)	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	0000	19	06037	34.158213	-118.328112	Los Angeles County
283303	Fee-for-Service	1861570947	1861570947	1	1	DOTSON, LARRY L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	33492	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
283365	Fee-for-Service	1588808901	1588808901	1	1	DROZD, REMIGIUSZ R DO	10/27/2021	207P00000X	NA	Other	026	PHYSICIANS	18747	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	1651	56	06111	34.27771547	-119.2540344	Ventura County
283374	Fee-for-Service	1497731533	1497731533	1	1	DJO LLC	1/24/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1430 DECISION ST	None	VISTA	CA	90281	8553	37	06073	33.1401491	-117.2284333	San Diego County
283379	Fee-for-Service	1497939599	1497939599	1	1	DAYEM MICHAEL MD	2/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12000 MCCRACKEN RD	SUITE 210	GARFIELD HTS	OH	44125	0000	00	None	41.4223943	-81.59928365	Cuyahoga County
283381	Fee-for-Service	1346326394	1346326394	1	2	DELALOZA, DAVID MD	9/25/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	82210	-	NOT APPLICABLE	0	In state provider	None	2010 N LINCOLN PARK AVE	None	LOS ANGELES	CA	90031	3119	19	06037	34.06862231	-118.2024176	Los Angeles County
283387	Fee-for-Service	1487115556	1487115556	1	1	DUNSON, TIARA M PT	12/18/2022	2081S0010X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24021 ALESSANDRO	109-112A	MORENO VALLEY	CA	92553	6707	33	06065	33.9171415	-117.2423475	Riverside County
283432	Fee-for-Service	1013675537	1013675537	1	1	DATE, GERALDINE M LCSW	2/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
283453	Fee-for-Service	1992734529	1992734529	1	1	DRAKE, THOMAS A MD	8/1/1998	207ZP0104X	NA	Other	026	PHYSICIANS	39263	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
283529	Fee-for-Service	1053585810	1053585810	1	1	DIAS, JANICE CRNA	1/6/2009	183500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
283531	Fee-for-Service	1982012944	1982012944	1	1	DURAN, MARCOS DO	10/23/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	14424	39	Preventive (M.D. only)	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
283556	Fee-for-Service	1073140182	1073140182	1	1	DO, REBECCA M MD	9/15/2022	207R00000X	NA	Other	026	PHYSICIANS	19820	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
283565	Fee-for-Service	1295878247	1295878247	1	1	DIAMOND, IRA A DPM	2/1/1996	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	425 W BONITA AVE	STE 110	SAN DIMAS	CA	91773	2543	19	06037	34.10669347	-117.814932	Los Angeles County
283685	Fee-for-Service	1174834931	1174834931	1	1	DREDAR, AHMID MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125375	01	General Practice	0	In state provider	None	3132 W MARCH LN	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
283703	Fee-for-Service	1225343601	1225343601	1	1	DAN, JENNIFER M MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119193	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283811	Fee-for-Service	1043390198	1043390198	1	1	DEMAR INDUSTRIES INC	11/22/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPORT CARE SERVICES	251 SHAW RD	None	S SAN FRANCISCO	CA	94080	6605	41	06081	37.64100969	-122.4070467	San Mateo County
283886	Fee-for-Service	1225343601	1225343601	1	1	DAN, JENNIFER M MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119193	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283921	Fee-for-Service	1417210600	1417210600	1	1	DAMAGHI, NIUSHA MD	6/18/2018	207R00000X	NA	Other	026	PHYSICIANS	136919	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
283972	Fee-for-Service	1437446036	1437446036	1	1	DUONG, HAN L OD	4/8/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 BLOSSOM HILL RD	STE 20	SAN JOSE	CA	95123	3056	43	06085	37.25049949	-121.84425	Santa Clara County
284043	Fee-for-Service	1093861411	1093861411	1	1	DAUER, PATRICIA M LCSW	9/1/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	265 S ANITA DR	202	ORANGE	CA	92868	3346	30	06059	33.78499409	-117.8811837	Orange County
284044	Fee-for-Service	1487700340	1487700340	1	1	DASTIC, SUSAN L CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
284048	Fee-for-Service	1326711573	1326711573	1	2	DNA LOGISTICS LLC	6/21/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5216 JILSON WAY	None	ELK GROVE	CA	95757	3501	34	06067	38.381301	-121.442436	Sacramento County
284052	Fee-for-Service	1851779839	1851779839	1	1	DYNIEWSKI, BRADLEY MD	3/10/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	168005	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
284068	Fee-for-Service	1750440343	1750440343	1	1	DIZON, JOSEPH G MD	7/1/1998	207RA0201X	NA	Other	026	PHYSICIANS	81399	03	Allergy	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
284092	Fee-for-Service	1952384463	1952384463	1	1	DIXON,MARK E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	0000	00	None	39.6612	-104.8603095	Arapahoe County
284101	Fee-for-Service	1417210600	1417210600	1	1	DAMAGHI, NIUSHA MD	6/18/2018	207R00000X	NA	Other	026	PHYSICIANS	136919	41	Internal Medicine	0	In state provider	None	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
284129	Fee-for-Service	1902933310	1902933310	1	1	DEISSEROTH, KARL A MD	7/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75949	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
284147	Fee-for-Service	1427009794	1427009794	1	1	DIAO, EDWARD MD	7/31/1992	2086S0105X	NA	General Surgery	026	PHYSICIANS	77448	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	# A632	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284158	Fee-for-Service	1982834719	1982834719	1	1	DAY, JANNETTE K	10/25/2010	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	140 N M STREET	None	TULARE	CA	93274	4147	54	06107	36.209174	-119.3436175	Tulare County
284170	Fee-for-Service	1518400787	1518400787	1	1	DIGNITY HEALTH	2/19/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2490 SISTER MARY COLUMBA	DR	RED BLUFF	CA	96080	4327	52	06103	40.14934625	-122.2206345	Tehama County
284176	Fee-for-Service	1588704498	1588704498	1	1	DORSO, MICHAEL A MD	2/23/1982	207P00000X	NA	Other	026	PHYSICIANS	29989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
284297	Fee-for-Service	1073047874	1073047874	1	1	DOKUKINA, EKATERINA CNP	4/4/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	14735 VENTURA BLVD	None	SHERMAN OAKS	CA	91403	3679	19	06037	34.15187275	-118.4543653	Los Angeles County
284322	Fee-for-Service	1316245111	1316245111	1	1	DEWITT, ROBERT D LCSW	7/29/2021	372600000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	19	06037	34.147521	-118.2549325	Los Angeles County
284347	Fee-for-Service	1518400787	1518400787	1	1	DIGNITY HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2490 SISTER MARY COLUMBA	DR	RED BLUFF	CA	96080	4327	52	06103	40.14934625	-122.2206345	Tehama County
284365	Fee-for-Service	1285847681	1285847681	1	1	DRAKE, DANIEL MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100982	41	Internal Medicine	0	In state provider	CALIF MED CTR	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	1329	19	06037	34.03719097	-118.2654105	Los Angeles County
284396	Fee-for-Service	1902436348	1902436348	1	1	DLV VISION ASC	9/18/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3180 WILLOW LANE	SUITE 118	THOUSAND OAKS	CA	91361	4986	56	06111	34.16552629	-118.8390377	Ventura County
284452	Fee-for-Service	1831217595	1831217595	1	1	DEUTSCH, DAVID LCSW	12/12/2023	101YA0400X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
284453	Fee-for-Service	1154681153	1154681153	1	1	DUSTIN, CAROLINE M MD DO	7/18/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13404	15	Obstetrics (D.O. only)	0	In state provider	None	10670 WEXFORD ST	None	SAN DIEGO	CA	92131	3940	37	06073	32.93893186	-117.0982186	San Diego County
284459	Fee-for-Service	1356389878	1356389878	1	1	DIGNITY HEALTH	12/31/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
284465	Fee-for-Service	1700834082	1700834082	1	1	DALY CITY ANESTHESIA MED	1/2/1979	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
284469	Fee-for-Service	1528135340	1528135340	1	1	DORIS, JONATHAN M MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74872	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
284504	Fee-for-Service	1134388879	1134388879	1	1	DE LOS REYES, KENNETH M MD	8/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131686	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	SUITE 108A	LOMA LINDA	CA	92354	3128	36	06071	34.04805253	-117.249534	San Bernardino County
284541	Fee-for-Service	1245887728	1245887728	1	1	DAVIS, LARRY D MD	7/21/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185596	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
284568	Fee-for-Service	1164795068	1164795068	1	1	DERRINGTON, STEPHEN M DO	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14038	25	Physical Medicine and Rehabilitation	0	In state provider	None	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
284576	Fee-for-Service	1184665721	1184665721	1	1	DELGADO, DANIEL C MD	10/31/1984	207P00000X	NA	Other	026	PHYSICIANS	51483	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
284607	Fee-for-Service	1225391287	1225391287	1	1	DING, ALBERT M MD	11/8/2018	207R00000X	NA	Other	026	PHYSICIANS	137239	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
284629	Fee-for-Service	1356389878	1356389878	1	1	DIGNITY HEALTH	12/31/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
284718	Fee-for-Service	1962484691	1962484691	1	1	DECKARD-JANATPOUR, KIM A	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80631	22	Pathology (M.D. only)	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
284723	Fee-for-Service	1144243916	1144243916	1	1	DARIN LEE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	0000	00	None	43.654374	-116.694738	Canyon County
284740	Fee-for-Service	1336301415	1336301415	1	1	DAVIS, TREVOR Z DO	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14020	None	None	0	In state provider	None	1504 N WISHON AVENUE	None	FRESNO	CA	93728	1827	10	06019	36.763497	-119.8010405	Fresno County
284788	Fee-for-Service	1356814776	1356814776	1	1	DAMATO, MICHELLE OT	4/6/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
284791	Fee-for-Service	1154425551	1154425551	1	1	DANIELZADEH, JAMES A MD	7/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	85175	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18370 BURBANK BLVD	STE 209	TARZANA	CA	91356	2855	19	06037	34.17173059	-118.5331881	Los Angeles County
284820	Fee-for-Service	1467775866	1467775866	1	1	DAM, DINH XUAN MD	9/21/2010	207R00000X	NA	Other	026	PHYSICIANS	77320	41	Internal Medicine	0	In state provider	CORPORATION	200 N JACKSON AVE	STE C	SAN JOSE	CA	95116	1601	43	06085	37.36335224	-121.8481803	Santa Clara County
284858	Fee-for-Service	1376898106	1376898106	1	1	DRUG PHARM INC	8/31/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3377 G STREET	SUITE B	MERCED	CA	95340	0964	24	06047	37.32530764	-120.4692797	Merced County
284861	Fee-for-Service	1780647065	1780647065	1	1	DICKMAN, PAUL S MD	4/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS ROAD	MAIN BUILDING	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
284891	Fee-for-Service	1316212814	1316212814	1	1	DUFFY, ALEXANDRA O DO	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12176	13	Neurology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
284893	Fee-for-Service	1710029541	1710029541	1	1	DWC HOME CARE, INC	9/1/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15340 MANZANARES RD	None	LA MIRADA	CA	90638	3949	19	06037	33.90185737	-118.0043488	Los Angeles County
284907	Fee-for-Service	1407019391	1407019391	1	1	DEBOTTIS, DANIEL P MD	6/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126199	20	Orthopedic Surgery	0	In state provider	None	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	30	06059	33.784695	-117.867327	Orange County
284948	Fee-for-Service	1972975761	1972975761	1	1	DAN D HOPNER MD ROMULO M	10/14/2016	193400000X	NA	Other	026	PHYSICIANS	36372	01	General Practice	0	In state provider	ROMERO PA	2060 ABORN RD	STE 100	SAN JOSE	CA	95121	1585	43	06085	37.3114718	-121.8072775	Santa Clara County
284960	Fee-for-Service	1306966122	1306966122	1	1	DE LA TORRE, PATRICIA LCSW	6/29/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD	4600	WHITTIER	CA	90605	1824	19	06037	33.9505367	-118.0054552	Los Angeles County
284973	Fee-for-Service	1275537524	1275537524	1	1	DARDASHTI, DAN E MD	2/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	61457	41	Internal Medicine	0	In state provider	None	12840 RIVERSIDE DR	STE 206	VALLEY VILLAGE	CA	91607	3342	19	06037	34.15759054	-118.4129775	Los Angeles County
284988	Fee-for-Service	1740458660	1740458660	1	1	DAU, KIM Q	9/12/2012	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	ROOM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
284989	Fee-for-Service	1831171263	1831171263	1	1	DIMITRY FOMIN MD	8/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2708 S RIFE MEDICAL LN	None	ROGERS	AR	72758	1452	00	None	36.310077	-94.182876	Benton County
285015	Fee-for-Service	1073793022	1073793022	1	1	DEENEY, KERRY J LCSW	6/13/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	25671	-	NOT APPLICABLE	0	In state provider	None	2120 W WILLIAMS ST	BLDG 1 AND 2	LONG BEACH	CA	90810	3636	19	06037	33.7929977	-118.2210007	Los Angeles County
285029	Fee-for-Service	1265469696	1265469696	1	1	DE CRUZ, DELORES MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65527	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
285031	Fee-for-Service	1780647065	1780647065	1	1	DICKMAN, PAUL S MD	4/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	1919 E THOMAS ROAD	MAIN BUILDING	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
285095	Fee-for-Service	1881985521	1881985521	1	1	DO, DUC H MD	5/5/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122050	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
285124	Fee-for-Service	1134527500	1134527500	1	1	DEL ROSA VILLAIDENCE OPCO	1/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	DEL ROSA VILLA LLC	2018 DEL ROSA AVE	None	SAN BERNARDINO	CA	92404	5642	36	06071	34.134543	-117.2524185	San Bernardino County
285132	Fee-for-Service	1457813388	1457813388	1	1	DALAL, SHANA MD	10/18/2023	390200000X	NA	Other	026	PHYSICIANS	185476	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
285141	Fee-for-Service	1710272810	1710272810	1	1	DEROSE, STEPHEN F MD	2/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84756	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
285150	Fee-for-Service	1487769733	1487769733	1	1	DANILOV, ALEXEY V MD	11/25/2019	207RH0000X	NA	Hematology	026	PHYSICIANS	166505	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
285174	Fee-for-Service	1255462248	1255462248	1	1	DAVOUDIAN, SOHAIL MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	44878	41	Internal Medicine	0	In state provider	None	1964 WESTWOOD BLVD	# 518	LOS ANGELES	CA	90025	4651	19	06037	34.04729378	-118.4346267	Los Angeles County
285181	Fee-for-Service	1104883610	1104883610	1	1	DUDA, VINCENT R MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	38938	41	Internal Medicine	0	In state provider	None	30281 GOLDEN LANTERN	None	LAGUNA NIGUEL	CA	92677	5979	30	06059	33.52255027	-117.6859055	Orange County
285190	Fee-for-Service	1265469696	1265469696	1	1	DE CRUZ, DELORES MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65527	01	General Practice	0	In state provider	None	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
285231	Fee-for-Service	1740248483	1740248483	1	1	DAWSON-JONES, LANITA M MD	7/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55711	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
285233	Fee-for-Service	1891097176	1891097176	1	1	DR VERONICA ABUSLEME MD INC	1/6/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	38422	None	None	0	In state provider	None	14621 NORDHOFF ST	STE 2A	PANORAMA CITY	CA	91402	1835	19	06037	34.23544349	-118.451079	Los Angeles County
285256	Fee-for-Service	1881985521	1881985521	1	1	DO, DUC H MD	5/5/2020	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122050	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
285278	Fee-for-Service	1295745768	1295745768	1	1	DME SOLUTIONS INC	6/9/2003	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	104 EL CERRITO DR	None	NIPOMO	CA	93444	8900	40	06079	35.01293599	-120.5048253	San Luis Obispo County
285293	Fee-for-Service	1982956306	1982956306	2	1	DITTMANN, MEGAN LCSW	9/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13500 SUMMIT RIDGE DR	None	NEVADA CITY	CA	95959	9540	29	06057	39.2635039	-120.9051174	Nevada County
285301	Fee-for-Service	1265537401	1265537401	1	1	DEVRIES, STEPHEN R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	680 N LAKE SHORE DR	STE 1000	CHICAGO	IL	60611	8709	00	None	41.89498774	-87.61585515	Cook County
285311	Fee-for-Service	1487769733	1487769733	1	1	DANILOV, ALEXEY V MD	11/25/2019	207RH0000X	NA	Hematology	026	PHYSICIANS	166505	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
285327	Fee-for-Service	1063866887	1063866887	1	1	DYER, SHARON M OD	9/14/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
285334	Fee-for-Service	1467480665	1467480665	1	1	DUONG, DAIHUNG J MD	7/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85845	05	Anesthesiology	0	In state provider	None	11632 BUTTERFIELD ST	None	LOMA LINDA	CA	92354	3956	36	06071	34.04245392	-117.2371028	San Bernardino County
285455	Fee-for-Service	1336228584	1336228584	1	1	DUONG, TU H DO	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7630	41	Internal Medicine	0	In state provider	None	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
285459	Fee-for-Service	1114931052	1114931052	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	2446 W. WHITTIER BLVD.	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
285463	Fee-for-Service	1497725758	1497725758	1	1	DARNSTEADT, DERRICK R MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	92752	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5900 W OLYMPIC BOULEVARD	None	LOS ANGELES	CA	90036	4671	19	06037	34.05760692	-118.3604361	Los Angeles County
285489	Fee-for-Service	1083835466	1083835466	1	1	DURANT, CHERYL A PT	11/8/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
285511	Fee-for-Service	1316084007	1316084007	1	1	DOYLE, JOSEPH G MD INC	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61904	02	General Surgery	0	In state provider	None	81880 DR CARREON BLVD	STE B201	INDIO	CA	92201	5585	33	06065	33.70742953	-116.23572	Riverside County
285516	Fee-for-Service	1780024083	1780024083	1	1	DUDA, ROBERT S LCSW	5/18/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
285617	Fee-for-Service	1114931052	1114931052	1	2	DE LA PENA EYE CLINIC, A MED	6/19/2023	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2446 W. WHITTIER BLVD.	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
285618	Fee-for-Service	1861474520	1861474520	1	1	DEMAYO, FRANK M MD	5/4/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	60003	20	Orthopedic Surgery	0	In state provider	None	211 CHERRY AVE	None	LONG BEACH	CA	90802	3930	19	06037	33.76698422	-118.1679747	Los Angeles County
285673	Fee-for-Service	1619041373	1619041373	1	1	DEGOEDE, DANIEL L PHD	7/18/1986	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5353 G ST	None	CHINO	CA	91710	5249	36	06071	34.00987149	-117.6880905	San Bernardino County
285698	Fee-for-Service	1821104423	1821104423	1	1	DAO, TRUNG DUY MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42590	08	Family Practice	0	In state provider	None	9211 BOLSA AVE	STE 217	WESTMINSTER	CA	92683	5570	30	06059	33.74498712	-117.9684267	Orange County
285700	Fee-for-Service	1013546472	1013546472	1	1	DURNEY, SARAH E MD	8/16/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186463	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
285704	Fee-for-Service	1245790120	1245790120	1	1	DIRKS, JESSICA LCSW	10/14/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
285705	Fee-for-Service	1427253244	1427253244	1	1	DUDAS, JASON R MD	10/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119840	24	Plastic Surgery	0	In state provider	None	1001 POTRERO AVE	RM 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
285716	Fee-for-Service	1245406628	1245406628	1	1	DOERNBERG, SARAH B MD	4/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103536	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
285728	Fee-for-Service	1235304817	1235304817	1	1	DENNY, SHANNON R	11/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18484 HWY 18	125	APPLE VALLEY	CA	92307	2305	36	06071	34.53970843	-117.2611301	San Bernardino County
285818	Fee-for-Service	1538137963	1538137963	1	1	DE PHILLIPS, JOANNE MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	34600	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	STE 2320	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
285858	Fee-for-Service	1043456106	1043456106	1	4	DIGNITY HEALTH MEDICAL FOUND	1/13/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	280 SIERRA COLLEGE DR	STE 105	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
285868	Fee-for-Service	1619213428	1619213428	1	1	DESCHAMPS-BRALY, JORDAN MD	12/2/2013	2086S0122X	NA	General Surgery	026	PHYSICIANS	121399	24	Plastic Surgery	0	In state provider	PC	450 SUTTER ST	STE 800	SAN FRANCISCO	CA	94108	1234	38	06075	37.78934929	-122.4077786	San Francisco County
285871	Fee-for-Service	1487964730	1487964730	1	1	DODGE, HEATHER L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
285873	Fee-for-Service	1043318983	1043318983	1	2	DAVIS JOINT UNIFIED SD	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	526 B STREET	None	DAVIS	CA	95616	3811	57	06113	38.54727463	-121.7456238	Yolo County
285926	Fee-for-Service	1346409067	1346409067	1	1	DEHAL, HIMDIP K MD	12/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116989	08	Family Practice	0	In state provider	None	550 WEST RANCH VIEW DR	None	ROCKLIN	CA	95765	5391	31	06061	38.83760761	-121.2972372	Placer County
285956	Fee-for-Service	1760423420	1760423420	1	1	DESNOYERS, JOHN R MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81907	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
285970	Fee-for-Service	1538137963	1538137963	1	1	DE PHILLIPS, JOANNE MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	34600	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	STE 2320	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
285981	Fee-for-Service	1134687734	1134687734	1	1	DIGNITY HEALTH	10/15/2019	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	TAL ONCOLOGY CENTER	2340 LIBERTY PKWY	200	RED BLUFF	CA	96080	4350	52	06103	40.15134646	-122.2220526	Tehama County
286008	Fee-for-Service	1306973615	1306973615	1	1	DIECKMANN, RONALD A MD	1/31/1986	207P00000X	NA	Other	026	PHYSICIANS	36970	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	# 1E	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
286011	Fee-for-Service	1942560024	1942560024	1	1	DWORSKY, ERIK M MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129764	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
286012	Fee-for-Service	1043456106	1043456106	1	4	DIGNITY HEALTH MEDICAL FOUND	1/13/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	None	280 SIERRA COLLEGE DR	STE 105	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
286014	Fee-for-Service	1477134906	1477134906	1	1	DAVIS, CAMILLE I MD	5/13/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
286023	Fee-for-Service	1427118355	1427118355	1	1	DARDASHTI, BEHROUZ E MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38320	01	General Practice	0	In state provider	None	5363 BALBOA BLVD	STE 546	ENCINO	CA	91316	2855	19	06037	34.169058	-118.5011265	Los Angeles County
286038	Fee-for-Service	1053868059	1053868059	1	1	DE ANGELIS, TAMARA LCSW	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
286058	Fee-for-Service	1386699841	1386699841	1	1	DETHLEFS, JUDITH L MD	3/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35356	66	Emergency Medicine (Urgent Care)	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
286060	Fee-for-Service	1609351394	1609351394	1	1	DALAFU, JASON PT	10/30/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	755 N. LEMOORE AVE.	SUITE C	LEMOORE	CA	93245	9998	16	06031	36.306108	-119.780838	Kings County
286095	Fee-for-Service	1740389642	1740389642	1	1	DONG, QING MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78998	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
286164	Fee-for-Service	1043456106	1043456106	1	4	DIGNITY HEALTH MEDICAL FOUND	1/13/2014	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	280 SIERRA COLLEGE DR	STE 105	GRASS VALLEY	CA	95945	5763	29	06057	39.23410746	-121.0515391	Nevada County
286165	Fee-for-Service	1437166527	1437166527	1	1	DE FREITAS, CHRYSTAL E MD	11/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	50161	40	Pediatrics	0	In state provider	None	12395 EL CAMINO REAL	SUITE 219	SAN DIEGO	CA	92130	3085	37	06073	32.94324259	-117.2396525	San Diego County
286183	Fee-for-Service	1871156919	1871156919	1	1	DIAZ, DAVID E MD	11/8/2022	207P00000X	NA	Other	026	PHYSICIANS	177407	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
286203	Fee-for-Service	1679836084	1679836084	1	10	DHP OF CALIFORNIA MEDICAL GR	6/20/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	OUP, INC.	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
286204	Fee-for-Service	1407240716	1407240716	1	1	DAWOOD, MOIZ MD	11/1/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	11	Aviation (M.D. only)	0	In state provider	None	145 TREVINO AVE	None	MANTECA	CA	95337	4200	39	06077	37.79842002	-121.2404921	San Joaquin County
286224	Fee-for-Service	1891059523	1891059523	1	1	DOWNEY, KELLY R MD	4/11/2018	207R00000X	NA	Other	026	PHYSICIANS	148018	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
286309	Fee-for-Service	1710418330	1710418330	1	1	DIAZ, JUSTINE R	2/9/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
286315	Fee-for-Service	1861034407	1861034407	1	1	DEMETRA HOME HEALTH CARE INC	2/13/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22543 VENTURA BLVD	STE 227	WOODLAND HILLS	CA	91364	1482	19	06037	34.16774548	-118.6179242	Los Angeles County
286327	Fee-for-Service	1295729515	1295729515	1	1	DICKERSON, JAIME L MD	3/1/2000	207L00000X	NA	Other	026	PHYSICIANS	85369	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
286353	Fee-for-Service	1679836084	1679836084	1	10	DHP OF CALIFORNIA MEDICAL GR	1/29/2024	193200000X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	OUP, INC.	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
286396	Fee-for-Service	1326189275	1326189275	1	1	DILAURO, GABRIELA M MD	10/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102532	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	488 E VALLEY PARKWAY	#310	ESCONDIDO	CA	92025	3373	37	06073	33.12523814	-117.0769715	San Diego County
286411	Fee-for-Service	1407205024	1407205024	1	1	DREMSA, DIANA L MD	11/1/2021	207R00000X	NA	Other	026	PHYSICIANS	168751	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
286427	Fee-for-Service	1194841759	1194841759	1	1	DAVIES, ANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1950 MOUNTAIN VIEW AVE	None	LONGMONT	CO	80501	3129	00	None	40.18134367	-105.1260049	Boulder County
286580	Fee-for-Service	1275161473	1275161473	1	1	DAVIS, JOHN DO	5/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22147	08	Family Practice	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
286600	Fee-for-Service	1205240264	1205240264	1	1	DANG, NATASHA MD	10/16/2020	207R00000X	NA	Other	026	PHYSICIANS	140254	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
286619	Fee-for-Service	1497728083	1497728083	1	1	DECARLI, CHARLES S MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85939	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
286621	Fee-for-Service	1356613186	1356613186	1	1	DR. BERGIN PSYCHOTHERAPY FAM	1/7/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ILY SERVICES INC	6800 INDIANA AVE	SUITE 130	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
286638	Fee-for-Service	1033856323	1033856323	1	1	DOME, NICOLETTE E AU	5/3/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
286675	Fee-for-Service	1730271784	1730271784	1	1	DOUDIKIAN-SCAFF, NAYIRI	10/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67181	24	Plastic Surgery	0	In state provider	MD INC	960 E GREEN ST	STE 168	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
286677	Fee-for-Service	1821061649	1821061649	1	1	DVA HEALTHCARE RENAL	11/23/2005	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	CARE INC	2130 W 24TH ST	None	YUMA	AZ	85364	6122	00	None	32.685165	-114.6456945	Yuma County
286687	Fee-for-Service	1700966314	1700966314	1	1	DELCASTILLO, SYLVIA L MD	6/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72530	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
286694	Fee-for-Service	1821305830	1821305830	1	1	DUNN, BETHANY M LCSW	9/9/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
286710	Fee-for-Service	1396741930	1396741930	1	1	DUCKOR, STEVEN L MD INC	4/24/1987	174400000X	NA	Other	026	PHYSICIANS	25497	41	Internal Medicine	0	In state provider	None	1211 W LA PALMA AVE	STE 309	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
286720	Fee-for-Service	1730151085	1730151085	1	1	DOHAD, SUHAIL Y MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74789	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3153	19	06037	34.06550726	-118.3775199	Los Angeles County
286728	Fee-for-Service	1235315912	1235315912	1	1	DAVEY, DEBRA L MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120323	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	#103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
286761	Fee-for-Service	1528462835	1528462835	1	2	DM CLINICAL COLLABORATIONS	4/22/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6108 SAN FERNANDO RD	None	GLENDALE	CA	91201	2240	19	06037	34.16215903	-118.2830502	Los Angeles County
286783	Fee-for-Service	1760576094	1760576094	1	1	DESHPANDE, PRAJAKTA A MD	1/5/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	133444	41	Internal Medicine	0	In state provider	None	6800 LINCOLN AVENUE	SUITE 203 B	BUENA PARK	CA	90620	4164	30	06059	33.83178874	-118.0144022	Orange County
286841	Fee-for-Service	1235635798	1235635798	1	1	DINH, DOANTRANG T MD	10/17/2024	2080P0214X	NA	Pulmonology	026	PHYSICIANS	164735	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
286849	Fee-for-Service	1396741930	1396741930	1	1	DUCKOR, STEVEN L MD INC	4/24/1987	174400000X	NA	Other	026	PHYSICIANS	25497	10	Gastroenterology (M.D. only)	0	In state provider	None	1211 W LA PALMA AVE	STE 309	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
286867	Fee-for-Service	1447216221	1447216221	1	1	DEDONATO, LARRY M OD	9/15/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1429 MAIN ST	None	DELANO	CA	93215	1726	15	06029	35.77534238	-119.2471008	Kern County
286883	Fee-for-Service	1750947297	1750947297	1	1	DR. MIKE LI OPTOMETRY INC	1/13/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6250 VALLEY SPRINGS PKWY	None	RIVERSIDE	CA	92507	0970	33	06065	33.93822925	-117.2877761	Riverside County
286886	Fee-for-Service	1184870248	1184870248	1	1	DIALYSIS CLINIC INC	7/8/2009	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	1281 KIMMERLING ROAD	# A 1	GARDNERVILLE	NV	89460	7565	00	None	38.89559024	-119.7437054	Douglas County
286923	Fee-for-Service	1760576094	1760576094	1	1	DESHPANDE, PRAJAKTA A MD	1/5/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	133444	01	General Practice	0	In state provider	None	6800 LINCOLN AVENUE	SUITE 203 B	BUENA PARK	CA	90620	4164	30	06059	33.83178874	-118.0144022	Orange County
286950	Fee-for-Service	1942213699	1942213699	1	1	DURANO,LILAN P FNP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	A PROF NURSING CORP	2585 TIGERS DR	None	TURLOCK	CA	95382	9191	50	06099	37.51687658	-120.8279677	Stanislaus County
286951	Fee-for-Service	1407964679	1407964679	1	1	DELTA EYE MEDICAL GRP IN	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1617 SAINT MARKS PLZ	STE D	STOCKTON	CA	95207	6478	39	06077	37.98864819	-121.3268062	San Joaquin County
286975	Fee-for-Service	1962487561	1962487561	1	1	DEPNER, THOMAS A MD	1/2/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	25912	01	General Practice	0	In state provider	UCD PROF SVCS GRP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
287089	Fee-for-Service	1740477850	1740477850	1	1	DIPIETRO, JAMIE L DO	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11764	34	Urology and Urological Surgery	0	In state provider	None	7014 N WHITNEY	None	FRESNO	CA	93720	0155	10	06019	36.83834474	-119.7423213	Fresno County
287102	Fee-for-Service	1144986043	1144986043	1	1	DECENT HOME HEALTH CARE INC	5/31/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6742 VAN NUYS BLVD	STE 113	VAN NUYS	CA	91405	4611	19	06037	34.19343344	-118.4487213	Los Angeles County
287106	Fee-for-Service	1407069719	1407069719	1	1	DIABLO VALLEY PEDIATRIC	11/18/1985	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	2299 BACON ST	STE 7	CONCORD	CA	94520	2046	07	06013	37.98199042	-122.0349518	Contra Costa County
287132	Fee-for-Service	1376866335	1376866335	1	1	DEETH, JONATHAN M MD	8/6/2020	207L00000X	NA	Other	026	PHYSICIANS	119464	05	Anesthesiology	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
287147	Fee-for-Service	1922699685	1922699685	1	1	DAVENPORT, LARIS O	9/23/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
287197	Fee-for-Service	1215346309	1215346309	1	1	DAHLSTROM, KATHLEEN R LMFT	10/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	669 PALMETTO	A	CHICO	CA	95926	4058	04	06007	39.73891284	-121.8343905	Butte County
287200	Fee-for-Service	1174048789	1174048789	1	1	DIAZ, MARICELA LMFT	12/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LING SERVICES	24445 HAWTHORNE	STE 109	TORRANCE	CA	90505	6562	19	06037	33.800319	-118.3512355	Los Angeles County
287257	Fee-for-Service	1215282827	1215282827	1	1	DAVILA, PAUL G LMFT	5/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
287345	Fee-for-Service	1114081056	1114081056	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
287399	Fee-for-Service	1801914544	1801914544	1	1	DE GUZMAN, ERNEST V MD	3/12/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	95424	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
287415	Fee-for-Service	1184681603	1184681603	1	1	DULL, MAUDE E MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152808	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
287437	Fee-for-Service	1780247486	1780247486	1	1	DHILLON, SANDALJIT K MD	9/12/2022	208M00000X	NA	Other	026	PHYSICIANS	177091	None	None	0	In state provider	None	9500 STOCKDALE HWY	STE 203	BAKERSFIELD	CA	93311	3620	15	06029	35.35452448	-119.1074625	Kern County
287475	Fee-for-Service	1619162864	1619162864	1	1	DIHMES, SARAH PHD	11/18/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287477	Fee-for-Service	1518593300	1518593300	1	1	DUCA, ALESSIA V NP	10/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
287479	Fee-for-Service	1114081056	1114081056	2	1	DIGNITY COMMUNITY CARE	2/1/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
287573	Fee-for-Service	1669035002	1669035002	1	1	DUSO, BREANNA M PT	11/16/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
287604	Fee-for-Service	1689627762	1689627762	1	1	DERIC PATTERSON M.D.	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
287626	Fee-for-Service	1669591020	1669591020	1	1	DUENAS, ALICIA L MD	2/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109782	36	Psychiatry	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
287671	Fee-for-Service	1235324773	1235324773	1	1	DAMANAN, SONIA MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96096	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
287740	Fee-for-Service	1043484850	1043484850	1	1	DIEMART, JENNIFER CCC-SLP	8/14/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
287783	Fee-for-Service	1083290605	1083290605	1	1	DAO, ANDREW D MD	9/24/2024	207R00000X	NA	Other	026	PHYSICIANS	192509	70	Clinic (mixed specialty)	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
287788	Fee-for-Service	1477922102	1477922102	1	1	DOMUSH, VANESSA L NP	4/18/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
287843	Fee-for-Service	1912944216	1912944216	1	1	DIEP, JIMMY MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84643	41	Internal Medicine	0	In state provider	None	11525 BROOKSHIRE AVE	None	DOWNEY	CA	90241	4985	19	06037	33.93544635	-118.1318321	Los Angeles County
287871	Fee-for-Service	1407855018	1407855018	1	1	DILWORTH, KRISTINA N NP	2/8/2015	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	DIABETES WELLNESS CENTER	855 N 4TH ST	MAILBOX 2	PISMO BEACH	CA	93449	3102	40	06079	35.13511685	-120.622287	San Luis Obispo County
287910	Fee-for-Service	1083290605	1083290605	1	1	DAO, ANDREW D MD	9/24/2024	207R00000X	NA	Other	026	PHYSICIANS	192509	41	Internal Medicine	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
287987	Fee-for-Service	1962967778	1962967778	1	1	DE LA ROSA, MICHELLIN A NP	7/26/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
287998	Fee-for-Service	1578731428	1578731428	1	1	DHILLON, KALWANT S MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30582	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6079 N FRESNO ST	STE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
288047	Fee-for-Service	1265732622	1265732622	1	1	DO, DOUGLAS D MD	10/31/2022	207R00000X	NA	Other	026	PHYSICIANS	114741	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
288065	Fee-for-Service	1053600940	1053600940	1	1	DAVIS, JASON A MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116229	20	Orthopedic Surgery	0	In state provider	None	729 N MED CENTER DR WEST	SUITE 111	CLOVIS	CA	93611	6880	10	06019	36.84152435	-119.6624818	Fresno County
288121	Fee-for-Service	1578731428	1578731428	1	1	DHILLON, KALWANT S MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30582	02	General Surgery	0	In state provider	None	6079 N FRESNO ST	STE 101	FRESNO	CA	93710	5276	10	06019	36.824301	-119.781437	Fresno County
288129	Fee-for-Service	1841553054	1841553054	1	1	DE, SOUMO MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153092	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	STE M-335	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
288173	Fee-for-Service	1700860285	1700860285	1	1	DETERVILLE, STEVEN M MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	33195	40	Pediatrics	0	In state provider	None	124 W 9TH ST	None	CORONA	CA	92882	3320	33	06065	33.87233134	-117.5677784	Riverside County
288209	Fee-for-Service	1902528706	1902528706	1	1	DE LEON, EMMANUEL P NP	4/9/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95030182	-	NOT APPLICABLE	0	In state provider	None	360 S WESTLAKE AVE	None	LOS ANGELES	CA	90057	2906	19	06037	34.0609146	-118.2724318	Los Angeles County
288236	Fee-for-Service	1073798310	1073798310	1	2	DIVINE GRACE HOME HEALTH INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	512 E WILSON AVE	SUITE 401	GLENDALE	CA	91206	4351	19	06037	34.14813015	-118.2494202	Los Angeles County
288270	Fee-for-Service	1659138329	1659138329	1	1	DELBARRIO, JAYCOB DP	12/17/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	SUITE 300	FREMONT	CA	94538	2331	01	06001	37.55399458	-121.9756047	Alameda County
288278	Fee-for-Service	1104889492	1104889492	1	1	DELAIRE, RONALD J DC	11/25/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	27620 LANDAU BLVD	STE 1	CATHEDRAL CITY	CA	92234	5540	33	06065	33.84709854	-116.4757864	Riverside County
288283	Fee-for-Service	1386114965	1386114965	1	1	DYNAMIC MEDICAL LLC	3/31/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1201 TEXAS STREET	None	SALEM	VA	24153	0000	00	None	37.28958079	-80.03523158	Salem city
288305	Fee-for-Service	1386879245	1386879245	1	1	DAHLFRED, LEAH B MD	4/19/2018	390200000X	NA	Other	026	PHYSICIANS	132771	08	Family Practice	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
288313	Fee-for-Service	1831203173	1831203173	1	1	DONNA M HARMON NP	3/23/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	759 CHESTNUT ST	None	SPRINGFIELD	MA	01199	1001	00	None	42.122601	-72.602856	Hampden County
288329	Fee-for-Service	1245580869	1245580869	1	1	DAISUKE, ARAI	2/14/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
288350	Fee-for-Service	1467443234	1467443234	1	1	DAWKINS, ROGELIO MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55107	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
288397	Fee-for-Service	1669550737	1669550737	1	1	DLOTT, RICHARD S MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64611	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
288401	Fee-for-Service	1326587478	1326587478	1	1	DIMAANO, FALLON VANESSA DO	9/16/2024	2086X0206X	NA	General Surgery	026	PHYSICIANS	21328	02	General Surgery	0	In state provider	None	3883 AIRWAY DRIVE	SUITE 220	SANTA ROSA	CA	95403	1670	49	06097	38.483226	-122.739705	Sonoma County
288452	Fee-for-Service	1528525755	1528525755	1	1	DOSKALCHUK, YEVGENIY L PT	11/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5120 MANZANITA AVE	110	CARMICHAEL	CA	95608	0590	34	06067	38.659392	-121.327155	Sacramento County
288464	Fee-for-Service	1467443234	1467443234	1	1	DAWKINS, ROGELIO MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55107	08	Family Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
288486	Fee-for-Service	1417921578	1417921578	1	1	DOSHI,NEELIMA G MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67626	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
288549	Fee-for-Service	1841234978	1841234978	1	1	DANGVU, ANGELA S MD	11/5/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66502	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	FLOOR 2	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
288586	Fee-for-Service	1699162305	1699162305	1	1	DALY, LAUREN T MD	6/24/2021	208200000X	NA	General Surgery	026	PHYSICIANS	171439	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
288591	Fee-for-Service	1720205214	1720205214	1	1	DABBOUS, HELLAL MD	1/31/1992	207U00000X	NA	Other	026	PHYSICIANS	50124	01	General Practice	0	In state provider	None	2301 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1735	19	06037	34.17252521	-118.3332018	Los Angeles County
288623	Fee-for-Service	1043297096	1043297096	1	1	DEMARTINI, JOSEPH R MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143585	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
288663	Fee-for-Service	1023485810	1023485810	1	1	DING, CAROLIN OT	7/25/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 310	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
288679	Fee-for-Service	1639926041	1639926041	1	1	DOULAFORU LLC	5/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
288731	Fee-for-Service	1528166774	1528166774	1	1	DOSSANTOS, CLYDE J MD	5/17/1982	207R00000X	NA	Other	026	PHYSICIANS	38413	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	171 W BORT ST	STE 106	LONG BEACH	CA	90805	2111	19	06037	33.87046199	-118.2050591	Los Angeles County
288761	Fee-for-Service	1164424305	1164424305	1	1	DOUGLAS COUNTY HOSPITAL	6/13/2015	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	111 17TH AVE	None	ALEXANDRIA	MN	56308	5273	00	None	45.87269049	-95.37631855	Douglas County
288763	Fee-for-Service	1134781313	1134781313	1	1	DORN, RANDE F LMFT	5/29/2024	103TC0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
288829	Fee-for-Service	1750504080	1750504080	1	1	DANJI, KATALIN MD	5/15/2019	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	159388	38	Geriatrics	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
288830	Fee-for-Service	1063941045	1063941045	1	1	DANIEL MEADOR MD INC	4/24/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	19929 GREENLEY RD	None	SONORA	CA	95370	5996	55	06109	37.9837971	-120.366851	Tuolumne County
288870	Fee-for-Service	1164424305	1164424305	1	1	DOUGLAS COUNTY HOSPITAL	6/13/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	111 17TH AVE	None	ALEXANDRIA	MN	56308	5273	00	None	45.87269049	-95.37631855	Douglas County
288915	Fee-for-Service	1992879506	1992879506	1	1	DELANEY, ANNE R MD	8/15/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	39605	02	General Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
288950	Fee-for-Service	1811222425	1811222425	1	1	DUNN, GRACIELA R LCSW	2/28/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
289031	Fee-for-Service	1659726404	1659726404	1	1	DONTUKURTHY, SUJANA	8/19/2021	207LP3000X	NA	Other	026	PHYSICIANS	173200	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
289045	Fee-for-Service	1891097655	1891097655	1	1	DINI, MONARA	7/1/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 3A36	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
289078	Fee-for-Service	1053481804	1053481804	1	1	DAVID, FLOYD C MD	1/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	70084	41	Internal Medicine	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
289121	Fee-for-Service	1811485816	1811485816	1	1	DIAZ, MICHAEL A MD	5/23/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	167003	None	None	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
289128	Fee-for-Service	1992319487	1992319487	1	1	DUNSON, TAMMY NP	8/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
289130	Fee-for-Service	1821660481	1821660481	1	1	DALES, KEVIN J DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	21901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
289134	Fee-for-Service	1659726404	1659726404	1	1	DONTUKURTHY, SUJANA	8/19/2021	207LP3000X	NA	Other	026	PHYSICIANS	173200	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
289146	Fee-for-Service	1104389923	1104389923	1	1	DREYFUS, ISAAC S MD	11/14/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	178326	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
289152	Fee-for-Service	1306164041	1306164041	1	1	DHATT, HARPREET S MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130649	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
289245	Fee-for-Service	1841966322	1841966322	1	1	DERITIS, PAMELA	11/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	740 W. 190TH ST	SUITE A	GARDENA	CA	90248	4235	19	06037	33.86022767	-118.2873851	Los Angeles County
289247	Fee-for-Service	1093989105	1093989105	1	1	DEHKHARGHANI, SEENA MD	5/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103456	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
289330	Fee-for-Service	1720199763	1720199763	1	1	DULGEROFF, ANTHONY	10/31/1989	207R00000X	NA	Other	026	PHYSICIANS	69233	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
289386	Fee-for-Service	1487151668	1487151668	1	1	DESAI, PRASHANT P MD	6/29/2021	390200000X	NA	Other	026	PHYSICIANS	165893	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
289409	Fee-for-Service	1467062000	1467062000	1	1	DYNAMIC CARE HOSPICE, INC	7/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 205C	GLENDALE	CA	91205	3385	19	06037	34.13065269	-118.2524619	Los Angeles County
289496	Fee-for-Service	1467062000	1467062000	1	1	DYNAMIC CARE HOSPICE, INC	7/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 205C	GLENDALE	CA	91205	3385	19	06037	34.13065269	-118.2524619	Los Angeles County
289497	Fee-for-Service	1407902224	1407902224	1	1	DUNNE, PAMELA PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1315 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	4901	19	06037	34.05665761	-118.4426344	Los Angeles County
289512	Fee-for-Service	1407974991	1407974991	1	1	DURACK, JEREMY C MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85904	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
289520	Fee-for-Service	1225090145	1225090145	1	1	DUARTE, MAYRA L LMFT	11/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
289523	Fee-for-Service	1548351349	1548351349	1	1	DAVIS,OAKLEY M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	407 ULUNIU STREET	4TH FLOOR	KAILUA	HI	96734	0000	00	None	21.39646318	-157.7434882	Honolulu County
289579	Fee-for-Service	1710018981	1710018981	1	1	DELYAEI, BELLA DC	8/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	SANTA CLARA CHIROPRACTIC	2265 EL CAMINO REAL	STE 1	SANTA CLARA	CA	95050	4064	43	06085	37.35247948	-121.964247	Santa Clara County
289642	Fee-for-Service	1770644122	1770644122	1	1	DERKACZ, MONICA L LCSW	7/5/2016	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	645 NORMAL ST	None	CHICO	CA	95928	5519	04	06007	39.72519055	-121.8394118	Butte County
289697	Fee-for-Service	1447593868	1447593868	1	1	DE LA PAZ MEDICAL CENTRE INC	5/30/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	934 S EUCLID ST	None	ANAHEIM	CA	92802	1523	30	06059	33.81900658	-117.9413125	Orange County
289722	Fee-for-Service	1447697123	1447697123	1	1	DORSEY, AMELIA N MD	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157419	02	General Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
289774	Fee-for-Service	1447593868	1447593868	1	1	DE LA PAZ MEDICAL CENTRE INC	5/30/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	934 S EUCLID ST	None	ANAHEIM	CA	92802	1523	30	06059	33.81900658	-117.9413125	Orange County
289887	Fee-for-Service	1790874337	1790874337	1	1	DESAI, RAMESH P MD	12/5/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31923	40	Pediatrics	0	In state provider	None	11100 WARNER AVE	STE 114	FOUNTAIN VALLEY	CA	92708	7500	30	06059	33.716291	-117.9355051	Orange County
289930	Fee-for-Service	1821368333	1821368333	1	1	DAVID F DOW	9/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	375 DIXMYTH AVE	None	CINCINNATI	OH	45220	2475	00	None	39.14076839	-84.52169161	Hamilton County
290016	Fee-for-Service	1548303803	1548303803	1	1	DERAVEDISSIAN, HRAYR DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	806 S CENTRAL AVE	None	GLENDALE	CA	91204	2013	19	06037	34.13639429	-118.257829	Los Angeles County
290059	Fee-for-Service	1790311546	1790311546	1	1	DINH, DIANA	5/27/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7631 WYOMING ST	107	WESTMINSTER	CA	92683	3904	30	06059	33.7610165	-117.996174	Orange County
290076	Fee-for-Service	1659466282	1659466282	1	1	DURAND, MANUEL F MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	35640	40	Pediatrics	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
290078	Fee-for-Service	1912083908	1912083908	1	1	DESAI, NIMA OD	1/2/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31824 VILLAGE CENTER ROA	SUITE F	WESTLAKE VILLAGE	CA	91361	4337	19	06037	34.1466537	-118.814283	Los Angeles County
290093	Fee-for-Service	1124184445	1124184445	1	1	DAVIS, CONNELL MD	12/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	45570	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
290110	Fee-for-Service	1144636606	1144636606	1	1	DUTT, DIKSHA DPM	7/25/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5 CENTERPOINTE DR	None	LA PALMA	CA	90623	1050	30	06059	33.86168254	-118.0308375	Orange County
290116	Fee-for-Service	1639268089	1639268089	1	1	DAVIS, KEITH A MD	6/5/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	74408	18	Ophthalmology	0	In state provider	None	1011 SYLVAN AVE	STE C	MODESTO	CA	95350	1693	50	06099	37.68896459	-120.979468	Stanislaus County
290132	Fee-for-Service	1659466282	1659466282	1	1	DURAND, MANUEL F MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	35640	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
290165	Fee-for-Service	1487026225	1487026225	1	1	DE LA CERDA, SARAH S LCSW	12/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
290262	Fee-for-Service	1083167977	1083167977	1	1	DELGADO, MELISSA DOULA	3/4/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
290306	Fee-for-Service	1841898624	1841898624	1	1	DELLASERRA, DAVID PT	10/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27699 JEFFERSON AVENUE	SUITE 202	TEMECULA	CA	92590	0000	33	06065	33.51449799	-117.1593524	Riverside County
290399	Fee-for-Service	1801026257	1801026257	1	1	DONALDSON, JAKE D MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116010	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
290429	Fee-for-Service	1427121128	1427121128	1	1	DESSER, TERRY S MD	11/30/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	74784	30	Radiology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
290482	Fee-for-Service	1205272614	1205272614	1	1	DAVID A KLIMPL	2/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
290494	Fee-for-Service	1376520114	1376520114	1	1	DOWD, CHRISTOPHER FOLEY	12/1/1989	174400000X	NA	Other	026	PHYSICIANS	52928	30	Radiology	0	In state provider	None	350 PARNASSUS AVE	STE 501	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
290512	Fee-for-Service	1619303310	1619303310	1	1	DELGADO, VICTOR H MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127266	None	None	0	In state provider	None	1756 N MAIN ST	None	SALINAS	CA	93906	5103	27	06053	36.71800104	-121.6534748	Monterey County
290535	Fee-for-Service	1376520114	1376520114	1	1	DOWD, CHRISTOPHER FOLEY	12/1/1989	174400000X	NA	Other	026	PHYSICIANS	52928	14	Neurological Surgery	0	In state provider	None	350 PARNASSUS AVE	STE 501	SAN FRANCISCO	CA	94117	3608	38	06075	37.76403932	-122.4561371	San Francisco County
290587	Fee-for-Service	1316034978	1316034978	1	1	DASSAH, NORMA B MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	37604	08	Family Practice	0	In state provider	None	972 SERENO DR	None	VALLEJO	CA	94589	2400	48	06095	38.12848098	-122.2475656	Solano County
290591	Fee-for-Service	1821027632	1821027632	1	1	DOUGLAS FIR HOLDINGS LLC	9/16/2000	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON VLY HLTHCARE	8382 NEWMAN AVE	STE 308	HUNTINGTON BEACH	CA	92647	7038	30	06059	33.70483894	-117.9824498	Orange County
290632	Fee-for-Service	1245318898	1245318898	1	1	DILELLA, VINCENT J MD	9/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	48949	36	Psychiatry	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
290637	Fee-for-Service	1336467620	1336467620	1	1	DAVIS, TREASA DO	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12858	08	Family Practice	0	In state provider	None	9089 BASELINE ROAD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
290661	Fee-for-Service	1346330453	1346330453	1	1	DAVID T LEE D.O.	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1329 LUSITANA ST	STE 809	HONOLULU	HI	96813	2435	00	None	21.30713158	-157.8522661	Honolulu County
290669	Fee-for-Service	1225415631	1225415631	1	1	DANG, YU-XUAN MD	9/11/2018	207R00000X	NA	Other	026	PHYSICIANS	147312	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
290679	Fee-for-Service	1437928702	1437928702	1	1	DELGADO, NOEMI BIRTH DOULA	6/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
290742	Fee-for-Service	1063830651	1063830651	1	1	DAVE, RINA J MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150158	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
290755	Fee-for-Service	1629224589	1629224589	1	1	DR. MICO LIU OPTOMETRY, INC	1/25/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8500 WASHINGTON BLVD	None	PICO RIVERA	CA	90660	3788	19	06037	33.985017	-118.1050785	Los Angeles County
290806	Fee-for-Service	1578904934	1578904934	1	1	DU, PINGFENG MD INC	11/5/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	95673	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	345 SAXONY ROAD	SUITE 202	ENCINITAS	CA	92024	2787	37	06073	33.05403165	-117.285548	San Diego County
290865	Fee-for-Service	1194027672	1194027672	1	1	DESTINY HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12364 PERRIS BLVD	None	MORENO VALLEY	CA	92557	7423	33	06065	33.94121164	-117.2263214	Riverside County
290895	Fee-for-Service	1194027672	1194027672	1	1	DESTINY HOSPICE CARE INC	6/1/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12364 PERRIS BLVD	None	MORENO VALLEY	CA	92557	7423	33	06065	33.94121164	-117.2263214	Riverside County
290909	Fee-for-Service	1508258559	1508258559	1	1	DESAI, RAJ D MD	9/6/2022	208VP0014X	NA	Other	026	PHYSICIANS	163057	None	None	0	In state provider	None	1700 CESAR E CHAVEZ AVE	STE 2200	LOS ANGELES	CA	90033	2476	19	06037	34.05101259	-118.217259	Los Angeles County
290924	Fee-for-Service	1578523593	1578523593	1	1	DASTGHEIB, KOUROSH A	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	85637	18	Ophthalmology	0	In state provider	None	12665 GARDEN GROVE BLVD	STE 401	GARDEN GROVE	CA	92843	1918	30	06059	33.77450141	-117.9123364	Orange County
290948	Fee-for-Service	1992749121	1992749121	1	1	DJEVALIKIAN, RAFFI MD	7/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78701	08	Family Practice	0	In state provider	None	301 E 13TH ST	None	MERCED	CA	95341	6211	24	06047	37.29248035	-120.4730619	Merced County
290994	Fee-for-Service	1710915095	1710915095	1	1	DIMEN JOSE M MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44438	41	Internal Medicine	0	In state provider	None	1275 E LATHAM AVE	SUITE A	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
291016	Fee-for-Service	1710915095	1710915095	1	1	DIMEN JOSE M MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	44438	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1275 E LATHAM AVE	SUITE A	HEMET	CA	92543	4424	33	06065	33.74938248	-116.9589555	Riverside County
291025	Fee-for-Service	1558522300	1558522300	1	1	DANN, KHALILAH C MD	9/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168238	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
291084	Fee-for-Service	1164564688	1164564688	1	1	DYNAMICS WALKAGAIN	5/1/2001	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	REHAB INC	1830 W OLYMPIC BLVD	STE 130	LOS ANGELES	CA	90006	3734	19	06037	34.05055886	-118.2773468	Los Angeles County
291110	Fee-for-Service	1568906063	1568906063	1	1	DAO, NU T NP	10/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	801 SOUTH MAIN ST	SUITE 201	CORONA	CA	92882	3410	33	06065	33.87299458	-117.566728	Riverside County
291111	Fee-for-Service	1740393180	1740393180	1	1	DANKE,WILLIAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 CEDAR	None	OROFINO	ID	83544	0000	00	None	46.48694067	-116.2595042	Clearwater County
291439	Fee-for-Service	1639286263	1639286263	1	1	DENICHOLAS, FATMA M MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63529	40	Pediatrics	0	In state provider	None	55 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3954	19	06037	34.13582278	-118.1491634	Los Angeles County
291503	Fee-for-Service	1750625836	1750625836	1	1	DELAROSA, KATHI LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
291548	Non-Physician Medical Practitioner	None	1811138712	0	0	DOOLIN, SHANA R NP	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	00	06000	40.57278686	-122.3958519	Shasta County
291569	Non-Physician Medical Practitioner	None	1992142780	0	0	DELAPLANE, KATHRYN E CNM	1/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
291629	Non-Physician Medical Practitioner	None	1629799127	0	0	DEOGRACIA, REEGAN A PA-C	4/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1798 N GAREY AVE	None	POMONA	CA	91767	2918	00	06000	34.076894	-117.7522688	Los Angeles County
291636	Non-Physician Medical Practitioner	None	1467478602	0	0	DILL, ROBERT SCOTT	4/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2222 N NEVADA AVE	FRONT RANGE EMERGENCY SP	COLORADO SPRINGS	CO	80907	6819	00	06000	38.86574509	-104.8201477	El Paso County
291654	Non-Physician Medical Practitioner	None	1619602570	0	0	DEDERICK, ELIZABETH A NP	9/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
291663	Non-Physician Medical Practitioner	None	1538332325	0	0	DOYLE, KATHRYN A NP	10/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	925 CARLSON DR	None	BREA	CA	92821	2210	00	06000	33.93496712	-117.9126968	Orange County
291695	Non-Physician Medical Practitioner	None	1114150703	0	0	DHALIWAL, MANJOT K	7/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8301 EXODUS LANE	None	BAKERSFIELD	CA	93312	6178	00	06000	35.41907209	-119.0945923	Kern County
291732	Non-Physician Medical Practitioner	None	1023129970	0	0	DUPLANTIER, TRACY A	11/12/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2023 ALTA LOMA ST	None	DAVIS	CA	95616	0713	00	06000	38.56144604	-121.7496965	Yolo County
291786	Non-Physician Medical Practitioner	None	1780299289	0	0	DORONIO, RACHEL J NP	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
291801	Non-Physician Medical Practitioner	None	1528566122	0	0	DANIELS, KYLE PA-C	1/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 MAGNOLIA AVE	STE 101	CORONA	CA	92879	3331	00	06000	33.85291987	-117.5664344	Riverside County
291803	Non-Physician Medical Practitioner	None	1558975466	0	0	DEA, ALISA PA-C	12/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
291821	Non-Physician Medical Practitioner	None	1548562671	0	0	DESAI, ROSHNI BALKRISHNA	10/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14777 LOS GATOS BLVD	SUIT 105	LOS GATOS	CA	95032	2059	00	06000	37.25342099	-121.9522578	Santa Clara County
291826	Non-Physician Medical Practitioner	None	1033542592	0	0	DE YOUNG, ALLISON J	10/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1784 ALVARADO AVE	None	WALNUT CREEK	CA	94597	3039	00	06000	37.91465163	-122.0701212	Contra Costa County
291845	Non-Physician Medical Practitioner	None	1851010748	0	0	DRONBERGER, EVELYNN H CNM	8/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
291882	Non-Physician Medical Practitioner	None	1215049523	0	0	DOMINGUEZ, ARTURO	5/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1540 W WEST COVINA PKWY	None	WEST COVINA	CA	91790	2703	00	06000	34.07034573	-117.9402713	Los Angeles County
291887	Non-Physician Medical Practitioner	None	1285720409	0	0	DAVIS, ELIZABETH C	2/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4407 SUGARLANE CT	None	CONCORD	CA	94521	5227	00	06000	37.95227023	-121.9797159	Contra Costa County
291901	Non-Physician Medical Practitioner	None	1700594967	0	0	DESPAIN, KELSEY	1/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
291908	Non-Physician Medical Practitioner	None	1992761449	0	0	DARIUS, MICHAEL R PA-C	9/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	329 W. 8TH ST.	SUITE 101	HANFORD	CA	93230	4533	00	06000	36.32698307	-119.6503466	Kings County
291910	Non-Physician Medical Practitioner	None	1083845069	0	0	DOAN, CHINH N	9/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2720 LOW CT	None	FAIRFIELD	CA	94534	9771	00	06000	38.23580279	-122.0858445	Solano County
291954	Non-Physician Medical Practitioner	None	1285061168	0	0	DAO, NAM A	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16411 MCFADDEN AVE	APT 323	TUSTIN	CA	92780	4868	00	06000	33.73384662	-117.841043	Orange County
291963	Non-Physician Medical Practitioner	None	1891441119	0	0	DOMINICK, AMANDA E PA	1/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
291976	Non-Physician Medical Practitioner	None	1104985811	0	0	DENKERS, DAVID K	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7615 STONEY CREEK CT	None	HIGHLAND	CA	92436	6505	00	06000	34.11531998	-117.1974328	San Bernardino County
292011	Non-Physician Medical Practitioner	None	1922087659	0	0	DANYLEYKO, GRAHAM T PA	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
292013	Non-Physician Medical Practitioner	None	1972995850	0	0	DODSON, CLAIRE A	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	466 CALLE DE ARAGON	None	REDONDO BEACH	CA	90277	6724	00	06000	33.80835082	-118.3785346	Los Angeles County
292044	Non-Physician Medical Practitioner	None	1245075985	0	0	DOOL, MANGPREET NP	12/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2222 E ORANGEBURG AVE	None	MODESTO	CA	95355	3399	00	06000	37.66353653	-120.9564675	Stanislaus County
292061	Non-Physician Medical Practitioner	None	1982752440	0	0	DEUTSCHE, KEVIN R	9/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1 ATWELL RD	None	COOPERSTOWN	NY	13326	1301	00	06000	42.695262	-74.9230425	Otsego County
292073	Non-Physician Medical Practitioner	None	1245971118	0	0	DENHOLM, KRIS B PA-C	1/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
292091	Non-Physician Medical Practitioner	None	1366773061	0	0	DEMARCO, TRACIE M NP	9/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2631 DARWIN ST	None	SACRAMENTO	CA	95821	5524	00	06000	38.613798	-121.4178795	Sacramento County
292103	Non-Physician Medical Practitioner	None	1912726019	0	0	DALOG, HONA ROSE NP	1/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8303 BRIMHALL RD	BLDG 1500	BAKERSFIELD	CA	93312	2243	00	06000	35.36875852	-119.0948805	Kern County
292134	Non-Physician Medical Practitioner	None	1316391642	0	0	DEPAOLI, JOEL R	3/15/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	00	06000	37.60573981	-122.0835989	Alameda County
292148	Non-Physician Medical Practitioner	None	1316484710	0	0	DAO, MICHELLE O	3/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4440 SEPULVEDA BLVD	APT 423	SHERMAN OAKS	CA	91403	3903	00	06000	34.15090698	-118.4673232	Los Angeles County
292173	Non-Physician Medical Practitioner	None	1629386230	0	0	DESCALLAR, EDDIE YEE	11/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 WILSHIRE BLVD	None	LOS ANGELES	CA	90057	3602	00	06000	34.0565363	-118.2728437	Los Angeles County
292201	Non-Physician Medical Practitioner	None	1528430600	0	0	DUGGAN, PEGGY L NP	1/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16350 VENTURA BLVD	APT 306	ENCINO	CA	91436	5307	00	06000	34.15710102	-118.489263	Los Angeles County
292246	Non-Physician Medical Practitioner	None	1891497517	0	0	DELPASSAND, SHADI K NP	5/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12665 GARDEN GROVE BLVD	STE 601	GARDEN GROVE	CA	92843	1920	00	06000	33.77450141	-117.9123364	Orange County
292253	Non-Physician Medical Practitioner	None	1275095663	0	0	DIYA, JOHN ANTHONY C NP	3/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5888 EDINGER AVE	None	HUNTINGTON BEACH	CA	92649	1705	00	06000	33.72993249	-118.0255995	Orange County
292260	Non-Physician Medical Practitioner	None	1306330444	0	0	DE GRASSI, CHARLENE NP	10/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	235 W GROVE ST	None	POMONA	CA	91767	1674	00	06000	34.1032719	-117.7509559	Los Angeles County
292262	Non-Physician Medical Practitioner	None	1699073320	0	0	DAVIDIAN, NORA A PA	6/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	00	06000	34.44509477	-119.7186392	Santa Barbara County
292268	Non-Physician Medical Practitioner	None	1144708876	0	0	DEVENCENZI, AMANDA PA-C	6/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	00	06000	36.66192801	-121.6413283	Monterey County
292309	Non-Physician Medical Practitioner	None	1417293283	0	0	DUARTE, JOSE L	1/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1207 W MIRAMAR ST	APT 116	LOS ANGELES	CA	90026	6155	00	06000	34.05743237	-118.2578471	Los Angeles County
292310	Non-Physician Medical Practitioner	None	1427264563	0	0	DIAZ, EDESSA O NP	11/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
292313	Non-Physician Medical Practitioner	None	1740560382	0	0	DEDIC, NATHAN A	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1576 SPRUCE ST	UNIT C	PLACENTIA	CA	92870	9406	00	06000	33.87023894	-117.8317086	Orange County
292318	Non-Physician Medical Practitioner	None	1548802390	0	0	DANG, CHRISTINA PA-C	2/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2097 COMPTON AVE	BLDG 1, SUITE 103	CORONA	CA	92881	7282	00	06000	33.847776	-117.536173	Riverside County
292354	Non-Physician Medical Practitioner	None	1184152753	0	0	DAVIS, RICA E NP	7/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2554 CORBEL WAY	None	SAN MARCOS	CA	92078	0908	00	06000	33.09768595	-117.2162079	San Diego County
292377	Non-Physician Medical Practitioner	None	1174143101	0	0	DETORE, ASHLEY L PA	2/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1240 SOUTH ELISEO DRIVE	SUITE 101	GREENBRAE	CA	94904	2028	00	06000	37.94422763	-122.5361926	Marin County
292379	Non-Physician Medical Practitioner	None	1285913053	0	0	DEMPSEY, ARIANNA B NP	4/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	663 WALLACE WAY	None	WEATHERLY	PA	18255	3359	00	06000	40.89767635	-75.8987444	Carbon County
292383	Non-Physician Medical Practitioner	None	1548924012	0	0	DE GUZMAN, CANDY GRACE J NP	2/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
292399	Non-Physician Medical Practitioner	None	1891112652	0	0	DASS, ASHLENA K	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 E ATHERTON DR	APT 200	MANTECA	CA	95337	7963	00	06000	37.78169673	-121.2028368	San Joaquin County
292421	Non-Physician Medical Practitioner	None	1750806378	0	0	DIKE, BRIDGET N NP	3/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
292457	Non-Physician Medical Practitioner	None	1548738198	0	0	DELGADO-LOPEZ, JONATHAN J PA-C	4/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	714 N AVALON BLVD	None	WILMINGTON	CA	90744	5809	00	06000	33.77897659	-118.2623373	Los Angeles County
292463	Non-Physician Medical Practitioner	None	1306454640	0	0	DHILLON, AMANDEEP NP	1/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6515 PANAMA LANE	SUITE 106-107	BAKERSFIELD	CA	93311	9729	00	06000	35.29604449	-119.0756205	Kern County
292484	Non-Physician Medical Practitioner	None	1043805401	0	0	DE ANGELIS, NICOLE NP	12/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	415 W CARROLL AVE	STE 100	GLENDORA	CA	91741	4208	00	06000	34.13420945	-117.870876	Los Angeles County
292504	Non-Physician Medical Practitioner	None	1528215076	0	0	DAVIS, JESSICA T NP	6/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	00	06000	34.42739162	-119.7253175	Santa Barbara County
292506	Non-Physician Medical Practitioner	None	1972512820	0	0	DEMARCO, PAUL NP	4/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	179 OLINDA DRIVE	None	BREA	CA	92823	7037	00	06000	33.92925758	-117.8038449	Orange County
292509	Non-Physician Medical Practitioner	None	1205192713	0	0	DAVEY, KELLY G NP	6/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
292557	Non-Physician Medical Practitioner	None	1841358256	0	0	DE LA CRUZ, LETISIA	2/26/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	SUITE 125	LOS ANGELES	CA	90033	2464	00	06000	34.05112725	-118.2173921	Los Angeles County
292566	Non-Physician Medical Practitioner	None	1114588266	0	0	DUTTON, ALISON PA	7/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
292570	Non-Physician Medical Practitioner	None	1982433983	0	0	DICKEY, MICHELLE E NP	9/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
292575	Non-Physician Medical Practitioner	None	1285071209	0	0	DIMMEL, KAITLYN	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	310 GLADYS AVE	APT 1	MOUNTAIN VIEW	CA	94043	3932	00	06000	37.39525329	-122.0613134	Santa Clara County
292583	Non-Physician Medical Practitioner	None	1427391820	0	0	DAVIS, KAREN NP	4/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
292587	Non-Physician Medical Practitioner	None	1467584532	0	0	DEWRI, WAYNE T.	11/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10430 RHONDDA ST	None	REDLANDS	CA	92374	2881	00	06000	34.06423134	-117.231202	San Bernardino County
292596	Non-Physician Medical Practitioner	None	1164655569	0	0	DEJESUS, ALFREDO	11/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	FALK CARDIOVASCULAR RESE	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292658	Non-Physician Medical Practitioner	None	1881010429	0	0	DUNCAN, KATRINA M NP	5/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
292677	Non-Physician Medical Practitioner	None	1316406796	0	0	DEPPEN, DAVID N NP	2/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	00	06000	36.06953472	-119.0273379	Tulare County
292712	Non-Physician Medical Practitioner	None	1932682176	0	0	DUNCAN, CAMERON D	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8440 N MILLBROOK AVE	APT 147	FRESNO	CA	93720	2158	00	06000	36.85797	-119.765742	Fresno County
292729	Non-Physician Medical Practitioner	None	1932726114	0	0	DATTA, SATHI	7/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	00	06000	34.43847322	-118.5729968	Los Angeles County
292768	Non-Physician Medical Practitioner	None	1578508503	0	0	DAL POGGETTO, JENNIFER A	10/5/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
292772	Non-Physician Medical Practitioner	None	1487423471	0	0	DUGARNYAM, ULEMJ PA-C	1/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 WARNER	SUITE 140	FOUNTAIN VALLEY	CA	92708	3207	00	06000	33.71568247	-117.977193	Orange County
292807	Non-Physician Medical Practitioner	None	1487167912	0	0	DIEP, VIVIAN K	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 JEFFERSON AVE	UNIT 416	REDWOOD CITY	CA	94063	1796	00	06000	37.489518	-122.2284275	San Mateo County
292824	Non-Physician Medical Practitioner	None	1366111965	0	0	DELABAHAN, SARAH NP	4/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	230 PROSPECT PLACE	SUITE 340B	CORONADO	CA	92118	1991	00	06000	32.69468235	-117.1677128	San Diego County
292924	Non-Physician Medical Practitioner	None	1467898437	0	0	DSOUZA, SHANTHI J NP	1/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3535 BARKWOOD DR	None	ANDERSON	CA	96007	4716	00	06000	40.46494359	-122.2999427	Shasta County
292941	Non-Physician Medical Practitioner	None	1144901844	0	0	DONG, DEXTER NP	9/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	00	06000	37.5531875	-121.9805141	Alameda County
292944	Non-Physician Medical Practitioner	None	1376059253	0	0	DANG, TIFFANY T NP	5/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	00	06000	33.91745451	-117.9133065	Orange County
292981	Non-Physician Medical Practitioner	None	1306563549	0	0	DOVAL, ASHLEY PA-C	3/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
292982	Non-Physician Medical Practitioner	None	1689884504	0	0	DONNA LEFFLER HEALTH CLINIC	10/11/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	815 S WILLOW AVE	None	RIALTO	CA	92376	6934	00	06000	34.08651162	-117.3745828	San Bernardino County
292991	Non-Physician Medical Practitioner	None	1841676889	0	0	DANESHVAR-JAHROMI, LOBAT NP	3/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9398 N RECREATION	None	FRESNO	CA	93720	4151	00	06000	36.87280159	-119.742327	Fresno County
292994	Non-Physician Medical Practitioner	None	1922581941	0	0	DUVALL, BRITTANY N NP	4/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
293045	Non-Physician Medical Practitioner	None	1245773670	0	0	DIAZ NAVARRO, LUPITA NP	10/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10721 WHITBURN ST	None	CULVER CITY	CA	90230	5420	00	06000	33.99904823	-118.3883391	Los Angeles County
293059	Non-Physician Medical Practitioner	None	1376853622	0	0	DONG, EMILY	6/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1746 PILGRIM AVE	None	MOUNTAIN VIEW	CA	94040	2324	00	06000	37.38941747	-122.098071	Santa Clara County
293075	Non-Physician Medical Practitioner	None	1891020228	0	0	DIPERT, JACQUELINE NICHOLE	2/4/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	STE 560	LA JOLLA	CA	92037	1224	00	06000	32.882913	-117.226341	San Diego County
293076	Non-Physician Medical Practitioner	None	1619531464	0	0	DUARTE, ESTEFANY L PA-C	11/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
293089	Non-Physician Medical Practitioner	None	1861877037	0	0	DORNBUSH, JENNIFER A NP	10/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 GELLERT BLVD	None	DALY CITY	CA	94015	2613	00	06000	37.66753085	-122.4686194	San Mateo County
293102	Non-Physician Medical Practitioner	None	1831376334	0	0	DENNIS, DARREN KYLE	5/28/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	350 LYCKMAN PL	None	FOUNTAIN	CO	80817	2861	00	06000	38.69354169	-104.7055578	El Paso County
293128	Non-Physician Medical Practitioner	None	1194948406	0	0	DE ZUBIRIA, RODRIGO A	11/14/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 N HERWALDT DR	None	FRESNO	CA	93701	2186	00	06000	36.745794	-119.7834345	Fresno County
293169	Non-Physician Medical Practitioner	None	1366124851	0	0	DEVINA, YEMIMA NP	9/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
293209	Non-Physician Medical Practitioner	None	1427265123	0	0	DRANCEA, GEORGETA LAURA	1/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 W BALL RD	SUITE 100 B	ANAHEIM	CA	92804	3738	00	06000	33.81724472	-118.0083216	Orange County
293220	Non-Physician Medical Practitioner	None	1063868784	0	0	DILMORE, HEATHER D NP	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 DARLINGHAM COURT	None	BAKERSFIELD	CA	93312	5614	00	06000	35.36597315	-119.1127143	Kern County
293269	Non-Physician Medical Practitioner	None	1770538720	0	0	DE BELEN-WILSON, CHRISTINE VALDEZ	7/7/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3911 NORWOOD AVE	None	SACRAMENTO	CA	95838	3361	00	06000	38.638197	-121.4573895	Sacramento County
293270	Non-Physician Medical Practitioner	None	1265183818	0	0	DICKESON, AMY S NP	2/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
293296	Non-Physician Medical Practitioner	None	1316275183	0	0	DODSON, TIFFANY A NP	9/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7115 GREENBACK LN	FL 2	CITRUS HEIGHTS	CA	95621	6133	00	06000	38.679237	-121.298859	Sacramento County
293297	Non-Physician Medical Practitioner	None	1619273091	0	0	DUTHIE, JOLENE PA-C	4/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
293328	Non-Physician Medical Practitioner	None	1326053174	0	0	DAILO, MARITA GRACE	3/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3350 LA JOLLA VILLAGE DR	None	SAN DIEGO	CA	92161	0002	00	06000	32.874021	-117.232191	San Diego County
293367	Non-Physician Medical Practitioner	None	1215379276	0	0	DARAMOLA, OLUWAYEMISI O NP	7/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	00	06000	34.09544496	-117.5747968	San Bernardino County
293378	Non-Physician Medical Practitioner	None	1992480990	0	0	DOOLEY, TORREY NP	1/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	00	06000	34.058745	-117.2000975	San Bernardino County
293409	Non-Physician Medical Practitioner	None	1881301190	0	0	DAWIS, MARIA CONRICA S NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	00	06000	34.06544724	-118.4459249	Los Angeles County
293434	Non-Physician Medical Practitioner	None	1730802570	0	0	DANYELL, KRYSTYNE NP	11/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1577 E. CHEVY CHASE DR.	SUITE 300	GLENDALE	CA	91206	4092	00	06000	34.15313959	-118.2299467	Los Angeles County
293439	Non-Physician Medical Practitioner	None	1831964121	0	0	DIAZ, DANIEL NP	2/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
293446	Non-Physician Medical Practitioner	None	1912434705	0	0	DINH, HARRISON H	12/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	731 S MANHATTAN PLACE	None	LOS ANGELES	CA	90005	3120	00	06000	34.05877309	-118.310201	Los Angeles County
293448	Non-Physician Medical Practitioner	None	1609538040	0	0	DIZON, REGINA	8/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1704 WEST MANCHESTER AVE	SUITE 106	LOS ANGELES	CA	90047	3056	00	06000	33.9599425	-118.307079	Los Angeles County
293451	Non-Physician Medical Practitioner	None	1831554682	0	0	DAUGHERTY, BRETTNEY R NP	1/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	648 SUNFISH WAY	None	PORT HUENEME	CA	93041	9998	00	06000	34.14245873	-119.190019	Ventura County
293456	Non-Physician Medical Practitioner	None	1942522016	0	0	DAVIS, SHANNON C	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4885 COLLWOOD BLVD	None	SAN DIEGO	CA	92115	2193	00	06000	32.76724035	-117.0840617	San Diego County
293461	Non-Physician Medical Practitioner	None	1841830627	0	0	DAVIS, ADRIAN L NP	6/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
293495	Non-Physician Medical Practitioner	None	1942734744	0	0	DEPIZZO, ALMA NP	4/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
293541	Non-Physician Medical Practitioner	None	1861811788	0	0	DE LA CRUZ, ANNE J G NP	12/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 N KENMORE AVE	None	LOS ANGELES	CA	90029	1506	00	06000	34.09456929	-118.2973322	Los Angeles County
293572	Non-Physician Medical Practitioner	None	1659652048	0	0	DOBRIN, SURIME S	5/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	385 E GREEN ST	# 2411	PASADENA	CA	91101	2324	00	06000	34.14454476	-118.1429075	Los Angeles County
293573	Non-Physician Medical Practitioner	None	1255672218	0	0	DICHTER, CHRISTINE E NP	2/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
293577	Non-Physician Medical Practitioner	None	1952708695	0	0	DODSON, EMILY E PA	2/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
293580	Non-Physician Medical Practitioner	None	1073281754	0	0	DOMINGO, LEO ERNIE M NP	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	00	06000	33.78785047	-117.8631495	Orange County
293593	Non-Physician Medical Practitioner	None	1831476506	0	0	DE LA MOTTE HURST, NICHOLAS PA	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	00	06000	34.27680789	-119.2480851	Ventura County
293611	Non-Physician Medical Practitioner	None	1962052316	0	0	DELACRUZ, FLORDELIS NP	9/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	00	06000	34.51312455	-117.325854	San Bernardino County
293633	Non-Physician Medical Practitioner	None	1659590883	0	0	DOYLE, CYNTHIA O	6/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5901 CLOVER HEIGHTS AVE	None	MALIBU	CA	90265	3704	00	06000	34.02845902	-118.8237302	Los Angeles County
293634	Non-Physician Medical Practitioner	None	1134694946	0	0	DEANGELO, ERICA PA-C	11/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
293692	Non-Physician Medical Practitioner	None	1649985615	0	0	DETIENNE, RACHEL PA	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
293694	Non-Physician Medical Practitioner	None	1770192536	0	0	DAO, QUY ALAN D PA-C	2/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4646 BROCKTON AVE	STE 103	RIVERSIDE	CA	92506	0103	00	06000	33.9760171	-117.3860626	Riverside County
293710	Non-Physician Medical Practitioner	None	1942603295	0	0	DRUMMEY, LAUREN C NP	12/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11470 CUMPSTON ST	None	N HOLLYWOOD	CA	91601	2619	00	06000	34.16962702	-118.3812981	Los Angeles County
293718	Non-Physician Medical Practitioner	None	1801089974	0	0	DENNY, EILEEN NP	8/14/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 SAN DIMAS ST STE B2	None	BAKERSFIELD	CA	93301	1496	00	06000	35.3946385	-119.008203	Kern County
293736	Non-Physician Medical Practitioner	None	1477010312	0	0	DHILLON, AMBER K PA	11/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
293740	Non-Physician Medical Practitioner	None	1790237485	0	0	DONKOR, KATE RN	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 PAULARINO AVE	D182	COSTA MESA	CA	92626	3302	00	06000	33.68149891	-117.8763277	Orange County
293746	Non-Physician Medical Practitioner	None	1801389507	0	0	DONAHUE, CODY PA	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
293773	Non-Physician Medical Practitioner	None	1952992539	0	0	DELATORRE, REBECCA J NP	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3409 CALLOWAY DR	SUITE 602	BAKERSFIELD	CA	93312	2534	00	06000	35.39132551	-119.11007	Kern County
293775	Non-Physician Medical Practitioner	None	1013084854	0	0	DEWITT, DAVID O	2/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	778 W EDNA PL	None	COVINA	CA	91722	3222	00	06000	34.09305003	-117.9053363	Los Angeles County
293785	Non-Physician Medical Practitioner	None	1366811861	0	0	DUBOWY, LINDSEY M PA-C	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2423 HAREWOOD DR	None	LIVERMORE	CA	94551	1700	00	06000	37.69187466	-121.7711445	Alameda County
293788	Non-Physician Medical Practitioner	None	1528395365	0	0	DOREN, TIM R PA-C	7/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
293841	Non-Physician Medical Practitioner	None	1831521681	0	0	DALLAL, VERONICA NP	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7096 LEMON GRASS AVE	None	EASTVALE	CA	92880	8964	00	06000	33.95942254	-117.5850018	Riverside County
293870	Non-Physician Medical Practitioner	None	1538934138	0	0	DAVIDSON, JAMIE NP	3/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41870 GARSTIN DRIVE	None	BIG BEAR LAKE	CA	92315	1649	00	06000	34.24602097	-116.8885243	San Bernardino County
293887	Non-Physician Medical Practitioner	None	1265509004	0	0	DOME, MARK E	8/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 S RASPBERRY LANE	None	ANAHEIM HILLS	CA	92808	2268	00	06000	33.86199563	-117.7536103	Orange County
293895	Non-Physician Medical Practitioner	None	1750681227	0	0	DE LA CUESTA, KAREN A NP	1/30/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1288 FORRESTAL AVE	None	SAN JOSE	CA	95110	1417	00	06000	37.3583565	-121.9111916	Santa Clara County
293940	Non-Physician Medical Practitioner	None	1205187432	0	0	DE PETRO, JULIE R NP	2/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8229 HASTINGS ST	None	BAKERSFIELD	CA	93311	1146	00	06000	35.34569397	-119.0954762	Kern County
293962	Non-Physician Medical Practitioner	None	1982616868	0	0	DE LA MORA, KAREN MARIE	6/17/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 E VALENCIA MESA DRIV	None	FULLERTON	CA	92835	0000	00	06000	33.89356031	-117.9271656	Orange County
293964	Non-Physician Medical Practitioner	None	1124746086	0	0	DAO, TRINH T NP	5/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
293981	Non-Physician Medical Practitioner	None	1609356484	0	0	DAVIS, STEVIA B NP	2/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
293985	Non-Physician Medical Practitioner	None	1841775509	0	0	DISHIGRIKYAN, ZEPYUR PA	1/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
294005	Non-Physician Medical Practitioner	None	1245933688	0	0	DUGGAN, JAEDELEEN NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15325 FAIRFIELD RANCH RD	STE. 150	CHINO HILLS	CA	91709	8834	00	06000	33.9729714	-117.6918388	San Bernardino County
294038	Non-Physician Medical Practitioner	None	1538370564	0	0	DELGADO, SARAH ANN HORNE	2/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12291 WASHINGTON BLVD	None	WHITTIER	CA	90606	2500	00	06000	33.96734104	-118.0508773	Los Angeles County
294067	Non-Physician Medical Practitioner	None	1225484975	0	0	DAVIS, DAVID NP	3/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1860 S CENTRAL ST STE B	None	VISALIA	CA	93277	4497	00	06000	36.31455	-119.310678	Tulare County
294070	Non-Physician Medical Practitioner	None	1295145449	0	0	DEGNER, ABIGAIL E	10/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	153 SUMMIT AVENUE	None	SONORA	CA	95370	5720	00	06000	37.98823691	-120.3824327	Tuolumne County
294101	Non-Physician Medical Practitioner	None	1235492299	0	0	DEVON, MASON D	2/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4242 ROSARIO RD	None	WOODLAND HILLS	CA	91364	6027	00	06000	34.14641215	-118.5913008	Los Angeles County
294141	Non-Physician Medical Practitioner	None	1932415072	0	0	DORWIN, NATALIE ROSE	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5333 MISSION CENTER RD	SUITE 100	SAN DIEGO	CA	92108	1302	00	06000	32.77178608	-117.1547851	San Diego County
294161	Non-Physician Medical Practitioner	None	1891860722	0	0	DRAPER, LINDA CHARLENE	11/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	00	06000	38.00403417	-121.8422798	Contra Costa County
294178	Non-Physician Medical Practitioner	None	1063192953	0	0	DANG, ANDREW NP	9/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
294181	Non-Physician Medical Practitioner	None	1073805032	0	0	DAMICO, MICHAEL A	2/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	18 JESSICA LN	None	RINGGOLD	GA	30736	5585	00	06000	34.90703773	-85.20933678	Catoosa County
294201	Non-Physician Medical Practitioner	None	1669735981	0	0	DUDLEY, GABE O	8/22/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	601 E MICHELTORENA ST	STE 13	SANTA BARBARA	CA	93103	1985	00	06000	34.43292239	-119.701137	Santa Barbara County
294259	Non-Physician Medical Practitioner	None	1376136689	0	0	DAHL, YEN N CNM	3/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
294280	Non-Physician Medical Practitioner	None	1922448240	0	0	DINELLO, KARI J NP	9/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	166 SALADA AVE	None	PACIFICA	CA	94044	2530	00	06000	37.63461851	-122.4908145	San Mateo County
294295	Non-Physician Medical Practitioner	None	1134555865	0	0	DELA CRUZ, ROWENA	11/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6037 ORANGE POPPY CT	None	LAS VEGAS	NV	89120	2566	00	06000	36.07984786	-115.0930744	Clark County
294298	Non-Physician Medical Practitioner	None	1184000630	0	0	DESVEAUX, ZHANAR M	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10819 LORO VERDE AVE	None	LOMA LINDA	CA	92354	2574	00	06000	34.05693821	-117.2423342	San Bernardino County
294339	Non-Physician Medical Practitioner	None	1548394711	0	0	DE WITT, JOCELYN M	3/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2240 LOMBAR ST	205	SAN FRANCISCO	CA	94123	2732	00	06000	37.79956129	-122.4384963	San Francisco County
294417	Non-Physician Medical Practitioner	None	1063700664	0	0	DAO, QUYNH	7/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	807 MANZANITA AVE	None	PASADENA	CA	91103	2950	00	06000	34.15884522	-118.1534576	Los Angeles County
294432	Non-Physician Medical Practitioner	None	1215912688	0	0	DEAMICIS, DUANE R	9/13/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1136 E MONTECITO ST	None	SANTA BARBARA	CA	93103	2635	00	06000	34.42699433	-119.6800449	Santa Barbara County
294443	Non-Physician Medical Practitioner	None	1639136674	0	0	DRUM-LAL, PATRICIA ANN	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1328 22ND STREET	None	SANTA MONICA	CA	90404	2091	00	06000	34.03122319	-118.4797185	Los Angeles County
294460	Non-Physician Medical Practitioner	None	1639335771	0	0	DODGE, GERALDINE M PA	5/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
294463	Non-Physician Medical Practitioner	None	1407265812	0	0	DAY, JOSHUA K	3/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6526 MODOC CT	None	VISALIA	CA	93291	8334	00	06000	36.353601	-119.3639535	Tulare County
294476	Non-Physician Medical Practitioner	None	1578868998	0	0	DINH, Y NHA T PA	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
294480	Non-Physician Medical Practitioner	None	1104844224	0	0	DEATON, DAVID LAWRENCE	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1100 S MEDICAL DR	None	MT PLEASANT	UT	84647	2222	00	06000	39.53181056	-111.4610021	Sanpete County
294508	Non-Physician Medical Practitioner	None	1356499255	0	0	DRAKE, DOUGLAS A	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3352 IRONWOOD PL	None	OCEANSIDE	CA	92056	3211	00	06000	33.19519953	-117.3160375	San Diego County
294568	Non-Physician Medical Practitioner	None	1992290977	0	0	DO, ANGELA C	8/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 VINELAND	None	BALDWIN PARK	CA	91706	5000	00	06000	34.07225907	-117.9677163	Los Angeles County
294582	Non-Physician Medical Practitioner	None	1760502603	0	0	DONNELLY, KATE L	11/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	806 RUTH COURT	None	PETALUMA	CA	94952	2072	00	06000	38.23554776	-122.6581098	Sonoma County
294596	Non-Physician Medical Practitioner	None	1508317934	0	0	DAQUIOAG, ROCELIZA B NP	4/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8915 RIBSTON AVE	None	BAKERSFIELD	CA	93312	2692	00	06000	35.37924233	-119.1020117	Kern County
294615	Non-Physician Medical Practitioner	None	1053142109	0	0	DECKER, DREW A PA	11/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
294616	Non-Physician Medical Practitioner	None	1376928309	0	0	DOYLE, PHILIP PA	1/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1508 ALHAMBRA BLVD	200	SACRAMENTO	CA	95816	6510	00	06000	38.567007	-121.468068	Sacramento County
294632	Non-Physician Medical Practitioner	None	1518473552	0	0	DIZON, CALEB A NP	5/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	438 W LAS TUNAS DRIVE	None	SAN GABRIEL	CA	91776	1216	00	06000	34.10243051	-118.105902	Los Angeles County
294646	Non-Physician Medical Practitioner	None	1407321169	0	0	DE LA ROSA, ALEJANDRA NP	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
294668	Non-Physician Medical Practitioner	None	1427710979	0	0	DONOGHUE, ELIZABETH T NP	11/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5395 RUFFIN ROAD	STE. 204	SAN DIEGO	CA	92123	1338	00	06000	32.832387	-117.1266225	San Diego County
294696	Non-Physician Medical Practitioner	None	1578966925	0	0	DOREY, DANIELLE B	12/9/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2140 ORINDA DR	UNIT C	CARDIFF	CA	92007	1942	00	06000	33.01916011	-117.2804909	San Diego County
294706	Non-Physician Medical Practitioner	None	1659749455	0	0	DENIO, DIANA M	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 E DEL MAR BLVD	UNIT 129	PASADENA	CA	91101	2751	00	06000	34.14035448	-118.1433285	Los Angeles County
294710	Non-Physician Medical Practitioner	None	1265293922	0	0	DANG, SOPHIA T PA-C	2/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 N. TUSTIN AVE	UNIT # 216	SANTA ANA	CA	92705	3528	00	06000	33.754167	-117.834191	Orange County
294718	Non-Physician Medical Practitioner	None	1154475721	0	0	DOYLE, BRAD THOMAS	12/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	00	06000	38.602089	-121.3925895	Sacramento County
294839	Non-Physician Medical Practitioner	None	1891151148	0	0	DUNAUSKAS, STEFAN A NP	3/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	280 SOUTH MAIN STREET	SUITE 200	ORANGE	CA	92868	3852	00	06000	33.784695	-117.867327	Orange County
294843	Non-Physician Medical Practitioner	None	1063878296	0	0	DEMEYERE, LISA M CNP	3/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
294864	Non-Physician Medical Practitioner	None	1144261785	0	0	DOYLE, ARLENE JANE	5/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2238 GEARY BLVD	INJURY CENTER, THIRD FLO	SAN FRANCISCO	CA	94115	3416	00	06000	37.78324881	-122.4405738	San Francisco County
294868	Non-Physician Medical Practitioner	None	1477923373	0	0	D'ELIA-VERROCCHI, AURORA PA	6/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15615 POMERADO ROAD	None	POWAY	CA	92064	2460	00	06000	32.99706	-117.05544	San Diego County
294885	Non-Physician Medical Practitioner	None	1922352681	0	0	DOWNER, NICOLE D NP	12/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	142 SANTA ROSA PLACE	None	SANTA BARBARA	CA	93109	0000	00	06000	34.39819432	-119.7082588	Santa Barbara County
294908	Non-Physician Medical Practitioner	None	1972913622	0	0	DUBBULA, YASHVEER P	9/25/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1818 GRANADA AVE	APT 3	SAN DIEGO	CA	92102	1135	00	06000	32.72469898	-117.1330125	San Diego County
294925	Non-Physician Medical Practitioner	None	1710098330	0	0	DRUMRIGHT, AARON R	1/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SUTTER PL	SUITE 101	DAVIS	CA	95616	6213	00	06000	38.56287659	-121.7715536	Yolo County
294927	Non-Physician Medical Practitioner	None	1851940423	0	0	DUBROW, DANIEL A PA	11/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
294947	Non-Physician Medical Practitioner	None	1518650605	0	0	DEMAREE, JENNIFER NP	7/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	711 EAST ROSECRANS AVE	None	COMPTON	CA	90221	2143	00	06000	33.9035073	-118.2158303	Los Angeles County
294952	Non-Physician Medical Practitioner	None	1275642274	0	0	DAVIS, MARCIA CAMILLE	12/22/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	124 W THOMAS RD	None	PHOENIX	AZ	85013	4405	00	06000	33.480594	-112.075632	Maricopa County
294957	Non-Physician Medical Practitioner	None	1255888590	0	0	DONG, JENNIE PA-C	7/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
294972	Non-Physician Medical Practitioner	None	1972655389	0	0	DICKINSON, ALLISON J PA	2/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
294980	Non-Physician Medical Practitioner	None	1609389329	0	0	DAVIDSON, CARRIE PA	6/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35200 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	1748	00	06000	33.79248	-116.405861	Riverside County
295000	Non-Physician Medical Practitioner	None	1548318942	0	0	DHARNI, RUPINDERVIR K	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2782 VANDERMOLEN DR	None	NORCO	CA	92860	5144	00	06000	33.92333138	-117.5184098	Riverside County
295014	Non-Physician Medical Practitioner	None	1750666210	0	0	DECOSTER, JAMIE M	6/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29835 HAVENWOOD LN	None	HIGHLAND	CA	92346	6261	00	06000	34.12028246	-117.152851	San Bernardino County
295019	Non-Physician Medical Practitioner	None	1194492777	0	0	DEL ROSARIO, YVONNE SONJA G NP	9/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 J STREET	SUITE 270	SACRAMENTO	CA	95819	3624	00	06000	38.570652	-121.4535465	Sacramento County
295026	Non-Physician Medical Practitioner	None	1730762345	0	0	DAVIDSON, JENNIFER NP	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1580 W EL CAMINO REAL	5	MOUNTAIN VIEW	CA	94040	2461	00	06000	37.39001812	-122.0922931	Santa Clara County
295041	Non-Physician Medical Practitioner	None	1023442985	0	0	DIAZ, MAIKEL H	3/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7074 SW 114TH PL	APT C	MIAMI	FL	33173	1848	00	06000	25.70182096	-80.37801655	Miami-Dade County
295098	Non-Physician Medical Practitioner	None	1679927834	0	0	DIAL, ELEAZAR S PA-C	8/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3975 JACKSON ST	STE 200	RIVERSIDE	CA	92503	3947	00	06000	33.92729721	-117.4413503	Riverside County
295115	Non-Physician Medical Practitioner	None	1720221872	0	0	DAY III	5/26/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11823 TRURO AVE APT A	None	HAWTHORNE	CA	90250	2835	00	06000	33.92685084	-118.3581453	Los Angeles County
295143	Non-Physician Medical Practitioner	None	1679850671	0	0	DAVIES, SUMMER R NP	7/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5423 TAFT AVE	None	LA JOLLA	CA	92037	7641	00	06000	32.81265487	-117.2615888	San Diego County
295173	Non-Physician Medical Practitioner	None	1114686847	0	0	DOUKOURE BALDE, MARIENE	2/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
295195	Non-Physician Medical Practitioner	None	1760626675	0	0	DE OLIVEIRA, ALCIDES ANTONIO	10/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 S MAIN ST	SUITE # 101	ORANGE	CA	92868	4507	00	06000	33.77991974	-117.8674745	Orange County
295207	Non-Physician Medical Practitioner	None	1164133195	0	0	DONCHEVA, VESSELINA Y PA	1/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
295233	Non-Physician Medical Practitioner	None	1932728821	0	0	DOMINGUEZ, ILIANA NP	6/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
295235	Non-Physician Medical Practitioner	None	1407254071	0	0	DEMPSEY, JACLYN A PA-C	9/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
295240	Non-Physician Medical Practitioner	None	1255086443	0	0	DEVERA, MAICA NP	2/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1127 WILSHIRE BLVD	909	LOS ANGELES	CA	90017	3910	00	06000	34.05270508	-118.2641005	Los Angeles County
295272	Non-Physician Medical Practitioner	None	1295275576	0	0	DUONG, BICH LIEU NP	9/29/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
295275	Non-Physician Medical Practitioner	None	1790216851	0	0	DUTKO, HELEN NP	2/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
295288	Non-Physician Medical Practitioner	None	1215052113	0	0	DI MERCURIO, NICOLE	3/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
295305	Non-Physician Medical Practitioner	None	1619251543	0	0	DODD, DALEY C PA	4/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12006 CANARY CT	None	GRAND TERRACE	CA	92313	5318	00	06000	34.03575	-117.303849	San Bernardino County
295314	Non-Physician Medical Practitioner	None	1750498846	0	0	DAVIS, CHYRON M	4/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4419 ELM AVE	None	LONG BEACH	CA	90807	1409	00	06000	33.8380893	-118.1895471	Los Angeles County
295345	Non-Physician Medical Practitioner	None	1710726948	0	0	DEROSA, ALEXANDRA PA-C	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 E ARTESIA ST	SUITE 325	POMONA	CA	91767	2922	00	06000	34.07556833	-117.7507835	Los Angeles County
295369	Non-Physician Medical Practitioner	None	1235880824	0	0	DAVIS, CHANTAL S CNM	3/31/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
295376	Non-Physician Medical Practitioner	None	1922115229	0	0	DAVIS, MICHAEL E	8/28/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	477 N EL CAMINO REAL	SUITE B301	ENCINITAS	CA	92024	1328	00	06000	33.05700866	-117.262449	San Diego County
295380	Non-Physician Medical Practitioner	None	1316396336	0	0	DAO, OANHTUYET PA	7/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
295407	Non-Physician Medical Practitioner	None	1760689699	0	0	DEMARA, DAVID	6/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 SAN JOSE ST	STE 301	SALINAS	CA	93901	3928	00	06000	36.65853377	-121.6476066	Monterey County
295444	Non-Physician Medical Practitioner	None	1972540599	0	0	DAVIS, LISA ANN	8/14/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2970 HILLTOP MALL RD	STE #203	RICHMOND	CA	94806	1947	00	06000	37.97819764	-122.329244	Contra Costa County
295475	Non-Physician Medical Practitioner	None	1588814719	0	0	DAHM, PEARL	12/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	00	06000	34.27623479	-119.2520218	Ventura County
295549	Non-Physician Medical Practitioner	None	1043523285	0	0	DESALES, KAREN	11/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16323 CLARK AVE	None	BELLFLOWER	CA	90706	5209	00	06000	33.885693	-118.1339975	Los Angeles County
295557	Non-Physician Medical Practitioner	None	1972840338	0	0	DEL VALLE, LORENA PA	9/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19042 SOLEDAD CANYON RD	A	SANTA CLARITA	CA	91351	3362	00	06000	34.4156522	-118.46848	Los Angeles County
295558	Non-Physician Medical Practitioner	None	1780301382	0	0	DOMINGO, JOANNE CNP	1/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	79440 CORPORATE CENTER D	STE 108	LA QUINTA	CA	92253	7243	00	06000	33.70937862	-116.2788139	Riverside County
295566	Non-Physician Medical Practitioner	None	1811353196	0	0	DETHOMAS, MARIE V CNP	8/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8112 MILLIKEN AVE	SUITE 201	RANCHO CUCAMONGA	CA	91730	7473	00	06000	34.10480366	-117.5570863	San Bernardino County
295567	Non-Physician Medical Practitioner	None	1396282190	0	0	DUCLOS, LAISNER	4/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13750 LEMOLI AVE	APT 68	HAWTHORNE	CA	90250	7767	00	06000	33.90658443	-118.3308371	Los Angeles County
295572	Non-Physician Medical Practitioner	None	1669129052	0	0	DADASHYAN, INNA NP	3/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 FIRESTONE BLVD	STE 100	DOWNEY	CA	90241	5242	00	06000	33.93691837	-118.1265474	Los Angeles County
295575	Non-Physician Medical Practitioner	None	1174096655	0	0	DRAUSE, MATTHEW PA	5/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295579	Non-Physician Medical Practitioner	None	1942822663	0	0	DORSEY, KIRSTEN M PA-C	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
295583	Non-Physician Medical Practitioner	None	1174999122	0	0	DAOUD, NICOLE PA	1/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 HOWE ST	None	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
295601	Non-Physician Medical Practitioner	None	1003171851	0	0	DILLAVOU, STEVEN K PA-C	9/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	00	06000	33.83760237	-118.3692467	Los Angeles County
295605	Non-Physician Medical Practitioner	None	1356451082	0	0	DEL PINAL, WALTER P	5/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16907 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	00	06000	34.25754015	-118.5004161	Los Angeles County
295631	Non-Physician Medical Practitioner	None	1316692841	0	0	DEMONT, BRITTANY NP	8/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	00	06000	37.84779018	-122.2868874	Alameda County
295652	Non-Physician Medical Practitioner	None	1659380699	0	0	DAVISIO, PHILIP M	4/22/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1045 PARK STREAM DR	None	GALT	CA	95632	3780	00	06000	38.288016	-121.2892605	Sacramento County
295664	Non-Physician Medical Practitioner	None	1568936920	0	0	DAVILA, GESSICA L PA	1/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
295701	Non-Physician Medical Practitioner	None	1841628930	0	0	DHAKAL, SARITA S NP	1/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
295712	Non-Physician Medical Practitioner	None	1821361528	0	0	DUTERTE, JASON V NP	7/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43360 MISSION BLVD	SUITE 100	FREMONT	CA	94539	5829	00	06000	37.53249631	-121.9198141	Alameda County
295727	Non-Physician Medical Practitioner	None	1538851480	0	0	DO, RANDY PA	3/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
295753	Non-Physician Medical Practitioner	None	1669407243	0	0	DORSEY, VINCENT C	3/28/1996	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7480 APPLE BLOSSOM CT	None	HIGHLAND	CA	92346	3869	00	06000	34.11768365	-117.1898525	San Bernardino County
295837	Non-Physician Medical Practitioner	None	1275086753	0	0	DJEUGOUE, BLAISE N NP	8/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12021 JACARANDA AVE	SUITE 101	HESPERIA	CA	92345	4978	00	06000	34.46963618	-117.263267	San Bernardino County
295843	Non-Physician Medical Practitioner	None	1548702459	0	0	DIAMOND, KATHERINE S NP	7/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25716 SUNRISE WAY	None	LOMA LINDA	CA	92354	3825	00	06000	34.04559477	-117.2429686	San Bernardino County
295874	Non-Physician Medical Practitioner	None	1891932703	0	0	DIGIOVANNI, MICHELLE A NP	2/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1311 E MARSHALL ST	None	TURLOCK	CA	95380	4130	00	06000	37.4963673	-120.8363286	Stanislaus County
295900	Non-Physician Medical Practitioner	None	1740242940	0	0	DAY, JULIE K	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	967 AGATE ST	None	SAN DIEGO	CA	92109	1175	00	06000	32.8102309	-117.2564495	San Diego County
295938	Non-Physician Medical Practitioner	None	1689885485	0	0	DAO, ALLISON T NP	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 SEVENTH ST	STE 100	BERKELEY	CA	94710	2703	00	06000	37.85385944	-122.2920618	Alameda County
295940	Non-Physician Medical Practitioner	None	1720005648	0	0	DEMETER, SHARON E	3/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	0000	00	06000	38.66314048	-121.794696	Yolo County
295956	Non-Physician Medical Practitioner	None	1073981627	0	0	DIFILIPPO, JENNIFER M NP	12/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
295968	Non-Physician Medical Practitioner	None	1184256976	0	0	DAMATO, SHARON N PA	6/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
295969	Non-Physician Medical Practitioner	None	1548890395	0	0	DONAGHEY, ASHLEY S PA	9/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
295973	Non-Physician Medical Practitioner	None	1811582539	0	0	DAVIDIANS, RACHEL G NP	3/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
295996	Non-Physician Medical Practitioner	None	1861779951	0	0	DE LA CRUZ, JOSEPH S PA-C	12/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	869 N CHERRY ST	None	TULARE	CA	93274	2207	00	06000	36.220932	-119.337698	Tulare County
296051	Non-Physician Medical Practitioner	None	1205079514	0	0	DAVILA, ANNA PA	11/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1552 COFFEE ROAD	SUITE 200	MODESTO	CA	95355	3122	00	06000	37.666872	-120.975684	Stanislaus County
296112	Non-Physician Medical Practitioner	None	1659536688	0	0	DEYOUNG, LATISHA L	4/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	0000	00	06000	33.808185	-118.1850575	Los Angeles County
296159	Non-Physician Medical Practitioner	None	1700314978	0	0	DELACRUZ, MARICEL V CNP	6/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	739 EAST PENNSYLVANIA AV	STE C	ESCONDIDO	CA	92025	3004	00	06000	33.12712182	-117.0727888	San Diego County
296163	Non-Physician Medical Practitioner	None	1396917043	0	0	DUTRA, GERALDINE M	8/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
296165	Non-Physician Medical Practitioner	None	1790176543	0	0	DEVOSSCHMIDT, DIANE L NP	4/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8675 SANTA ROSA ROAD	None	ATASCADERO	CA	93422	5428	00	06000	35.4644045	-120.6546075	San Luis Obispo County
296236	Non-Physician Medical Practitioner	None	1003037631	0	0	DUNZO, LINDA RAE	7/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1629 W. 17TH STREET	SUITE A	SANTA ANA	CA	92706	0000	00	06000	33.7601103	-117.890505	Orange County
296308	Non-Physician Medical Practitioner	None	1760416572	0	0	DOLKAS LICKL, SHELLEY	1/28/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 HOAG DR	ECU	NEWPORT BEACH	CA	92663	4162	00	06000	33.62421676	-117.9309656	Orange County
296318	Non-Physician Medical Practitioner	None	1992172696	0	0	DANG, THUY T N	7/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4339 W 1ST STREET	None	SANTA ANA	CA	92703	4339	00	06000	33.74514846	-117.9270315	Orange County
296340	Non-Physician Medical Practitioner	None	1871724567	0	0	DAVIS, CAROL L	10/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17165 WALNUT AVE	None	FONTANA	CA	92336	1526	00	06000	34.1279865	-117.4302675	San Bernardino County
296372	Non-Physician Medical Practitioner	None	1679657316	0	0	DARLING, MEISHA R	12/7/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
296439	Non-Physician Medical Practitioner	None	1255344768	0	0	DERAMO, BERNADINE M NP	8/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7125 E LA CUMBRE DRIVE	None	ORANGE	CA	92869	4462	00	06000	33.78882551	-117.7775973	Orange County
296492	Non-Physician Medical Practitioner	None	1235116955	0	0	DAVISON, JULIA E PA	6/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1551 BISHOP ST	A 150	SAN LUIS OBISPO	CA	93401	4635	00	06000	35.27475609	-120.6454494	San Luis Obispo County
296511	Non-Physician Medical Practitioner	None	1801808852	0	0	DURR, DENNIS G	8/10/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 W H ST	None	OAKDALE	CA	95361	3557	00	06000	37.75794715	-120.8623247	Stanislaus County
296521	Non-Physician Medical Practitioner	None	1356788269	0	0	DUTCHER, APRIL L	4/15/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1920 MARSHALLFIELD LANE	STE 3	REDONDO BEACH	CA	90278	4264	00	06000	33.86519413	-118.3772669	Los Angeles County
296528	Non-Physician Medical Practitioner	None	1184070187	0	0	DER, JESSICA B PA-C	8/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
296535	Non-Physician Medical Practitioner	None	1275044703	0	0	DAGALA, SNOOKY G NP	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12472 WASHINGTON BLVD	B	WHITTIER	CA	90602	1005	00	06000	33.96774843	-118.0457572	Los Angeles County
296545	Non-Physician Medical Practitioner	None	1932721651	0	0	DINH, NANCY M PA-C	5/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29100 PORTOLA PKWY	SUITE B	LAKE FOREST	CA	92630	8712	00	06000	33.66214655	-117.6532809	Orange County
296570	Non-Physician Medical Practitioner	None	1902320450	0	0	DONNER, ARIELLE M	9/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 W SEASIDE WAY	#3310	LONG BEACH	CA	90802	7911	00	06000	33.76536347	-118.194309	Los Angeles County
296590	Non-Physician Medical Practitioner	None	1669684932	0	0	DELAWARE, SUZETTE	8/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	911 N WALNUT ST	APT Q	LA HABRA	CA	90631	2851	00	06000	33.940377	-117.9505785	Orange County
296605	Non-Physician Medical Practitioner	None	1861469389	0	0	DOWNEY, MIRIAM	3/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
296614	Non-Physician Medical Practitioner	None	1790468312	0	0	DAVIS, MONICA NP	9/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS	STE 406	FRESNO	CA	93701	2167	00	06000	36.74500687	-119.7846885	Fresno County
296618	Non-Physician Medical Practitioner	None	1376273334	0	0	DEMBEK, MARISSA PA-C	4/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W STEWART DR	STE 306	ORANGE	CA	92868	3838	00	06000	33.78236048	-117.8664975	Orange County
296650	Non-Physician Medical Practitioner	None	1194136655	0	0	DELVIN, JESSE K	8/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39206 GUARDINO DRIVE	212	FREMONT	CA	94538	3026	00	06000	37.55735064	-121.9695591	Alameda County
296669	Non-Physician Medical Practitioner	None	1548894066	0	0	DEAN, EVAN C NP	3/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	869 N CHERRY ST	None	TULARE	CA	93274	2207	00	06000	36.220932	-119.337698	Tulare County
296690	Non-Physician Medical Practitioner	None	1649545336	0	0	DUTTON, AMANDA E PA-C	1/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
296694	Non-Physician Medical Practitioner	None	1033493226	0	0	DREW, COLIN T PA	1/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
296736	Non-Physician Medical Practitioner	None	1578630323	0	0	DAVID, RONALD T	3/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12970 CANYONWIND RD	None	RIVERSIDE	CA	92503	9761	00	06000	33.87648488	-117.4363484	Riverside County
296756	Non-Physician Medical Practitioner	None	1417434515	0	0	DECKER, AMY M NP	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
296762	Non-Physician Medical Practitioner	None	1053581462	0	0	DAWSON, KAREN B	7/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13323 REVA ST	None	CERRITOS	CA	90703	8727	00	06000	33.86780636	-118.0476203	Los Angeles County
296772	Non-Physician Medical Practitioner	None	1689216475	0	0	DINH, JIMMY P PA	8/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
296786	Non-Physician Medical Practitioner	None	1568529048	0	0	DELGADO, CONNIE	10/17/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	49111 HWY 111	4	COACHELLA	CA	92236	0000	00	06000	33.68950858	-116.1825133	Riverside County
296790	Non-Physician Medical Practitioner	None	1114020997	0	0	DOUGLAS, ANA E	12/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3364 LINDA MESA WAY	None	NAPA	CA	94558	4234	00	06000	38.31087766	-122.3378769	Napa County
296807	Non-Physician Medical Practitioner	None	1952619173	0	0	DOWELL, THOMAS PATRICK	5/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 MERCY AVE	None	MERCED	CA	95340	8319	00	06000	37.33875148	-120.467457	Merced County
296814	Non-Physician Medical Practitioner	None	1790880300	0	0	DOTY, MELANIE ANNE	4/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
296820	Non-Physician Medical Practitioner	None	1861056640	0	0	DORJI, KALSANG D NP	7/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
296831	Non-Physician Medical Practitioner	None	1306204698	0	0	DOFREDO, MELISSA G C NP	10/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23 MARINER COVE	None	BUENA PARK	CA	90621	1662	00	06000	33.87769044	-117.9778586	Orange County
296841	Non-Physician Medical Practitioner	None	1831715507	0	0	DIP, PEGGY NP	2/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20055 LAKE CHABOT RD	STE 230	CASTRO VALLEY	CA	94546	5333	00	06000	37.69836512	-122.0873587	Alameda County
296854	Non-Physician Medical Practitioner	None	1265652671	0	0	DECK, KAREN M NP	3/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
296877	Non-Physician Medical Practitioner	None	1639547607	0	0	DEAN, EMILEE T NP	3/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	424 MOUNT MCKINLEY PLACE	None	RIDGECREST	CA	93555	5518	00	06000	35.64337447	-117.677898	Kern County
296889	Non-Physician Medical Practitioner	None	1629531686	0	0	DY, FRANCES L NP	6/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
296901	Non-Physician Medical Practitioner	None	1659569846	0	0	DUFFEY, KATHRYN	6/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5701 BOW POINTE DR	SUITE 300	CLARKSTON	MI	48346	3198	00	06000	42.72832402	-83.37677951	Oakland County
296903	Non-Physician Medical Practitioner	None	1093424368	0	0	DOWD, MOLLY NP	4/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1108 4TH ST	None	SOUTH LAKE TAHOE	CA	96150	3476	00	06000	38.912904	-119.998638	El Dorado County
296921	Non-Physician Medical Practitioner	None	1477543841	0	0	DEBOS, ROBERT J	11/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1051 E TUOLUMNE RD	STE 103	TURLOCK	CA	95382	1546	00	06000	37.51464553	-120.837501	Stanislaus County
296939	Non-Physician Medical Practitioner	None	1932152683	0	0	DEBEBE, YOHANNES	7/1/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17593 LANDIS DR	None	VICTORVILLE	CA	92395	7745	00	06000	34.49707922	-117.2798761	San Bernardino County
296946	Non-Physician Medical Practitioner	None	1144612243	0	0	DONG, MATTHEW J	1/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30 BUENA VISTA ROAD	None	S SAN FRANCISCO	CA	94080	5575	00	06000	37.64270189	-122.4499233	San Mateo County
296972	Non-Physician Medical Practitioner	None	1497055198	0	0	DEL VALLE, ALMA ROCIO	1/5/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3635 BRADSHAW RD STE B	None	SACRAMENTO	CA	95827	3277	00	06000	38.555568	-121.3357815	Sacramento County
296974	Non-Physician Medical Practitioner	None	1831868520	0	0	DESINOR, JANDI O PA	4/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 SOUTH GRAND AVE	None	GLENDORA	CA	91741	4218	00	06000	34.132842	-117.872523	Los Angeles County
297007	Non-Physician Medical Practitioner	None	1336261429	0	0	DAVIS, CASAUNDRA MICHELE	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT. 282	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
297050	Non-Physician Medical Practitioner	None	1992218168	0	0	DION, ZACHARY D NP	9/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	06000	33.478749	-112.0426515	Maricopa County
297128	Non-Physician Medical Practitioner	None	1831241959	0	0	DAVIS, DAWN PA	2/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
297135	Non-Physician Medical Practitioner	None	1225291974	0	0	DU, QUOC	7/22/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	SUMC - PEDS PHYSICIAN BI	PALO ALTO	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
297136	Non-Physician Medical Practitioner	None	1003814468	0	0	DAVIS, LASONYA ADELE	7/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	613 FLATHEAD RIVER ST	None	OXNARD	CA	93036	5308	00	06000	34.24434366	-119.1753201	Ventura County
297145	Non-Physician Medical Practitioner	None	1073713673	0	0	DHILLON, JASVEEN	8/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4561 DICKEY DR	None	LA MESA	CA	91941	5735	00	06000	32.761873	-116.9695045	San Diego County
297148	Non-Physician Medical Practitioner	None	1477850097	0	0	DRAKE, KIMBERLY A NP	2/28/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29863 YORKTON RD	None	MURRIETA	CA	92563	4749	00	06000	33.57480886	-117.1386482	Riverside County
297214	Non-Physician Medical Practitioner	None	1861665739	0	0	DACOSTA, ELIZABETH M	4/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	107 WILDWOOD AVENUE	None	PIEDMONT	CA	94610	1046	00	06000	37.81975628	-122.2410818	Alameda County
297258	Non-Physician Medical Practitioner	None	1902116080	0	0	DEWAR, SANDRA	12/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 WESTWOOD PLZ	RM 1250 RNRC	LOS ANGELES	CA	90095	6975	00	06000	34.06680182	-118.4450804	Los Angeles County
297261	Non-Physician Medical Practitioner	None	1508946351	0	0	DAVIS, BRIAN M PA	11/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	00	06000	40.58769807	-122.3879041	Shasta County
297290	Non-Physician Medical Practitioner	None	1306186259	0	0	DE GROOT, JACLYN M NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2800 KELLER DR	STE 276	TUSTIN	CA	92782	1010	00	06000	33.73272752	-117.7879626	Orange County
297304	Non-Physician Medical Practitioner	None	1659540185	0	0	DELVENTHAL-WONG, GISCELA LIZBELL	7/29/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4131 GEARY BLVD #404	None	SAN FRACISCO	CA	94118	0000	00	06000	37.78096053	-122.4637512	San Francisco
297350	Non-Physician Medical Practitioner	None	1396459624	0	0	DURHAM, JUSTIN M PA	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14847323	-122.2180997	Tehama County
297363	Non-Physician Medical Practitioner	None	1952770539	0	0	DE GUZMAN, CHRISTOPHER R D	12/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	665 ABBOT AVE	None	DALY CITY	CA	94014	2769	00	06000	37.6880995	-122.4568392	San Mateo County
297370	Non-Physician Medical Practitioner	None	1134777568	0	0	DAVID, ELROMA A PA	11/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
297392	Non-Physician Medical Practitioner	None	1124109665	0	0	DUNCAN, JODIE	4/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	00	06000	37.60573981	-122.0835989	Alameda County
297393	Non-Physician Medical Practitioner	None	1962815837	0	0	DICKMAN, CHELSEA R PA-C	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1960 N MAIN ST	STE 229	WALNUT CREEK	CA	94596	3925	00	06000	37.9059099	-122.0641367	Contra Costa County
297395	Non-Physician Medical Practitioner	None	1740623453	0	0	DITHOMAS, PAULA A NP	8/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	427 7TH STREET	None	HUNTINGTON BEACH	CA	92648	4608	00	06000	33.66229504	-118.0009623	Orange County
297401	Non-Physician Medical Practitioner	None	1750043824	0	0	DAO, VINCENT H PA-C	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
297457	Non-Physician Medical Practitioner	None	1932851482	0	0	DABU, NATHANIEL P PA	5/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
297511	Non-Physician Medical Practitioner	None	1033113535	0	0	DIETZ, SUZANNE M NP	4/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	00	06000	40.78745765	-124.1396643	Humboldt County
297543	Non-Physician Medical Practitioner	None	1053894204	0	0	DUNCAN, SARAH M H	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8440 N MILLBROOK	APT 147	FRESNO	CA	93720	5158	00	06000	36.85797	-119.765742	Fresno County
297564	Non-Physician Medical Practitioner	None	1689447674	0	0	DIDIER, KRISTIN A PA	1/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
297585	Non-Physician Medical Practitioner	None	1912030255	0	0	DELAO, SARA E NP	7/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
297626	Non-Physician Medical Practitioner	None	1265860167	0	0	DURU, CHIDI R NP	7/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1120 N PARK AVE	None	RIALTO	CA	92376	3283	00	06000	34.12021827	-117.3797004	San Bernardino County
297693	Non-Physician Medical Practitioner	None	1902183098	0	0	DEBORAH ANN HIGER	4/18/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 PINE ST	None	MOUNT SHASTA	CA	96067	2133	00	06000	41.31593884	-122.3193143	Siskiyou County
297700	Non-Physician Medical Practitioner	None	1992002687	0	0	DE LA CERNA, MELISSA O NP	3/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	00	06000	34.0653985	-118.3769177	Los Angeles County
297764	Non-Physician Medical Practitioner	None	1801898341	0	0	DANTUONO, DOMINICK A	10/20/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1245 WILSHIRE BLVD	SUITE 606	LOS ANGELES	CA	90017	0000	00	06000	34.05362775	-118.2661889	Los Angeles County
297840	Non-Physician Medical Practitioner	None	1508348632	0	0	DO, TIEN T K NP	1/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15612 WILSON ST	None	MIDWAY CITY	CA	92655	1647	00	06000	33.73581072	-117.9834724	Orange County
297869	Non-Physician Medical Practitioner	None	1356511687	0	0	DANIOLCO, CHERRY	8/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W 3RD ST	SUITE 800E	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
297881	Non-Physician Medical Practitioner	None	1861960213	0	0	DECARLO, CARRI PA	12/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	00	06000	40.58769807	-122.3879041	Shasta County
297896	Non-Physician Medical Practitioner	None	1346882800	0	0	DIAZ, LETICIA M PA-C	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1429 W FREMONT ST	None	STOCKTON	CA	95203	2635	00	06000	37.95439432	-121.3112101	San Joaquin County
297966	Non-Physician Medical Practitioner	None	1235129289	0	0	DEGIOVANNI, TODD WILLIAM	9/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7025	00	06000	38.91235444	-119.996422	El Dorado County
298001	Non-Physician Medical Practitioner	None	1225583735	0	0	DORSETT, RACHEL C	12/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	421 BATH ST	APT B	SANTA BARBARA	CA	93103	8040	00	06000	34.41323267	-119.6984296	Santa Barbara County
298029	Non-Physician Medical Practitioner	None	1912268905	0	0	DALIZU, ELSEN C NP	12/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3275 VILLA LN	None	NAPA	CA	94558	3016	00	06000	38.32223637	-122.2927198	Napa County
298049	Non-Physician Medical Practitioner	None	1215525480	0	0	DADHANIA, SHIVALEE M	4/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13132 STUDEBAKER RD	10	NORWALK	CA	90650	2562	00	06000	33.911874	-118.099151	Los Angeles County
298068	Non-Physician Medical Practitioner	None	1912022419	0	0	DONOVAN, HELEN M	7/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2048 CAMBRIDGE AVE	None	CARDIFF BY THE SE	CA	92007	1708	00	06000	33.02374991	-117.2790685	San Diego County
298086	Non-Physician Medical Practitioner	None	1942690599	0	0	DALVA, CHRISTINE B NP	10/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5685 MAIN ST	None	KELSEYVILLE	CA	95451	8945	00	06000	38.97222647	-122.8301393	Lake County
298123	Non-Physician Medical Practitioner	None	1982816443	0	0	DASALLA, ROMA CIELLA C NP	7/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
298130	Non-Physician Medical Practitioner	None	1821705112	0	0	DELISO, KATHRYN NP	3/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4900 COMMERCE DR	None	BAKERSFIELD	CA	93309	0418	00	06000	35.3696013	-119.0558857	Kern County
298148	Non-Physician Medical Practitioner	None	1033487145	0	0	DESHMUKH, SHUBHANGI V	10/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3710 GLEN AVENUE	None	CARLSBAD	CA	92010	5522	00	06000	33.15421544	-117.2909941	San Diego County
298160	Non-Physician Medical Practitioner	None	1730777210	0	0	DINH, ANNE L PA-C	5/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	00	06000	37.98252	-121.8030615	Contra Costa County
298167	Non-Physician Medical Practitioner	None	1679355192	0	0	DEBS, FRANCISCO PA	2/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	361 TOWN CTR W	None	SANTA MARIA	CA	93454	6900	00	06000	34.95008211	-120.437386	Santa Barbara County
298170	Non-Physician Medical Practitioner	None	1528076536	0	0	DEGUZMAN, CATHERINE F HAO	10/21/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	STE 101	ORANGE	CA	92868	4213	00	06000	33.78034779	-117.8655767	Orange County
298174	Non-Physician Medical Practitioner	None	1376953216	0	0	DILLARD, KAMISHA G NP	9/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3332 YOSEMITE PARK WAY	None	ELK GROVE	CA	95758	4662	00	06000	38.415303	-121.4658	Sacramento County
298220	Non-Physician Medical Practitioner	None	1215172267	0	0	DOLINSKIY, OKSANA	6/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5901 W OLYMPIC BLVD	#505	LOS ANGELES	CA	90036	4667	00	06000	34.05764121	-118.3603115	Los Angeles County
298233	Non-Physician Medical Practitioner	None	1437701885	0	0	DAVIS, MIKYLA	12/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298342	Non-Physician Medical Practitioner	None	1376933416	0	0	DANOUSH, JESSICA	3/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6223 LINDLEY AVE	None	TARZANA	CA	91335	7118	00	06000	34.18260669	-118.5272907	Los Angeles County
298366	Non-Physician Medical Practitioner	None	1669775490	0	0	DUNN, ALISON ELIZABETH	11/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 BUHNE ST	SUITE C	EUREKA	CA	95501	3238	00	06000	40.78592523	-124.1422103	Humboldt County
298367	Non-Physician Medical Practitioner	None	1003498213	0	0	DEDIC, AMBERA NP	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
298427	Non-Physician Medical Practitioner	None	1588483812	0	0	DIZON, ALEXIS MAE NP	11/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1135 S SUNSET AVE	SUITE 401	WEST COVINA	CA	91790	3937	00	06000	34.06215064	-117.9453997	Los Angeles County
298451	Non-Physician Medical Practitioner	None	1770514697	0	0	DEJESUS JINZO, SOPHIE E NP	8/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11405 FLOSSMOOR RD	None	SANTA FE SPRINGS	CA	90670	3127	00	06000	33.95105675	-118.0888917	Los Angeles County
298453	Non-Physician Medical Practitioner	None	1265448294	0	0	DE GUZMAN, GLENN MICHAEL	3/7/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13330 BLOOMFIELD AVE STE	None	NORWALK	CA	90650	3264	00	06000	33.90988905	-118.0644875	Los Angeles County
298496	Non-Physician Medical Practitioner	None	1669760310	0	0	DENJALEARN, WARAPORN NP	8/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5828 E EUGENIA AVE	None	FRESNO	CA	93727	9021	00	06000	36.71422015	-119.6891461	Fresno County
298507	Non-Physician Medical Practitioner	None	1356718753	0	0	DINH, TRUNG Q	11/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10271 CALLE INDEPENDENCI	None	FOUNTAIN VALLEY	CA	92708	3707	00	06000	33.71089269	-117.9493991	Orange County
298519	Non-Physician Medical Practitioner	None	1669128153	0	0	DEFELICE, BRIDGET T NP	4/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
298538	Non-Physician Medical Practitioner	None	1063983708	0	0	DINH, PAULINA K NP	4/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1837 SUNNY CREST	None	FULLERTON	CA	92835	3616	00	06000	33.89224326	-117.9312781	Orange County
298575	Non-Physician Medical Practitioner	None	1902087745	0	0	DE LEON, JAMES BALLESTEROS	12/27/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	SUITE 510	LOS ANGELES	CA	90033	2464	00	06000	34.05112725	-118.2173921	Los Angeles County
298594	Non-Physician Medical Practitioner	None	1407848484	0	0	DAVIS, ANNE R NP	9/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21 ERBA LANE	None	SCOTTS VALLEY	CA	95066	4103	00	06000	37.04971598	-122.0201849	Santa Cruz County
298600	Non-Physician Medical Practitioner	None	1376093088	0	0	DANG, NICHOLE N PA	9/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	805 LA VETA	STE 101	ORANGE	CA	98268	3901	00	06000	33.78064152	-117.8606475	Orange County
298603	Non-Physician Medical Practitioner	None	1194770651	0	0	DI FRANCESCO, CAROLYN JOY	2/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	0000	00	06000	37.66508443	-120.9962589	Stanislaus County
298620	Non-Physician Medical Practitioner	None	1750872503	0	0	DANFORD-JOHN, KENDRA E NP	9/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12616 SPRUCE HILL RD	None	MORENO VALLEY	CA	92555	2540	00	06000	33.93782301	-117.196422	Riverside County
298625	Non-Physician Medical Practitioner	None	1730195728	0	0	DORIGUZZI, DAVID M PA-C	3/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44725 10TH ST WEST	170	LANCASTER	CA	93534	4936	00	06000	34.695693	-118.1480965	Los Angeles County
298626	Non-Physician Medical Practitioner	None	1376067819	0	0	DAKIN, JAMES NP	4/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	00	06000	32.77510996	-117.1277427	San Diego County
298645	Non-Physician Medical Practitioner	None	1730223694	0	0	DUARTE, CHRISTOPHER PA-C	10/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	TWO MEDICAL PLAZA	STE 205	ROSEVILLE	CA	95661	3044	00	06000	38.76507948	-121.2477476	Placer County
298656	Non-Physician Medical Practitioner	None	1477790046	0	0	DYE, CASEY ALEXIS	10/5/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6630 S MCCARRAN BLVD	#4	RENO	NV	89509	6145	00	06000	39.47661126	-119.8019233	Washoe County
298657	Non-Physician Medical Practitioner	None	1255562724	0	0	DEVEREUX, MAURA	1/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45 CASTRO ST STE 125	None	SAN FRANCISCO	CA	94114	1032	00	06000	37.76829732	-122.4357056	San Francisco County
298661	Non-Physician Medical Practitioner	None	1518370519	0	0	DIMOND, DENA N NP	10/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	775 BAYWOOD DRIVE	SUITE 109	PETALUMA	CA	94954	5500	00	06000	38.23188752	-122.61398	Sonoma County
298704	Non-Physician Medical Practitioner	None	1831632843	0	0	DINNALL, CHRISTINA M NP	12/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
298721	Non-Physician Medical Practitioner	None	1699413914	0	0	DO, TU PA	7/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
298803	Non-Physician Medical Practitioner	None	1962914580	0	0	DOMINISSE, MICHAEL W PA-C	9/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5601 J ST	None	SACRAMENTO	CA	95819	3948	00	06000	38.564901	-121.4344755	Sacramento County
298811	Non-Physician Medical Practitioner	None	1912676180	0	0	DIMEO, KAYLEE D PA-C	12/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
298852	Non-Physician Medical Practitioner	None	1922411933	0	0	DU BOIS, KAYLA R PA	6/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
298858	Non-Physician Medical Practitioner	None	1851833214	0	0	DEGRASSE, MARSII S NP	11/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22574 HONNOLD DRIVE	None	SAUGUS	CA	91350	1371	00	06000	34.45678141	-118.5308358	Los Angeles County
298868	Non-Physician Medical Practitioner	None	1689928541	0	0	DARAKIAN, HASMIG	4/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5757 WILSHIRE BLVD	SUITE 490	LOS ANGELES	CA	90036	5810	00	06000	34.0624504	-118.3534253	Los Angeles County
298904	Non-Physician Medical Practitioner	None	1528784345	0	0	DU, CLARISA P NP	6/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
298920	Non-Physician Medical Practitioner	None	1346785235	0	0	DORAN, EMILY PA-C	12/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	00	06000	34.44229705	-119.2645703	Ventura County
298925	Non-Physician Medical Practitioner	None	1760761449	0	0	DONNELLY, SARA NICHOLE	10/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	175 S UNION BLVD	SUITE 350	COLORADO SPRINGS	CO	80910	3113	00	06000	38.82979499	-104.7948803	El Paso County
298939	Non-Physician Medical Practitioner	None	1114788767	0	0	DAVIS-MARENCO, NICOLE NP	7/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	00	06000	32.781195	-117.0070695	San Diego County
298942	Non-Physician Medical Practitioner	None	1225018237	0	0	DOSANJH, KULJINDER	4/3/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17750 SAN CANDELO ST	None	FOUNTAIN VALLEY	CA	92708	5336	00	06000	33.70544849	-117.9375265	Orange County
298963	Non-Physician Medical Practitioner	None	1609809045	0	0	DORWARD, JENNIFER A NP	3/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13285 CALLE DEL CAMPO	#4	SAN DIEGO	CA	92129	4685	00	06000	32.96221968	-117.1575806	San Diego County
298968	Non-Physician Medical Practitioner	None	1902275993	0	0	DETTMAR, MEREDITH A	10/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16705 CAROB AVE	None	CHINO HILLS	CA	91709	6524	00	06000	33.94994972	-117.6862563	San Bernardino County
298977	Non-Physician Medical Practitioner	None	1285257063	0	0	DREIHAUS, BLAKE P PA	9/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
299017	Non-Physician Medical Practitioner	None	1598404261	0	0	DAVIS, MICHELLE NP	1/29/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3075 HEALTH CENTER DR	STE 102	SAN DIEGO	CA	92123	2773	00	06000	32.79963065	-117.1556197	San Diego County
299019	Non-Physician Medical Practitioner	None	1609987619	0	0	DOUGHERTY, CLARA W PA	3/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 440	SAN DIEGO	CA	92037	1212	00	06000	32.882913	-117.226341	San Diego County
299056	Non-Physician Medical Practitioner	None	1023609401	0	0	DONLON, RYAN NP	12/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	00	06000	33.4799323	-117.1033702	Riverside County
299091	Non-Physician Medical Practitioner	None	1811094923	0	0	DAVIDSON, ROSSLYNN	11/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
299120	Non-Physician Medical Practitioner	None	1598367112	0	0	DOLINAR, KAITLIN J PA-C	3/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19341 BEAR VALLEY RD	STE 105	APPLE VALLEY	CA	92308	5152	00	06000	34.47101125	-117.2412548	San Bernardino County
299175	Non-Physician Medical Practitioner	None	1114400959	0	0	DI FLAURO, PAUL O NP	9/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
299176	Non-Physician Medical Practitioner	None	1194532960	0	0	DEROSA, DANIELLE PA-C	3/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1430 22ND STREET	None	SACRAMENTO	CA	95816	5708	00	06000	38.570715	-121.4797995	Sacramento County
299185	Non-Physician Medical Practitioner	None	1356489678	0	0	DIFELICE, MARGARET LINDA	3/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1525 WEBSTER ST STE A	None	FAIRFIELD	CA	94533	4935	00	06000	38.25692443	-122.0475319	Solano County
299194	Non-Physician Medical Practitioner	None	1639925399	0	0	DAVID, MALLORY NP	9/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	304 WEST F STREET	None	ONTARIO	CA	91762	3206	00	06000	34.069563	-117.6538005	San Bernardino County
299231	Non-Physician Medical Practitioner	None	1952064826	0	0	DAY, SAMARA	8/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
299243	Non-Physician Medical Practitioner	None	1184295826	0	0	DY, LALAINE C NP	3/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39210 STATE ST	209	FREMONT	CA	94538	1456	00	06000	37.54911562	-121.9827983	Alameda County
299258	Non-Physician Medical Practitioner	None	1083166615	0	0	DEPTALA, MARISA L NP	4/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 FOURTH AVE.	STE 408	CHULA VISTA	CA	91910	4430	00	06000	32.63513513	-117.0820663	San Diego County
299273	Non-Physician Medical Practitioner	None	1710426218	0	0	DAO, TU ANH N NP	3/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1223 DEVONWOOD DRIVE	APT 102	MERCED	CA	95348	1733	00	06000	37.31640526	-120.4919601	Merced County
299276	Non-Physician Medical Practitioner	None	1366435448	0	0	DEOL, RUPINDER M	8/18/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	00	06000	38.74399612	-121.2349547	Placer County
299287	Non-Physician Medical Practitioner	None	1770298267	0	0	DRINKWARD, EMILY PA	6/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8860 CENTER DRIVE	SUITE 240	LA MESA	CA	91942	7000	00	06000	32.78189749	-117.0075062	San Diego County
299310	Non-Physician Medical Practitioner	None	1891517157	0	0	DANIELS, ISABELLA PA	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
299330	Non-Physician Medical Practitioner	None	1356713648	0	0	DAVAROS, DANIELLE PA-C	1/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 MENDOCINO AVE	None	SANTA ROSA	CA	95403	2805	00	06000	38.46672	-122.720724	Sonoma County
299353	Non-Physician Medical Practitioner	None	1164049847	0	0	DIAZ, ASHLEY A NP	12/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	00	06000	38.55204	-121.455387	Sacramento County
299407	Non-Physician Medical Practitioner	None	1831783315	0	0	DOCKSTADER, ERIKA K NP	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
299410	Non-Physician Medical Practitioner	None	1326520545	0	0	DONZE, AMBER R PA-C	4/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	714 N AVALON BLVD	None	WILMINGTON	CA	90744	5809	00	06000	33.77897659	-118.2623373	Los Angeles County
299420	Non-Physician Medical Practitioner	None	1396321998	0	0	DIAZ, DIANA M NP	7/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	585 W COLLEGE AVE	STE A	SANTA ROSA	CA	95401	5060	00	06000	38.445903	-122.735601	Sonoma County
299437	Non-Physician Medical Practitioner	None	1447985395	0	0	DE LEON, KRISTOFER ANDREW F NP	11/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
299445	Non-Physician Medical Practitioner	None	1598131799	0	0	DANDAN, OSMAN N	11/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7521 EDINGER AVE	#1203	HUNTINGTON BEACH	CA	92647	0625	00	06000	33.73024635	-117.9966274	Orange County
299453	Non-Physician Medical Practitioner	None	1205481157	0	0	DAVIDSON, JULIE D	4/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3349 G STREET	SUITE F	MERCED	CA	95340	0978	00	06000	37.32432497	-120.4693064	Merced County
299478	Non-Physician Medical Practitioner	None	1700482452	0	0	DELEON, KATHERINE M CNP	1/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25405 HANCOCK AVENUE	STE. 105	MURRIETA	CA	92562	5978	00	06000	33.5580833	-117.1850127	Riverside County
299490	Non-Physician Medical Practitioner	None	1285711259	0	0	DAVIS, CATHERINE	11/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 RESPONSE RD	None	SACRAMENTO	CA	95815	4807	00	06000	38.596581	-121.4303535	Sacramento County
299519	Non-Physician Medical Practitioner	None	1225890759	0	0	DE LEOZ, ALAIN M NP	1/21/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
299543	Non-Physician Medical Practitioner	None	1033722608	0	0	DI CRISTINA, CURT G PA	12/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
299550	Non-Physician Medical Practitioner	None	1619390614	0	0	DAVIDSON, TAMAR PA-C	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S BROOKHURST ST.	None	ANAHEIM	CA	92804	4302	00	06000	33.821568	-117.9589665	Orange County
299558	Non-Physician Medical Practitioner	None	1174236756	0	0	DE CASTRO, GEOFFREY B NP	3/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
299563	Non-Physician Medical Practitioner	None	1447913603	0	0	DENOLO, PRINCESS M NP	12/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	00	06000	33.83760674	-118.3572569	Los Angeles County
299586	Non-Physician Medical Practitioner	None	1770022899	0	0	DOMINGUEZ PICENO, MARTHA NP	4/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	121 BELMONT AVE	STE 100	MENDOTA	CA	93640	8231	00	06000	36.74934166	-120.3867513	Fresno County
299663	Non-Physician Medical Practitioner	None	1427035344	0	0	DAVIS, KATHLEEN ANNE	2/25/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3152 N MILLBROOK AVE	SUITE B	FRESNO	CA	93703	1400	00	06000	36.779166	-119.7634925	Fresno County
299674	Non-Physician Medical Practitioner	None	1407835101	0	0	DACUS, ROBERTA ANN	7/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2925 SYCAMORE DR	SUITE 204-205	SIMI VALLEY	CA	93065	1207	00	06000	34.288398	-118.7439175	Ventura County
299683	Non-Physician Medical Practitioner	None	1053522870	0	0	DOODA, KIMBERLY	3/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32861 ROVATO STREET	None	TEMECULA	CA	92592	9119	00	06000	33.48491811	-117.085861	Riverside County
299691	Non-Physician Medical Practitioner	None	1538548771	0	0	DESAI, TAMANNA NP	1/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26 RANCHO DEL MAR	None	APTOS	CA	95003	3973	00	06000	36.97832273	-121.9080422	Santa Cruz County
299693	Non-Physician Medical Practitioner	None	1811407265	0	0	DIAKHATE, MOUSLY PA-C	2/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1650 CREEKSIDE DRIVE	None	FOLSOM	CA	95630	3400	00	06000	38.67021	-121.145382	Sacramento County
299731	Non-Physician Medical Practitioner	None	1902162357	0	0	DAVIES, SHAUN B PA-C	5/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4244 RIVERWALK PKWY	170	RIVERSIDE	CA	92505	8509	00	06000	33.90336622	-117.49394	Riverside County
299734	Non-Physician Medical Practitioner	None	1417951096	0	0	DETTMAR, ROBYN H	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	257 W SONORA PLACE	None	CLAREMONT	CA	91711	1747	00	06000	34.12398281	-117.7191781	Los Angeles County
299745	Non-Physician Medical Practitioner	None	1043495021	0	0	DUNCAN, JENNIFER ANN	1/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	414 G ST	SUITE 208	MARYSVILLE	CA	95901	5663	00	06000	39.13913942	-121.5934649	Yuba County
299798	Non-Physician Medical Practitioner	None	1912571134	0	0	DORSCH, JOSEPH F PA	10/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
299821	Non-Physician Medical Practitioner	None	1700621026	0	0	DIZON, SHARMAGNE LYNNE NP	7/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4310 ORANGE ST	None	RIVERSIDE	CA	92501	3829	00	06000	33.97629981	-117.3766255	Riverside County
299824	Non-Physician Medical Practitioner	None	1003188368	0	0	DEL VALLE, SANDRA J PA-C	2/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
299845	Non-Physician Medical Practitioner	None	1518092899	0	0	DEBATTISTA, ANNE M	11/15/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
299849	Non-Physician Medical Practitioner	None	1114466679	0	0	DOERING, JARROD P	2/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	15423 COUNTY ROAD 9	None	SUMMERDALE	AL	36580	4226	00	06000	30.44954316	-87.79982168	Baldwin County
299853	Non-Physician Medical Practitioner	None	1710103445	0	0	DELGADILLO, MARIA D NP	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 DANA DR	None	SANTA PAULA	CA	93060	1615	00	06000	34.35938999	-119.0722112	Ventura County
299864	Non-Physician Medical Practitioner	None	1225170384	0	0	DIHEN, ILDIKO JUDITH	8/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	#290	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
299878	Non-Physician Medical Practitioner	None	1689045510	0	0	DOWSE, CLINTON T PA	9/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
299890	Non-Physician Medical Practitioner	None	1821334970	0	0	DAWOOD, DIANA R	4/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16171 TOMAS LN	None	HUNTINGTON BEACH	CA	92649	2432	00	06000	33.72721627	-118.041004	Orange County
299949	Non-Physician Medical Practitioner	None	1790827830	0	0	DALE, GRACE T NP	2/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	235 E CHESTNUT AVE	UNIT J	MONROVIA	CA	91016	3583	00	06000	34.1426932	-117.996979	Los Angeles County
299979	Non-Physician Medical Practitioner	None	1740382787	0	0	DOCTOLERO, REX T	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2327 E LOCUST AVE	None	FRESNO	CA	93720	0326	00	06000	36.8405976	-119.7416692	Fresno County
299996	Non-Physician Medical Practitioner	None	1154097293	0	0	DALATEN, CHRISTOPHER V PA-C	2/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
300023	Non-Physician Medical Practitioner	None	1144861493	0	0	DHILLON, JASPREET K NP	9/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4501 X ST	None	SACRAMENTO	CA	95817	2229	00	06000	38.553822	-121.452822	Sacramento County
300030	Non-Physician Medical Practitioner	None	1780024554	0	0	DANELLA, MATTHEW M PA	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	00	06000	38.746836	-121.250529	Placer County
300042	Non-Physician Medical Practitioner	None	1407353311	0	0	DEL ROSARIO, GLYNIS T NP	6/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
300046	Non-Physician Medical Practitioner	None	1316435365	0	0	DHALIWAL, AMRIT K NP	7/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8670 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	2930	00	06000	34.06629779	-118.3807407	Los Angeles County
300049	Non-Physician Medical Practitioner	None	1922437672	0	0	DANG, QUAN T PA-C	3/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3269 LAHAR LANE	None	CLOVIS	CA	93619	5407	00	06000	36.792576	-119.654073	Fresno County
300056	Non-Physician Medical Practitioner	None	1255483632	0	0	DUENES, OMAR	6/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2625 W ALAMEDA AVE	SUITE 116	BURBANK	CA	91505	4806	00	06000	34.1577056	-118.329779	Los Angeles County
300065	Non-Physician Medical Practitioner	None	1528632742	0	0	DE DIOS, SARAH JANE R NP	10/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44045 MARGARITA RD	STE 106	TEMECULA	CA	92592	2729	00	06000	33.48351542	-117.1027964	Riverside County
300097	Non-Physician Medical Practitioner	None	1346672250	0	0	DAHL, ELIZABETH A	8/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	00	06000	36.61275747	-121.9010674	Monterey County
300130	Non-Physician Medical Practitioner	None	1174058978	0	0	DIMATTEO, CAROLINE PA-C	10/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	901 W CIVIC CENTER DR	STE 120	SANTA ANA	CA	92703	2380	00	06000	33.75155572	-117.8778014	Orange County
300134	Non-Physician Medical Practitioner	None	1679120661	0	0	DAVISON, TRAVIS D PA-C	1/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
300173	Non-Physician Medical Practitioner	None	1386455210	0	0	DUMERTON, BRENNA N NP	2/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	00	06000	33.67718578	-117.9887516	Orange County
300197	Non-Physician Medical Practitioner	None	1467996918	0	0	DJAFROODI, SHEHRAM	1/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4080 PARADISE ROAD	NUMBER 15-233	LAS VEGAS	NV	89169	4834	00	06000	36.11499359	-115.1541847	Clark County
300221	Non-Physician Medical Practitioner	None	1518950195	0	0	DRAKE, BELINDA T NP	7/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33654 EUGINA LN	None	MURRIETA	CA	92563	2484	00	06000	0	0	None
300256	Non-Physician Medical Practitioner	None	1477755684	0	0	DRISCOLL, SUSAN D NP	2/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
300294	Non-Physician Medical Practitioner	None	1306146626	0	0	DOW, CLAIRE M NP	2/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	00	06000	34.0653985	-118.3769177	Los Angeles County
300324	Non-Physician Medical Practitioner	None	1194876284	0	0	D'AMICO, LINDA A NP	8/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3603 CERRITO AVENUE	None	RICHMOND	CA	94805	1761	00	06000	37.94034358	-122.3333119	Contra Costa County
300330	Non-Physician Medical Practitioner	None	1376585497	0	0	DOUGLAS, ANDREA PA-C	2/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	440 W FOOTHILL BLVD	None	GLENDORA	CA	91741	3361	00	06000	34.13599629	-117.8714999	Los Angeles County
300340	Non-Physician Medical Practitioner	None	1801461983	0	0	DIMPEL, COURTNEY J PA	9/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	00	06000	36.98863619	-121.9830754	Santa Cruz County
300423	Non-Physician Medical Practitioner	None	1104605740	0	0	DERBEDERIAN, SONA NP	1/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	00	06000	34.069509	-118.383743	Los Angeles County
300460	Non-Physician Medical Practitioner	None	1497005623	0	0	DARIAN, NISA K NP	8/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
300518	Non-Physician Medical Practitioner	None	1336557644	0	0	DANIEL, BRIAN PA	12/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
300574	Non-Physician Medical Practitioner	None	1578643250	0	0	DAVIS, KRISTEN B PA	6/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	00	06000	34.44509477	-119.7186392	Santa Barbara County
300580	Non-Physician Medical Practitioner	None	1053542837	0	0	DULLINGER, DANIELLE L	9/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	880 GOLFERS PASS RD	None	INCLINE VILLAGE	NV	89451	8878	00	06000	39.26209569	-119.9499442	Washoe County
300631	Non-Physician Medical Practitioner	None	1700031267	0	0	DODD, REBECCA L	3/25/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4141 D STREET	None	SACRAMENTO	CA	95819	2804	00	06000	38.575314	-121.447206	Sacramento County
300647	Non-Physician Medical Practitioner	None	1992054456	0	0	DU, DEBORAH PA-C	4/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	00	06000	33.67718578	-117.9887516	Orange County
300761	Non-Physician Medical Practitioner	None	1609313360	0	0	DOHERTY, MICHAEL PA-C	6/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 MARSHALL WAY	None	PLACERVILLE	CA	95667	6533	00	06000	38.72453536	-120.7921649	El Dorado County
300770	Non-Physician Medical Practitioner	None	1093913881	0	0	DEAN, SUSAN J	5/2/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2435 MARSHALL AVE	None	IMPERIAL	CA	92251	9599	00	06000	32.83113431	-115.569167	Imperial County
300774	Non-Physician Medical Practitioner	None	1194970574	0	0	DIAZ, LUCIA NP	2/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
300801	Non-Physician Medical Practitioner	None	1437437274	0	0	DHANOTA, NISHI J	5/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4010 DRESSER RD	None	YUBA CITY	CA	95993	8507	00	06000	39.15059686	-121.6892257	Sutter County
300810	Non-Physician Medical Practitioner	None	1720179450	0	0	DHILLON, KULBIR	4/9/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11600 EDUCATION ST	None	AUBURN	CA	95602	2468	00	06000	38.94384696	-121.1061469	Placer County
300832	Non-Physician Medical Practitioner	None	1477035392	0	0	DIEP, AMANDA L PA-C	9/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
300834	Non-Physician Medical Practitioner	None	1902288921	0	0	DEWOSKIN, RUTH E	9/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31529 VIA SAN CARLOS	None	TEMECULA	CA	92592	1619	00	06000	33.47198527	-117.1075834	Riverside County
300837	Non-Physician Medical Practitioner	None	1669401477	0	0	DINH-CHUNG, HELEN T	5/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	361 BARNHART CIRCLE	None	SACRAMENTO	CA	95835	1526	00	06000	38.675169	-121.5140625	Sacramento County
300860	Non-Physician Medical Practitioner	None	1770093221	0	0	DECHAPE, BRITTANY PA	1/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
300864	Non-Physician Medical Practitioner	None	1326414376	0	0	DESAI, AMRITA J	12/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6461 W 83RD ST	None	LOS ANGELES	CA	90045	2885	00	06000	33.96382465	-118.4012487	Los Angeles County
300867	Non-Physician Medical Practitioner	None	1609065705	0	0	DO, LAN T	1/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2819 PEPPERTREE WAY	None	POMONA	CA	91767	1917	00	06000	34.09686741	-117.7397355	Los Angeles County
300877	Non-Physician Medical Practitioner	None	1962046110	0	0	DOVIDIO, JOSEPH J NP	3/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
300900	Non-Physician Medical Practitioner	None	1467500314	0	0	DIAZ, ADRIANA E	4/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1440 CAJON ST	None	REDLANDS	CA	92373	7046	00	06000	34.03456091	-117.1681528	San Bernardino County
300983	Non-Physician Medical Practitioner	None	1922446889	0	0	DOUGLASS, MACKENZIE E CNM	7/31/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1505 SOQUEL DR	STE 1	SANTA CRUZ	CA	95065	1716	00	06000	36.98803429	-121.9848045	Santa Cruz County
300991	Non-Physician Medical Practitioner	None	1669845186	0	0	DE LA ROSA, MAGDIEL NP	9/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
301020	Non-Physician Medical Practitioner	None	1932369469	0	0	DERENZI, JULIA	9/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2540 EAST ST	None	CONCORD	CA	94520	1906	00	06000	37.98292379	-122.0341876	Contra Costa County
301056	Non-Physician Medical Practitioner	None	1881324374	0	0	DHALIWAL, AMANDEEP NP	10/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	145 TREVINO AVE	None	MANTECA	CA	95337	4200	00	06000	37.79842002	-121.2404921	San Joaquin County
301103	Non-Physician Medical Practitioner	None	1003216482	0	0	DORONILA, DENISE M PA-C	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	00	06000	36.68590557	-121.8010492	Monterey County
301113	Non-Physician Medical Practitioner	None	1568549970	0	0	DETRANA, ALEX S	10/1/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4254 MERIDIAN AVE	None	OXNARD	CA	93035	3732	00	06000	34.17784143	-119.2287522	Ventura County
301240	Non-Physician Medical Practitioner	None	1285005249	0	0	DO, STEVEN P NP	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17821 NEWLAND ST	SUITE D	HUNTINGTON BEACH	CA	92647	7055	00	06000	33.70357696	-117.980423	Orange County
301241	Non-Physician Medical Practitioner	None	1518584036	0	0	DUMONT, ABIGAIL N PA	3/25/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
301247	Non-Physician Medical Practitioner	None	1841847183	0	0	DARDEN, JAMES W NP	7/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	00	06000	36.57482436	-121.8101797	Monterey County
301257	Non-Physician Medical Practitioner	None	1730586322	0	0	DRAGOO, SUSAN A NP	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	234 N MOUNTAIN AVENUE	None	MONROVIA	CA	91016	2437	00	06000	34.15508163	-117.9876031	Los Angeles County
301308	Non-Physician Medical Practitioner	None	1689140535	0	0	DICKINSON, KYLE G PA-C	3/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1225 NORTH H STREET	None	LOMPOC	CA	93436	3301	00	06000	34.65803329	-120.4576446	Santa Barbara County
301311	Non-Physician Medical Practitioner	None	1861004533	0	0	DOSIER, ROKZANNE NP	11/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2702 LOW CT	None	FAIRFIELD	CA	94534	9771	00	06000	38.23678474	-122.0847463	Solano County
301333	Non-Physician Medical Practitioner	None	1306623525	0	0	DIEGO, CHASE	3/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3095 OLD CONEJO RD	SUITE 200	NEWBURY PARK	CA	91320	2130	00	06000	34.18969088	-118.9412876	Ventura County
301337	Non-Physician Medical Practitioner	None	1982461372	0	0	DE LA TORRE ASTORGA, ANA	3/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
301350	Non-Physician Medical Practitioner	None	1801815899	0	0	DELESKE, MICHELE M NP	11/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17792 PRESCOTT LN	None	HUNTINGTON BEACH	CA	92697	6432	00	06000	33.70369089	-118.0203181	Orange County
301359	Non-Physician Medical Practitioner	None	1487950705	0	0	DUNBAR, MARC	4/21/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
301386	Non-Physician Medical Practitioner	None	1871750257	0	0	DEPRATI, KIM L PA-C	2/26/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
301416	Non-Physician Medical Practitioner	None	1164700258	0	0	DAHMER, MARIAN E PA-C	6/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3201 23RD ST	APT 301	SAN FRANCISCO	CA	94110	3263	00	06000	37.7539224	-122.4166933	San Francisco County
301429	Non-Physician Medical Practitioner	None	1083081608	0	0	DE BREE, OLIVIA D NP	7/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
301487	Non-Physician Medical Practitioner	None	1235202144	0	0	DEGUZMAN, MICHAEL G	6/9/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6940 VALETTA PLACE	None	ALTA LOMA	CA	91701	8656	00	06000	34.12806173	-117.54727	San Bernardino County
301498	Non-Physician Medical Practitioner	None	1487926689	0	0	DONOHOE, TERESA R NP	2/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1503 WILLIAMS ST	None	BELMONT	CA	94002	1941	00	06000	37.52253281	-122.2882949	San Mateo County
301505	Non-Physician Medical Practitioner	None	1639295884	0	0	DEJARNETT, JENNIFER M	6/26/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6915 SONG SPARROW ROAD	None	CORONA	CA	92880	8985	00	06000	33.96269074	-117.5832024	Riverside County
301523	Non-Physician Medical Practitioner	None	1104480581	0	0	DI FRANCO, PAMELA G NP	6/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3903 LONE TREE WAY	SUITE 104A	ANTIOCH	CA	94509	6249	00	06000	37.98216807	-121.8054744	Contra Costa County
301528	Non-Physician Medical Practitioner	None	1801370887	0	0	DELATORRE, BELINDA J PA	11/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
301537	Non-Physician Medical Practitioner	None	1730337858	0	0	DAVENPORT, CORY S PA-C	11/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 SAN JOSE ST	STE 301	SALINAS	CA	93901	3928	00	06000	36.65853377	-121.6476066	Monterey County
301542	Non-Physician Medical Practitioner	None	1134586209	0	0	DERRICK, KRISTEEN A	5/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1204 WESTWAY DR	None	WOODLAND	CA	95695	4551	00	06000	38.66556357	-121.7857962	Yolo County
301567	Non-Physician Medical Practitioner	None	1902237894	0	0	DINER, ELISE L	12/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	132 S BEDFORD DRIVE	UNIT 101	BEVERLY HILLS	CA	90212	2266	00	06000	34.0659777	-118.4045162	Los Angeles County
301606	Non-Physician Medical Practitioner	None	1619152170	0	0	DANG, TUTRAN NGUYEN	12/13/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5995 TOPANGA CANYON BLVD	None	WOODLAND HILLS	CA	91367	3623	00	06000	34.17870522	-118.6051211	Los Angeles County
301618	Non-Physician Medical Practitioner	None	1093151508	0	0	DOYLEY, ANTHONY A JR	5/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1333 TORGERSON ROAD	None	PALM BAY	FL	32909	8412	00	06000	27.91171182	-80.63384492	Brevard County
301626	Non-Physician Medical Practitioner	None	1215458120	0	0	DERICKSON, JENNA M	10/10/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3643 AVIANO WAY	None	DUBLIN	CA	94568	7338	00	06000	37.71134562	-121.8665717	Alameda County
301628	Non-Physician Medical Practitioner	None	1609337625	0	0	DE GUZMAN, GAYNELLE S NP	4/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4240 HIGHLAND	None	HIGHLAND	CA	92346	2764	00	06000	34.13583752	-117.194355	San Bernardino County
301637	Non-Physician Medical Practitioner	None	1942031703	0	0	DIXON, ANNA M NP	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3805 SAN DIMAS STREET	SUITE B	BAKERSFIELD	CA	93301	2014	00	06000	35.39508529	-119.0082516	Kern County
301641	Non-Physician Medical Practitioner	None	1023138625	0	0	DAVIS, DAVID M	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	535 BEVERLY DR	None	OXNARD	CA	93030	4624	00	06000	34.20606076	-119.1832083	Ventura County
301645	Non-Physician Medical Practitioner	None	1386034296	0	0	DO, HELEN H NP	8/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9181 TRASK AVE	APT 17	GARDEN GROVE	CA	92844	2239	00	06000	33.76669351	-117.9694755	Orange County
301655	Non-Physician Medical Practitioner	None	1932666476	0	0	DICE-GOLDBERG, SARAH L NP	7/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
301699	Non-Physician Medical Practitioner	None	1609385194	0	0	DOWNS, LAUREN E PA	1/31/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
301711	Non-Physician Medical Practitioner	None	1881989846	0	0	DIMACALI, RACHEL PA	11/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	00	06000	33.94435533	-117.9931159	Los Angeles County
301726	Non-Physician Medical Practitioner	None	1407855018	0	0	DILWORTH, KRISTINA N NP	7/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1198 LEXINGTON COURT	None	SAN LUIS OBISPO	CA	93401	5845	00	06000	35.26546949	-120.6421428	San Luis Obispo County
301731	Non-Physician Medical Practitioner	None	1104855105	0	0	DAU, TRACY V PA-C	9/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27700 MEDICAL CENTER	None	MISSION VIEJO	CA	92691	6426	00	06000	33.56008604	-117.6657795	Orange County
301737	Non-Physician Medical Practitioner	None	1558194613	0	0	DAWSON, JANICE	9/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
301751	Non-Physician Medical Practitioner	None	1205067410	0	0	DEMONNER, CHERYL S	11/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2625 BARREGAS DR	None	APTOS	CA	95003	3203	00	06000	36.98321861	-121.9208036	Santa Cruz County
301761	Non-Physician Medical Practitioner	None	1386467942	0	0	DHALIWAL, HARVIR NP	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
301785	Non-Physician Medical Practitioner	None	1972024701	0	0	DAVE, SHIVALI K	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3722 S LAS VEGAS BLVD	2802E	LAS VEGAS	NV	89158	4301	00	06000	36.10739039	-115.1731774	Clark County
301791	Non-Physician Medical Practitioner	None	1124130976	0	0	DEREFIELD, CHRISTIAN J	1/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 77607	None	CORONA	CA	92877	0120	00	06000	0	0	None
301797	Non-Physician Medical Practitioner	None	1821232778	0	0	DELA VINA, JANELLE PENNY	6/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8010 FROST ST	SUITE 414	SAN DIEGO	CA	92123	2778	00	06000	32.80026879	-117.1520059	San Diego County
301804	Non-Physician Medical Practitioner	None	1831704113	0	0	DITTMAR, BRANDON M NP	2/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	00	06000	34.2202663	-119.1484221	Ventura County
301848	Non-Physician Medical Practitioner	None	1154454908	0	0	DESPAS, QUYEN T PA-C	11/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	941 KENDALL DRIVE	C	SAN BERNARDINO	CA	92407	4156	00	06000	34.16328244	-117.3035643	San Bernardino County
301854	Non-Physician Medical Practitioner	None	1194349654	0	0	DEREMER, VALERIE PA	1/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47110 WASHINGTON ST	STE 103	LA QUINTA	CA	92253	2186	00	06000	33.70698194	-116.2929821	Riverside County
301870	Non-Physician Medical Practitioner	None	1649345281	0	0	DOLL, STEPHEN J	9/7/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1255 LIBERTY STREET	None	REDDING	CA	96001	0814	00	06000	40.58769807	-122.3879041	Shasta County
301879	Non-Physician Medical Practitioner	None	1952932113	0	0	DADASHI, AMANDA M NP	12/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13768 ROSWELL AVE	STE 205	CHINO	CA	91710	1405	00	06000	34.0038	-117.7218555	San Bernardino County
301889	Non-Physician Medical Practitioner	None	1144572876	0	0	DATU, MELISSA S	7/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2516 LAUREL STREET	None	NAPA	CA	94558	5723	00	06000	38.29398344	-122.3036137	Napa County
301901	Non-Physician Medical Practitioner	None	1447355474	0	0	DERUM, JAMES P	4/3/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	67871 VALLEY VISTA DR	None	CATHEDRAL CITY	CA	92234	2351	00	06000	33.76530464	-116.479888	Riverside County
301911	Non-Physician Medical Practitioner	None	1376854943	0	0	DEOL, GURMIT SINGH	11/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 W BULLARD AVE	SUITE 124	CLOVIS	CA	93612	0861	00	06000	36.82308345	-119.714949	Fresno County
301931	Non-Physician Medical Practitioner	None	1265532279	0	0	DUKE, CAROL JEAN	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7520 ARROYO CIR	None	GILROY	CA	95020	7303	00	06000	37.01225317	-121.5604444	Santa Clara County
301966	Non-Physician Medical Practitioner	None	1376963074	0	0	DENHA, MONA T NP	6/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
301985	Non-Physician Medical Practitioner	None	1265056170	0	0	DIEMERT, MARY N PA	4/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	862 MEINECKE AVE	STE 100	SAN LUIS OBISPO	CA	93405	3701	00	06000	35.29243951	-120.668652	San Luis Obispo County
301991	Non-Physician Medical Practitioner	None	1568160810	0	0	DJOKOVIC, SELMA PA-C	6/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	770 MAGNOLIA AVE	STE 2A	CORONA	CA	92879	3122	00	06000	33.85936872	-117.5534605	Riverside County
301994	Non-Physician Medical Practitioner	None	1164666442	0	0	DELAPEDRAJA, KYRA M NP	6/23/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	14701 E EXPOSITION AVE	None	AURORA	CO	80012	2623	00	06000	39.704553	-104.8170465	Arapahoe County
302003	Non-Physician Medical Practitioner	None	1083963805	0	0	DAHLIN, JESSICA L PA-C	3/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	66 FAIRMOUNT AVE	APT 44	OAKLAND	CA	94611	5908	00	06000	37.81585981	-122.2597649	Alameda County
302055	Non-Physician Medical Practitioner	None	1083288104	0	0	DRAMISE, JENNA PA-C	2/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1139 THIRD STREET	None	SOUTH LAKE TAHOE	CA	96150	3465	00	06000	38.91323462	-119.9965999	El Dorado County
302081	Non-Physician Medical Practitioner	None	1669805214	0	0	DE GUZMAN, CAROL L NP	5/11/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3099 W CHAPMAN AVE	SUITE 141	ORANGE	CA	92868	1714	00	06000	33.78897424	-117.8857504	Orange County
302119	Non-Physician Medical Practitioner	None	1114494010	0	0	DAVILA, LINDA D NP	2/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
302146	Non-Physician Medical Practitioner	None	1265547087	0	0	DEMATTIA, JOSEPH S	5/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39828 CROSS CREEK CT	None	TEMECULA	CA	92591	7339	00	06000	33.54191313	-117.1309273	Riverside County
302155	Non-Physician Medical Practitioner	None	1366569576	0	0	DAVIS, JENNIFER L NP	8/31/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2517 E HARVARD CT	None	VISALIA	CA	93292	5672	00	06000	36.315639	-119.264823	Tulare County
302159	Non-Physician Medical Practitioner	None	1891122610	0	0	DUNCAN-ARFAA, CHRISTA D NP	11/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
302170	Non-Physician Medical Practitioner	None	1740503093	0	0	DITTRICH, DANIELLE M RN	2/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2410 MATHEWS AVE	UNIT B	REDONDO BEACH	CA	90278	3202	00	06000	33.87378973	-118.3675528	Los Angeles County
302181	Non-Physician Medical Practitioner	None	1619990447	0	0	DUKE, PATRICK R	10/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4148 SUNDANCE LN	None	NORCO	CA	92860	4203	00	06000	33.91773116	-117.5901964	Riverside County
302219	Non-Physician Medical Practitioner	None	1083918445	0	0	DACUMOS, MARICRIS B NP	3/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	265 DARLEY DRIVE	None	VALLEJO	CA	94591	8504	00	06000	38.12234655	-122.2130421	Solano County
302226	Non-Physician Medical Practitioner	None	1083460307	0	0	DUONG, JENNY PA-C	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6385	00	06000	37.36812305	-122.0312314	Santa Clara County
302236	Non-Physician Medical Practitioner	None	1386248011	0	0	DAVIDSON, KATHRYN A PA	4/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
302292	Non-Physician Medical Practitioner	None	1124231758	0	0	DON, TROY A NP	8/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1751 FISKE AVE	None	PASADENA	CA	91104	1218	00	06000	34.17606	-118.1338555	Los Angeles County
302308	Non-Physician Medical Practitioner	None	1114128386	0	0	DE PEREZ, ROSEMARY	6/29/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	995 POTRERO AVE BLDG.80	SFGH AIDS - PHP CLINIC	SAN FRANCISCO	CA	94110	0000	00	06000	37.75729541	-122.4066641	San Francisco County
302317	Non-Physician Medical Practitioner	None	1205190618	0	0	DUFFY, KRISTEN E NP	11/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2290 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	7082	00	06000	38.568366	-121.403637	Sacramento County
302379	Non-Physician Medical Practitioner	None	1568698447	0	0	DICKEY, MELISSA ANN	9/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
302387	Non-Physician Medical Practitioner	None	1265783880	0	0	DEMAYO, VALENTINO A	9/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
302402	Non-Physician Medical Practitioner	None	1518536119	0	0	DUFFY, ERIN C PA-C	9/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1820 41ST AVE	SUITE C	CAPITOLA	CA	95010	2516	00	06000	36.975573	-121.964832	Santa Cruz County
302403	Non-Physician Medical Practitioner	None	1972752368	0	0	DE NOVO HEALTH CARE, INC.	4/6/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	803 E ROSECRANS AVE	None	EAST RANCHO DOMIN	CA	90221	2145	00	06000	33.9035073	-118.2153406	Los Angeles County
302428	Non-Physician Medical Practitioner	None	1104336833	0	0	DE LEON, LARA CAMILLE S NP	9/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	STE 120	LOS ANGELES	CA	90024	0000	00	06000	34.06527974	-118.4462792	Los Angeles County
302570	Non-Physician Medical Practitioner	None	1235720210	0	0	DY JUANCO, STEPHANIE M NP	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
302601	Non-Physician Medical Practitioner	None	1568601037	0	0	DE-PAZ, CLARYDILIA ORIBEL	3/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	844 S DORA ST	None	UKIAH	CA	95482	5711	00	06000	39.14040107	-123.2102865	Mendocino County
302659	Non-Physician Medical Practitioner	None	1609247477	0	0	DAVIS, BENJAMIN R	11/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24902 HENDON ST	None	LAGUNA HILLS	CA	92653	4606	00	06000	33.60173012	-117.6955609	Orange County
302662	Non-Physician Medical Practitioner	None	1679086755	0	0	DEEN, DANIELLE B PA	2/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1541 FLORIDA AVE	STE 100	MODESTO	CA	95350	4438	00	06000	37.666863	-120.9962775	Stanislaus County
302708	Non-Physician Medical Practitioner	None	1104298736	0	0	DAHLIN, KRISTINA A	5/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3422 GREENSWARD RD	None	LOS ANGELES	CA	90039	2109	00	06000	34.11332371	-118.2622219	Los Angeles County
302725	Non-Physician Medical Practitioner	None	1588673842	0	0	DAVID, MORENO C	6/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 WEDGEWOOD PL	None	CHULA VISTA	CA	91913	8312	00	06000	32.61303435	-116.9717956	San Diego County
302750	Non-Physician Medical Practitioner	None	1457673121	0	0	DUDLEY, CAROLINE ANN MARIE	11/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1129 COOK ST	None	SAN JOSE	CA	95126	1009	00	06000	37.3458847	-121.9269084	Santa Clara County
302777	Non-Physician Medical Practitioner	None	1386377703	0	0	DOS SANTOS, ANDRE PA	7/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	00	06000	32.77718098	-117.0571332	San Diego County
302808	Non-Physician Medical Practitioner	None	1043384134	0	0	DE WITT, MONICA THERESE	5/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
302828	Non-Physician Medical Practitioner	None	1407159288	0	0	DAVIS, CAMILLA LEE	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36921 COOK ST	SUITE 102	PALM DESERT	CA	92211	6070	00	06000	33.78003284	-116.3558511	Riverside County
302832	Non-Physician Medical Practitioner	None	1962839357	0	0	DAVISON, LINDSEY J NP	7/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 W BONITA AVE	100	POMONA	CA	91767	1863	00	06000	34.09664881	-117.751261	Los Angeles County
302834	Non-Physician Medical Practitioner	None	1720478829	0	0	DE GUIA, CHRISTIAN NP	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
302892	Non-Physician Medical Practitioner	None	1457866436	0	0	DANIEL, JENNIFER PA	1/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6079 N FRESNO ST	SUITE 101	FRESNO	CA	93710	5276	00	06000	36.824301	-119.781437	Fresno County
302895	Non-Physician Medical Practitioner	None	1134901804	0	0	DHANDA, PARTIKSHA NP	2/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
302922	Non-Physician Medical Practitioner	None	1194173047	0	0	DAVIS, DANIEL P	9/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7742 12TH STREET	APT A	WESTMINSTER	CA	92683	1006	00	06000	33.75462816	-117.9938661	Orange County
302926	Non-Physician Medical Practitioner	None	1942597737	0	0	DILLON, MARYANNE	12/29/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	UCLA PEDS I.D.- RM 22-44	LOS ANGELES	CA	90095	1752	00	06000	34.06373445	-118.443537	Los Angeles County
302967	Non-Physician Medical Practitioner	None	1619282308	0	0	DIGNITY HEALTH MEDICAL FOUNDATION	12/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 SUNRISE BLVD	SUITE 250	GOLD RIVER	CA	95670	4374	00	06000	38.62287	-121.2672825	Sacramento County
303004	Non-Physician Medical Practitioner	None	1508237587	0	0	DUNGO, GERALD G NP	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 S OLIVE STREET	None	ANAHEIM	CA	92805	3926	00	06000	33.83494218	-117.9097187	Orange County
303031	Non-Physician Medical Practitioner	None	1942310420	0	0	DHUDSHIA, CHARLOTTE L NP	4/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	288 IVYWOOD CT	None	LAS VEGAS	NV	89183	4559	00	06000	35.99550662	-115.1592623	Clark County
303051	Non-Physician Medical Practitioner	None	1295458149	0	0	DAVILA, LORIEL PA-C	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11190 WARNER AVE	408	FOUNTAIN VALLEY	CA	92708	4047	00	06000	33.714	-117.9333585	Orange County
303072	Non-Physician Medical Practitioner	None	1083492094	0	0	DHINDSA, KAMALJIT K NP	3/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
303081	Non-Physician Medical Practitioner	None	1477522035	0	0	DONATO, MICHELLE M NP	11/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	102 23RD STREET	STE B	COSTA MESA	CA	92627	1782	00	06000	33.65440717	-117.9052797	Orange County
303108	Non-Physician Medical Practitioner	None	1629472196	0	0	DELAPARRA, FRANCISCO A	11/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5137 W WESTGATE AVE	None	VISALIA	CA	93277	3410	00	06000	36.318546	-119.3482665	Tulare County
303109	Non-Physician Medical Practitioner	None	1164643250	0	0	DOUGLAS, TIANA PA-C	4/2/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6795 WELLS SPRINGS	None	MIRA LOMA	CA	91752	3434	00	06000	33.96478785	-117.5529229	Riverside County
303121	Non-Physician Medical Practitioner	None	1740821164	0	0	DAVIS, ERIN E PA	8/22/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
303141	Non-Physician Medical Practitioner	None	1003867474	0	0	DOTY, KELLY A	9/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 WAYNE STREET	33	RIDGECREST	CA	93555	2578	00	06000	35.6462493	-117.674259	Kern County
303180	Non-Physician Medical Practitioner	None	1255421921	0	0	DE LA VEGA, ERIC R	7/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15535 YORBA AVENUE	None	CHINO HILLS	CA	91709	3160	00	06000	33.97120578	-117.7011047	San Bernardino County
303187	Non-Physician Medical Practitioner	None	1306353420	0	0	DENTON, JESSICA A PA	7/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
303192	Non-Physician Medical Practitioner	None	1073163986	0	0	DAWSON, GAVIN	12/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	00	06000	34.02308948	-118.3972101	Los Angeles County
303225	Non-Physician Medical Practitioner	None	1447586128	0	0	DAVIES, KATHLEEN A	5/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	314 3RD ST	None	PACIFIC GROVE	CA	93950	3614	00	06000	36.61673461	-121.9098052	Monterey County
303277	Non-Physician Medical Practitioner	None	1760426449	0	0	DAVIS, JOHN PAUL NP	8/12/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	HI-DESERT MEDICAL CENTER	6601 WHITE FEATHER ROAD	JOSHUA TREE	CA	92252	0000	00	06000	34.14735796	-116.2998959	San Bernardino County
303331	Non-Physician Medical Practitioner	None	1336498666	0	0	DEMOSS, VANESSA L NP	7/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	820 W LAUREL AVE	APT 8	LOMPOC	CA	93436	5243	00	06000	34.6438439	-120.4676544	Santa Barbara County
303370	Non-Physician Medical Practitioner	None	1336151224	0	0	DEPMORE, DANIEL B	4/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23 SOFTWIND	None	ALISO VIEJO	CA	92656	1356	00	06000	33.58365305	-117.7200166	Orange County
303380	Non-Physician Medical Practitioner	None	1144324336	0	0	DURAN, KIMBERLY R	8/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 LAYSAN TEAL DR	None	ROSEVILLE	CA	95747	4643	00	06000	38.796849	-121.3208955	Placer County
303403	Non-Physician Medical Practitioner	None	1235986647	0	0	DUROMOLA, MARYJANE	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
303422	Non-Physician Medical Practitioner	None	1306842364	0	0	DAVISON, IRMA L NP	10/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5749 EAST BUTLER AVE	None	FRESNO	CA	93727	5410	00	06000	36.72899673	-119.6935682	Fresno County
303441	Non-Physician Medical Practitioner	None	1740235423	0	0	DOWDY, CARLA K	11/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	415 ANDERSON AVE	None	EKALAKA	MT	59324	0047	00	06000	45.885636	-104.5494315	Carter County
303468	Non-Physician Medical Practitioner	None	1740706670	0	0	DAVISON, TIANA A	10/11/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	254 EAST FERN AVENUE	APT 106	REDLANDS	CA	92373	6071	00	06000	34.05246673	-117.1749801	San Bernardino County
303513	Non-Physician Medical Practitioner	None	1235417791	0	0	DOWELL, MATTHEW ALLEN	12/3/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
303522	Non-Physician Medical Practitioner	None	1255386181	0	0	DOMINIGUEZ, DONNA L NP	4/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1880 CIRCLE DRIVE	None	RENO	NV	89509	3274	00	06000	39.50575426	-119.824719	Washoe County
303525	Non-Physician Medical Practitioner	None	1437817897	0	0	DOUGLES, KAITLIN M NP	12/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
303582	Non-Physician Medical Practitioner	None	1467470450	0	0	DALESSANDRO, RICHARD R	4/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1718 NW 23RD AVE	None	BATTLE GROUND	WA	98604	4399	00	06000	45.793638	-122.561991	Clark County
303588	Non-Physician Medical Practitioner	None	1053690024	0	0	DANIELS, MONICA M NP	9/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10720 N SEAL COVE	None	FRESNO	CA	93730	0713	00	06000	36.89166413	-119.7729212	Fresno County
303593	Non-Physician Medical Practitioner	None	1205239134	0	0	DANKO, ROMILYNN NP	11/9/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
303606	Non-Physician Medical Practitioner	None	1699839415	0	0	DAUN, GRACE SUN	5/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
303614	Non-Physician Medical Practitioner	None	1548532344	0	0	DAMBRUOSO, SARAH FRANCES	1/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 15TH ST	None	SANTA MONICA	CA	90404	1135	00	06000	34.02648965	-118.4867439	Los Angeles County
303648	Non-Physician Medical Practitioner	None	1043689748	0	0	DURNING, CHELSEA PA	8/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
303678	Non-Physician Medical Practitioner	None	1992119960	0	0	DE LEON-LUCK, JOVIE NP	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7991 SUNKIST DR	None	OAKLAND	CA	94605	3050	00	06000	37.76686172	-122.1601072	Alameda County
303681	Non-Physician Medical Practitioner	None	1972726784	0	0	DAVIS BURTON, KYLA A	12/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	152 E OLIVE AVE	APT B	MONROVIA	CA	91016	5193	00	06000	34.14481256	-117.999169	Los Angeles County
303691	Non-Physician Medical Practitioner	None	1164942116	0	0	DIAZ, MARK J	9/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3270 AVENIDO DEL LAGO WA	None	FAIRFIELD	CA	94533	7784	00	06000	38.29011622	-122.0150049	Solano County
303706	Non-Physician Medical Practitioner	None	1497479901	0	0	DHILLON, ANJULI M NP	9/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
303716	Non-Physician Medical Practitioner	None	1154535136	0	0	DOMINGUEZ, LORRAINE SUSAN	9/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4301 S FIGUEROA ST	STE. F	LOS ANGELES	CA	90037	2660	00	06000	34.005132	-118.282769	Los Angeles County
303728	Non-Physician Medical Practitioner	None	1578603460	0	0	DELVO, DANIELLE L	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2162 OUTRIGGER DR	None	EL DORADO HILLS	CA	95762	3735	00	06000	38.71992121	-121.0983491	El Dorado County
303768	Non-Physician Medical Practitioner	None	1407196454	0	0	DONG, YING PA-C	10/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
303777	Non-Physician Medical Practitioner	None	1790217735	0	0	DADHANIA, AKRUTI J	6/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17802 ELAINE AVE	None	ARTESIA	CA	90701	4125	00	06000	33.86934347	-118.0768485	Los Angeles County
303783	Non-Physician Medical Practitioner	None	1184280505	0	0	DAHLBERG, HELEN E PA-C	2/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 C ST	STE 550	SACRAMENTO	CA	95816	3372	00	06000	38.579877	-121.456143	Sacramento County
303795	Non-Physician Medical Practitioner	None	1417649013	0	0	DADE, ETHLENE	12/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
303809	Non-Physician Medical Practitioner	None	1518375179	0	0	DOULAKI, HEATHER M PA-C	6/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	741 KEVIN COURT	None	LEMOORE	CA	93245	4009	00	06000	36.2916151	-119.7919419	Kings County
303814	Non-Physician Medical Practitioner	None	1437750874	0	0	DYMARCZYK, DOMINIKA M CNM	8/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST.	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
303819	Non-Physician Medical Practitioner	None	1780624692	0	0	DAVIES, SUMMER R NP	6/29/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5423 TAFT AVE	None	LA JOLLA	CA	92037	7641	00	06000	32.81265487	-117.2615888	San Diego County
303827	Non-Physician Medical Practitioner	None	1982975488	0	0	DONESKY, DORANNE	3/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2330 POST ST	SUITE 420	SAN FRANCISCO	CA	94115	3465	00	06000	37.78424041	-122.4403628	San Francisco County
303834	Non-Physician Medical Practitioner	None	1841453693	0	0	DANIEL, BEVERLY J NP	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	366 SOUTH MENTOR AVENUE	None	PASADENA	CA	91106	3380	00	06000	34.139574	-118.1307825	Los Angeles County
303849	Non-Physician Medical Practitioner	None	1902411739	0	0	DEWITT, JESSICA NP	5/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18200 YORBA LINDA BLVD	101-102	YORBA LINDA	CA	92886	4006	00	06000	33.88842824	-117.8154698	Orange County
303899	Non-Physician Medical Practitioner	None	1295127108	0	0	DAVIS, ASHLEY PA-C	7/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	00	06000	34.2064445	-118.8824085	Ventura County
303933	Non-Physician Medical Practitioner	None	1952382350	0	0	DUCLO, PAULA S NP	2/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9990 GILLETE ROAD	None	LE GRAND	CA	95333	9776	00	06000	37.239813	-120.3089805	Merced County
303959	Non-Physician Medical Practitioner	None	1326416926	0	0	DEGROFF, ASHLEY A PA	12/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	06000	33.38982	-111.8760885	Maricopa County
304002	Non-Physician Medical Practitioner	None	1821297482	0	0	DELGADILLO, ANGEL V	2/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5804 LANCEWOOD CT	None	FONTANA	CA	92336	5914	00	06000	34.151481	-117.44658	San Bernardino County
304026	Non-Physician Medical Practitioner	None	1881090330	0	0	DESTEFANO, LINDA NP	4/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3 COASTAL OAK	None	NEWPORT COAST	CA	92657	1655	00	06000	33.59966139	-117.8083065	Orange County
304027	Non-Physician Medical Practitioner	None	1619462736	0	0	DO, MIJIN NP	8/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9730 BRIMHALL RD	STE 1	BAKERSFIELD	CA	93312	2786	00	06000	35.36873516	-119.1105773	Kern County
304036	Non-Physician Medical Practitioner	None	1801402912	0	0	DUONG, VIVIAN N NP	11/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	00	06000	33.67620851	-117.7948348	Orange County
304098	Non-Physician Medical Practitioner	None	1861740961	0	0	DAVIS, JUSTIN C PA-C	10/17/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1601 FIFTH AVE	None	SAN RAFAEL	CA	94901	1808	00	06000	37.9748462	-122.5354152	Marin County
304134	Non-Physician Medical Practitioner	None	1376194605	0	0	DURAN, REBECCA M NP	1/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 TERRACINA BLVD	SUITE 202	REDLANDS	CA	92373	4870	00	06000	34.03788441	-117.2055761	San Bernardino County
304141	Non-Physician Medical Practitioner	None	1831782218	0	0	DONALDSON-FLETCHER, KATHERINE M NP	2/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2299 MOWRY AVE	STE 3C	FREMONT	CA	94538	1621	00	06000	37.55671415	-121.9817758	Alameda County
304177	Non-Physician Medical Practitioner	None	1952349284	0	0	DILLON, MATTHEW J	10/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2900 WHIPPLE AVE	SUITE 230	REDWOOD CITY	CA	94062	2843	00	06000	37.4783072	-122.2551089	San Mateo County
304179	Non-Physician Medical Practitioner	None	1104145861	0	0	DON MICHAEL ENDRESS MD	5/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3191 EL PRADO RD	SUITE D	LA GRANGE	CA	95329	9761	00	06000	37.682568	-120.326651	Tuolumne County
304182	Non-Physician Medical Practitioner	None	1053366815	0	0	DOMHOFF, LYNNE	1/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1212 S MAIN ST	None	SALINAS	CA	93901	2260	00	06000	36.65759539	-121.6594973	Monterey County
304204	Non-Physician Medical Practitioner	None	1144967852	0	0	DIAZ, ROCIO A NP	8/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3737 SAN DIMAS ST	STE 101	BAKERSFIELD	CA	93301	5732	00	06000	35.39412578	-119.0082617	Kern County
304225	Non-Physician Medical Practitioner	None	1740623685	0	0	DORSEY, IRISH DAWN PA	3/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1280 S VICTORIA AVE	250	VENTURA	CA	93003	6521	00	06000	34.26344767	-119.2119344	Ventura County
304229	Non-Physician Medical Practitioner	None	1295391704	0	0	DANG, JENNIFER T PA	3/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	975 S. FAIRMONT AVENUE	None	LODI	CA	95241	5118	00	06000	38.12188356	-121.285872	San Joaquin County
304255	Non-Physician Medical Practitioner	None	1043614605	0	0	DIANA, FABRIZIO NP	1/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2656 EDITH AVE	STE B	REDDING	CA	96001	3030	00	06000	40.57073094	-122.3974088	Shasta County
304257	Non-Physician Medical Practitioner	None	1326203936	0	0	DEHN, RICHARD WILLIAM	7/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST STE 1600	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
304274	Non-Physician Medical Practitioner	None	1265828370	0	0	DARBY, TAMMY E	8/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1293 SUNSET AVENUE	None	PERRIS	CA	92571	3788	00	06000	33.80474453	-117.197577	Riverside County
304275	Non-Physician Medical Practitioner	None	1184906695	0	0	DAVIS, CHRISTOPHER J	10/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 I ST	SUITE A	MARYSVILLE	CA	95901	5626	00	06000	39.13882888	-121.5963884	Yuba County
304279	Non-Physician Medical Practitioner	None	1598443897	0	0	DIGEORGE, SARAH NP	8/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1860 PENNSYLVANIA AVE	120	FAIRFIELD	CA	94533	3590	00	06000	38.261952	-122.0498745	Solano County
304296	Non-Physician Medical Practitioner	None	1831559756	0	0	DELANEY, FARA J NP	5/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DRIV	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
304301	Non-Physician Medical Practitioner	None	1740942481	0	0	DERAYUNAN, ROSAN NP	3/13/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3828 DELMAS	None	CULVER CITY	CA	90232	2713	00	06000	34.02308948	-118.3972101	Los Angeles County
304320	Non-Physician Medical Practitioner	None	1225280159	0	0	DUESTER, ROSANNA	11/19/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 BLAKE WILBUR DR	None	PALO ALTO	CA	94304	2201	00	06000	37.43563834	-122.1767991	Santa Clara County
304351	Non-Physician Medical Practitioner	None	1801229794	0	0	DOYLE, JACLYN S NP	8/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	444 SARATOGA AVE	APT 39L	SANTA CLARA	CA	95050	6208	00	06000	37.33441149	-121.9606478	Santa Clara County
304376	Non-Physician Medical Practitioner	None	1730461054	0	0	DIZON, WILLIAM M	10/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 WILLOW GLEN COURT	None	SAN JOSE	CA	95125	1205	00	06000	37.30425604	-121.8798727	Santa Clara County
304411	Non-Physician Medical Practitioner	None	1093019077	0	0	DYER, KAROLY M NP	3/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7 LANSDALE AVENUE	None	SAN FRANCISCO	CA	94127	1608	00	06000	37.73888864	-122.459388	San Francisco County
304444	Non-Physician Medical Practitioner	None	1790056166	0	0	DAVID, RHYS S NP	3/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
304461	Non-Physician Medical Practitioner	None	1477721702	0	0	DEMOOR, PATRICIA A PA	2/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
304473	Non-Physician Medical Practitioner	None	1003350950	0	0	DUONG, CHRISTINE P NP	2/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17261 CROSS CREEK LN	None	RIVERSIDE	CA	92503	6741	00	06000	33.86968539	-117.4425119	Riverside County
304477	Non-Physician Medical Practitioner	None	1134169410	0	0	DIBELLA, RICHARD T	7/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	682 S SAN ANTONIO RD	None	LOS ALTOS	CA	94022	1262	00	06000	37.37723214	-122.1142611	Santa Clara County
304499	Non-Physician Medical Practitioner	None	1447582119	0	0	DUNCAN, LAURA M	2/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1918 CRYSTAL CT	None	ROCKLIN	CA	95765	5402	00	06000	38.81617161	-121.273545	Placer County
304542	Non-Physician Medical Practitioner	None	1780054858	0	0	DIEZ, WILLIAM A JR	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27000 WEST LUGONIA AVE	APT 12307	REDLANDS	CA	92374	2099	00	06000	34.07034148	-117.2136377	San Bernardino County
304549	Non-Physician Medical Practitioner	None	1811392871	0	0	DAVID, JON PATRICK G NP	7/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 WESTWOOD BLVD	None	LOS ANGELES	CA	90024	5608	00	06000	34.05159882	-118.4385447	Los Angeles County
304587	Non-Physician Medical Practitioner	None	1811640279	0	0	DANIALIAN, TALIA PA-C	6/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
304592	Non-Physician Medical Practitioner	None	1811902661	0	0	DRENNAN, KATHLEEN M NP	5/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4409 MAPLE DR	None	OCEANSIDE	CA	92056	3535	00	06000	33.20846889	-117.275144	San Diego County
304650	Non-Physician Medical Practitioner	None	1740419621	0	0	DUDY, KELLIE A	8/12/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3711 BALBOA TERRACE	UNIT C	SAN DIEGO	CA	92117	5432	00	06000	32.80985166	-117.2084365	San Diego County
304654	Non-Physician Medical Practitioner	None	1447844568	0	0	DIEU, CAROL	11/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	00	06000	34.27560199	-118.5696701	Los Angeles County
304660	Non-Physician Medical Practitioner	None	1366495368	0	0	DIAZ, CAROLYN A NP	12/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 WEST HENDERSON AVE	None	PORTERVILLE	CA	93257	1731	00	06000	36.0804034	-119.0217006	Tulare County
304661	Non-Physician Medical Practitioner	None	1720481526	0	0	DENWORTH, CORRINE L NP	10/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	637 N CENTRAL AVE	None	CAMPBELL	CA	95008	0130	00	06000	37.29638135	-121.9435356	Santa Clara County
304667	Non-Physician Medical Practitioner	None	1588260780	0	0	DUQUE, ERIK PA	8/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	00	06000	33.74753552	-116.9593245	Riverside County
304719	Non-Physician Medical Practitioner	None	1083233555	0	0	D'AMATO, RACHEL M PA	6/16/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304731	Non-Physician Medical Practitioner	None	1740777127	0	0	DRAKE, CHELSEA N	7/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2625 E DIVSADERO ST	None	FRESNO	CA	93721	1431	00	06000	36.74334386	-119.7795358	Fresno County
304755	Non-Physician Medical Practitioner	None	1922259423	0	0	DANG, JARED	10/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7007 POWERS BLVD	UNIVERSITY PARMA MEDICAL	PARMA	OH	44123	0000	00	06000	41.38275149	-81.73188744	Cuyahoga County
304760	Non-Physician Medical Practitioner	None	1427031285	0	0	DA RE, NEIL GEORGE	10/4/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9201 WHITTIER BLVD	None	PICO RIVERA	CA	90660	2450	00	06000	34.00017083	-118.0809649	Los Angeles County
304762	Non-Physician Medical Practitioner	None	1154360154	0	0	DAVIDSON, WENDY L NP	6/13/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	187 WHITWORTH ST	None	THOUSAND OAKS	CA	91360	1824	00	06000	34.21140711	-118.8817195	Ventura County
304779	Non-Physician Medical Practitioner	None	1700628385	0	0	DIOSDADO, MARIA G NP	7/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2151 N HARBOR BLVD	None	FULLERTON	CA	92835	3801	00	06000	33.89443025	-117.9288328	Orange County
304782	Non-Physician Medical Practitioner	None	1497819395	0	0	DRIVAS, PAULA	4/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	17 BEACHWOOD DRIVE	None	GLEN HEAD	NY	94558	2274	00	06000	40.843305	-73.631727	Nassau County
304805	Non-Physician Medical Practitioner	None	1114784832	0	0	DELFINO, MARIA	11/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	558 ABBOTT ST	A	SALINAS	CA	93901	4326	00	06000	36.66276002	-121.6420145	Monterey County
304836	Non-Physician Medical Practitioner	None	1346021755	0	0	DEVARAJ, AMIT NP	11/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	00	06000	33.94354395	-117.394926	Riverside County
304861	Non-Physician Medical Practitioner	None	1851460307	0	0	DRAUDT, BEVERLY	1/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 N STATE ST	None	UKIAH	CA	95482	3414	00	06000	39.1623719	-123.2098216	Mendocino County
304893	Non-Physician Medical Practitioner	None	1396593281	0	0	DAVIS, HANNAH N PA-C	7/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	00	06000	40.57278686	-122.3958519	Shasta County
304900	Non-Physician Medical Practitioner	None	1144363748	0	0	DUNCAN, STACEY ANNETTE	10/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12021 WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	00	06000	33.922863	-118.2431655	Los Angeles County
304905	Non-Physician Medical Practitioner	None	1316361942	0	0	DETOY, MEGAN M PA-C	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	549 25TH ST	None	HERMOSA BEACH	CA	90254	2091	00	06000	33.87238649	-118.3994415	Los Angeles County
304911	Non-Physician Medical Practitioner	None	1801134994	0	0	DE LEON, SCARLETTE M NP	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
304934	Non-Physician Medical Practitioner	None	1023480159	0	0	DOMINGUEZ, ISAAC	3/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3066 HORTALEZA PL	None	DAVIS	CA	95618	6533	00	06000	38.5584655	-121.7109565	Yolo County
304946	Non-Physician Medical Practitioner	None	1831634708	0	0	DION-GOKAN, JENNIFER A NP	5/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 SPANOS CT	STE 130	MODESTO	CA	95355	2815	00	06000	37.66975543	-120.9724048	Stanislaus County
304958	Non-Physician Medical Practitioner	None	1316371842	0	0	DILLMAN, DANIELA S NP	11/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6022 W 76TH PLACE	None	LOS ANGELES	CA	90045	1640	00	06000	33.97102703	-118.3894246	Los Angeles County
304970	Non-Physician Medical Practitioner	None	1245668623	0	0	DECKARD, KELLY D NP	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40936 LACROIX AVENUE	None	MURRIETA	CA	92562	6306	00	06000	33.57416691	-117.2111079	Riverside County
304983	Non-Physician Medical Practitioner	None	1821466574	0	0	DEJKOVICH, GEORGE NP	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1752 N EL MOLINO AVE	None	PASADENA	CA	91104	1213	00	06000	34.17599465	-118.1372056	Los Angeles County
304984	Non-Physician Medical Practitioner	None	1215566625	0	0	DENNING, CYDNEY T PA-C	8/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44725 10TH ST WEST	170	LANCASTER	CA	93534	4936	00	06000	34.695693	-118.1480965	Los Angeles County
305048	Non-Physician Medical Practitioner	None	1245871151	0	0	DAIBER-SALHI, SARA NP	11/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4190 CHICAGO AVE	None	RIVERSIDE	CA	92507	5348	00	06000	33.97217008	-117.3484877	Riverside County
305051	Non-Physician Medical Practitioner	None	1497990246	0	0	DAVID, FLORA G NP	4/7/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25271 BEAR VALLEY RD	None	TEHACHAPI	CA	93561	8337	00	06000	35.14861413	-118.5789673	Kern County
305077	Non-Physician Medical Practitioner	None	1558818054	0	0	DHILLON, JATINDER NP	8/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
305084	Non-Physician Medical Practitioner	None	1740561083	0	0	DUNCAN, JAMIE T PA	2/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
305085	Non-Physician Medical Practitioner	None	1245645050	0	0	DOYLE, MICHAEL N PA-C	10/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1941 JOHNSON AVE	STE 101	SAN LUIS OBISPO	CA	93401	4154	00	06000	35.27804785	-120.649711	San Luis Obispo County
305095	Non-Physician Medical Practitioner	None	1174953640	0	0	DEPPER, JULIE A	9/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 TAYLOR STREET	None	SAN FRANCISCO	CA	94133	4744	00	06000	37.79556318	-122.4132765	San Francisco County
305137	Non-Physician Medical Practitioner	None	1518531698	0	0	DOAN, CHRISTOPHER PA-C	6/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	00	06000	34.58364037	-118.1441012	Los Angeles County
305161	Non-Physician Medical Practitioner	None	1750755617	0	0	DEVITA, SHANNON L NP	1/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
305170	Non-Physician Medical Practitioner	None	1477014454	0	0	DONICI, NATALIA NP	10/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	00	06000	35.29325417	-120.667547	San Luis Obispo County
305182	Non-Physician Medical Practitioner	None	1184931446	0	0	DAUGHERTY, RYAN WRIGHT	6/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	H3652 MC 5642	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305203	Non-Physician Medical Practitioner	None	1346076189	0	0	DOMINGO, BREVIN JOSEPH C PA-C	1/2/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1115 S SUNSET AVE	None	WEST COVINA	CA	91790	3940	00	06000	34.062852	-117.9446658	Los Angeles County
305280	Non-Physician Medical Practitioner	None	1235507286	0	0	DHANOTA, KAMALPREET K NP	12/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2322 HOWLETT AVE	None	YUBA CITY	CA	95993	9614	00	06000	39.16680213	-121.6943705	Sutter County
305336	Non-Physician Medical Practitioner	None	1437312527	0	0	DAVIS, PAULA E.	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1630 STAGS LEAP LN	None	TRACY	CA	95376	5372	00	06000	37.7341748	-121.4458995	San Joaquin County
305345	Non-Physician Medical Practitioner	None	1073968459	0	0	DIETZLER, MARQUE R	12/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30500 SILVER SANAS CIR	None	MENIFEE	CA	92584	8980	00	06000	33.67853285	-117.1600557	Riverside County
305382	Non-Physician Medical Practitioner	None	1407386816	0	0	DUCOMBS, CHRISTOPHER D	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3451 NE 1ST AVENUE	M403	MIAMI	FL	33137	3984	00	06000	25.80950766	-80.19245491	Miami-Dade County
305396	Non-Physician Medical Practitioner	None	1508263435	0	0	DOUBININA, GAIANE NP	1/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14358 MAGNOLIA BLVD	232	SHERMAN OAKS	CA	91423	1027	00	06000	34.16483888	-118.4459118	Los Angeles County
305401	Non-Physician Medical Practitioner	None	1538564869	0	0	DURHAM, ELIZABETH	7/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	00	06000	37.48892015	-122.218747	San Mateo County
305409	Non-Physician Medical Practitioner	None	1114107018	0	0	DOROSIN, J ANDREW	5/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	107 ATHERTON LOOP	None	APTOS	CA	95003	3177	00	06000	36.99001633	-121.9302583	Santa Cruz County
305462	Non-Physician Medical Practitioner	None	1801525621	0	0	DAGGETT, LAUREN M PA-C	10/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 LA VETA	STE 430	ORANGE	CA	92868	4226	00	06000	33.7802984	-117.8651669	Orange County
305496	Non-Physician Medical Practitioner	None	1174953384	0	0	DANN, RAYMOND PA	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	00	06000	32.72663119	-117.1611714	San Diego County
305556	Non-Physician Medical Practitioner	None	1811921380	0	0	DEVERE, JOHN J JR	9/28/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30159 CHANNEL WAY DR	None	CANYON LAKE	CA	92587	7984	00	06000	33.68255155	-117.2540132	Riverside County
305568	Non-Physician Medical Practitioner	None	1235527912	0	0	DUBOSE, MARIA L	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5341 CORAL RIBBON AVE	None	LAS VEGAS	NV	89139	5832	00	06000	36.05277244	-115.2141141	Clark County
305574	Non-Physician Medical Practitioner	None	1487767539	0	0	DIEDRICH, ALEJANDRA K PA	9/2/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	00	06000	32.83133206	-117.1252363	San Diego County
305578	Non-Physician Medical Practitioner	None	1851749881	0	0	DEHART, AMANDA L NP	1/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
305589	Non-Physician Medical Practitioner	None	1548225303	0	0	DURFEE, ANTHONY J	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5085 MOUNT LA PLATTA DR	None	SAN DIEGO	CA	92117	3007	00	06000	32.82489165	-117.1860763	San Diego County
305607	Non-Physician Medical Practitioner	None	1568632388	0	0	DANIELS, DENNIS	10/20/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
305657	Non-Physician Medical Practitioner	None	1063588507	0	0	DUAG, MELISSA D PA-C	6/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 W TEMPLE AVE	BUILDING #46	POMONA	CA	91768	2557	00	06000	34.061508	-117.821268	Los Angeles County
305664	Non-Physician Medical Practitioner	None	1750019824	0	0	DE CASTRO, SHARLENE JOYCE	8/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
305672	Non-Physician Medical Practitioner	None	1083259725	0	0	DAEISADEGHI, ALEX R NP	8/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 J STREET	STE 260	SACRAMENTO	CA	95819	3663	00	06000	38.570652	-121.4535465	Sacramento County
305722	Non-Physician Medical Practitioner	None	1255707493	0	0	DHINSA, SUKHVIR K NP	10/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39508 AVENIR CT	None	PALMDALE	CA	93551	1083	00	06000	34.5999479	-118.1809421	Los Angeles County
305737	Non-Physician Medical Practitioner	None	1982239430	0	0	DAM, CATHERINE PA	3/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	00	06000	37.78487142	-122.4398095	San Francisco County
305741	Non-Physician Medical Practitioner	None	1780395897	0	0	DELROSARIO, HELEN NP	11/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 ROSECRANS ST	None	SAN DIEGO	CA	92106	1928	00	06000	32.72903913	-117.2254885	San Diego County
305767	Non-Physician Medical Practitioner	None	1952077216	0	0	DE LEON, SERENE NP	11/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
305768	Non-Physician Medical Practitioner	None	1396391397	0	0	DOMINGUEZ, SANTA A NP	3/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	00	06000	33.33904622	-118.3307237	Los Angeles County
305780	Non-Physician Medical Practitioner	None	1629102173	0	0	DELACRUZ, JAYCEELYN GUZMAN	6/26/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16415 COLORADO AVE	SUITE 207	PARAMOUNT	CA	90723	5035	00	06000	33.8853075	-118.1614695	Los Angeles County
305791	Non-Physician Medical Practitioner	None	1194438622	0	0	DIAZ, ANGELIQUE M PA	3/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2825 CAPITOL AVENUE	None	SACRAMENTO	CA	95816	6039	00	06000	38.570805	-121.4696385	Sacramento County
305792	Non-Physician Medical Practitioner	None	1518682509	0	0	DESAI, MAUNA NP	3/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
305803	Non-Physician Medical Practitioner	None	1831364652	0	0	DRECHSLER-FERNANDEZ, DARLENE MARIE	9/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 OFARRELL ST	7TH FLOOR	SAN FRANCISCO	CA	94115	3357	00	06000	37.78224789	-122.4412946	San Francisco County
305814	Non-Physician Medical Practitioner	None	1952493413	0	0	DIOGO, MARY J CNM	10/19/1991	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15 BENEDICT COURT	None	ALAMEDA	CA	94502	7758	00	06000	37.7369744	-122.2543681	Alameda County
305844	Non-Physician Medical Practitioner	None	1366902629	0	0	DEL TORO, ISABEL C NP	5/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2621 BRISTOL	207	SANTA ANA	CA	92704	5766	00	06000	33.711876	-117.885371	Orange County
305883	Non-Physician Medical Practitioner	None	1780660761	0	0	DOUGHERTY, SIMON F	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10677 LANDMARK WAY	None	CLOVIS	CA	93619	4676	00	06000	36.79899404	-119.5971114	Fresno County
305922	Non-Physician Medical Practitioner	None	1689309569	0	0	DEYLING, LAUREN M PA	10/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
305947	Non-Physician Medical Practitioner	None	1194771147	0	0	DABNEY, JOSEPH D	3/5/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1737	00	06000	33.808185	-118.1850575	Los Angeles County
305953	Non-Physician Medical Practitioner	None	1184819807	0	0	DEFAZIO, WILLIAM E	1/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6690 13TH ST	None	SACRAMENTO	CA	95831	2258	00	06000	38.505249	-121.5150525	Sacramento County
305973	Non-Physician Medical Practitioner	None	1912378936	0	0	DIAMANTE, REINANTE U NP	4/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23838 VALENCIA BLVD	SUITE 205	VALENCIA	CA	91355	1339	00	06000	34.41337791	-118.5520369	Los Angeles County
306003	Non-Physician Medical Practitioner	None	1528492162	0	0	DE OCA, ANA M V NP	2/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17912 E KELBY ST	None	COVINA	CA	91722	3237	00	06000	34.09331453	-117.8996355	Los Angeles County
306005	Non-Physician Medical Practitioner	None	1700520384	0	0	DABABNEH, RHONDA	8/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	00	06000	34.27560199	-118.5696701	Los Angeles County
306034	Non-Physician Medical Practitioner	None	1316428642	0	0	DEL VALLE, AIME NP	10/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
306060	Non-Physician Medical Practitioner	None	1508420258	0	0	DAVIS, ASHLEY	2/26/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
306065	Non-Physician Medical Practitioner	None	1972022192	0	0	DUNIVAN, ALLISON N PA-C	3/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	00	06000	36.65911769	-121.6448024	Monterey County
306143	Non-Physician Medical Practitioner	None	1902865066	0	0	DAS, RAJIB	2/16/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1934 N WHITEASH AVE	None	CLOVIS	CA	93619	9509	00	06000	36.86510289	-119.6486038	Fresno County
306164	Non-Physician Medical Practitioner	None	1407588296	0	0	DUONG, KIEU T	10/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5725 S SOTO ST	None	HUNTINGTON PARK	CA	90255	9993	00	06000	33.990444	-118.2193965	Los Angeles County
306197	Non-Physician Medical Practitioner	None	1730100504	0	0	DYSICO, ANTHONY SUBIDO	12/5/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
306220	Non-Physician Medical Practitioner	None	1386278927	0	0	DOROTHEO, DURISH ANN A NP	3/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2110 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	00	06000	35.37344851	-119.0261655	Kern County
306230	Non-Physician Medical Practitioner	None	1821292376	0	0	DAHLBERG, LAURIE S NP	3/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2165 LESTER AVENUE	None	CLOVIS	CA	93619	2822	00	06000	36.86423138	-119.6763235	Fresno County
306329	Non-Physician Medical Practitioner	None	1467933903	0	0	DARPLI, LILY D NP	10/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6535 N SPALDING AVENUE	None	FRESNO	CA	93710	4321	00	06000	36.8326691	-119.7581418	Fresno County
306337	Non-Physician Medical Practitioner	None	1164570073	0	0	DUFFY, LAURA J	6/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10297 LARIAT DR	None	SANTEE	CA	92071	1671	00	06000	32.86523526	-116.9828733	San Diego County
306352	Non-Physician Medical Practitioner	None	1003253824	0	0	DUNDAS, SUSAN H PA	12/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	847 W CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.28825369	-120.4963159	Merced County
306391	Non-Physician Medical Practitioner	None	1629241799	0	0	DEGOLIER, SARA D NP	5/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	18184 E WEAVER DRIVE	None	AURORA	CO	80016	3136	00	06000	39.59977969	-104.7777651	Arapahoe County
306433	Non-Physician Medical Practitioner	None	1902952013	0	0	DAVIS, BROOKE	10/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
306440	Non-Physician Medical Practitioner	None	1982823027	0	0	DHAH, MANJIT S	4/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1455 PARK BLVD	None	ORANGE COVE	CA	93646	9322	00	06000	36.62466137	-119.3227461	Fresno County
306444	Non-Physician Medical Practitioner	None	1285996611	0	0	DUGAN, JOY A PA-C	1/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 TRANCAS ST	None	NAPA	CA	94558	2906	00	06000	38.32349768	-122.2963137	Napa County
306454	Non-Physician Medical Practitioner	None	1508943671	0	0	DEBIAK, KATHLEEN DIANA	12/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2550 N THUNDERBIRD CIRCL	STE. 303	MESA	AZ	85215	0000	00	06000	33.462567	-111.7199025	Maricopa County
306488	Non-Physician Medical Practitioner	None	1992485643	0	0	DODGE, KAISA PA-C	12/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
306497	Non-Physician Medical Practitioner	None	1700099165	0	0	DEOL, GURLEEN	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
306528	Non-Physician Medical Practitioner	None	1811583545	0	0	DO, MANLE NP	1/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	00	06000	37.66975543	-120.9724048	Stanislaus County
306534	Non-Physician Medical Practitioner	None	1659551877	0	0	D, BELL M	8/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2720 LOW COURT	None	FAIRFIELD	CA	94533	0000	00	06000	38.23580279	-122.0858445	Solano County
306545	Non-Physician Medical Practitioner	None	1467639385	0	0	DEMANN, AKOSUA S	10/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2550 HILBORN ROAD	257	FAIRFIELD	CA	94534	1070	00	06000	38.27799	-122.050431	Solano County
306556	Non-Physician Medical Practitioner	None	1639590300	0	0	DJOKOVIC, MARIJA NP	11/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2956 BARRETT SPRING AVE	None	HENDERSON	NV	89044	1612	00	06000	35.9339776	-115.1140391	Clark County
306559	Non-Physician Medical Practitioner	None	1699097121	0	0	DE LOS SANTOS, ANNABELLE R	9/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9948 YELOWFIN WAY	None	ELK GROVE	CA	95757	6266	00	06000	38.395737	-121.4075475	Sacramento County
306594	Non-Physician Medical Practitioner	None	1972810216	0	0	DAHLQUIST, CECILE D T NP	5/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1330 SEQUOIA DR	None	LAKE ARROWHEAD	CA	92352	0000	00	06000	34.27395085	-117.1764656	San Bernardino County
306632	Non-Physician Medical Practitioner	None	1184303679	0	0	DICTOR, MICHELLE R NP	8/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	00	06000	37.36797679	-122.0297112	Santa Clara County
306643	Non-Physician Medical Practitioner	None	1386747210	0	0	DAN, FU	1/17/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
306657	Non-Physician Medical Practitioner	None	1780732495	0	0	DENSLOW, ANNE J	3/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1640 POPPY PEAK DRIVE	None	PASADENA	CA	91105	2763	00	06000	34.13023184	-118.1802947	Los Angeles County
306733	Non-Physician Medical Practitioner	None	1922571926	0	0	DE LA FUENTE, ADRIANA C PA	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
306734	Non-Physician Medical Practitioner	None	1619025525	0	0	DOAN, CHRISTINE P	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10229 CASSIA GLEN DR	None	SAN DIEGO	CA	92127	2864	00	06000	33.02835618	-117.1168867	San Diego County
306744	Non-Physician Medical Practitioner	None	1386482735	0	0	DOLBIER, JUSTINE PA	10/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	00	06000	33.94909549	-118.3481595	Los Angeles County
306748	Non-Physician Medical Practitioner	None	1043739311	0	0	DAGUE, MEGHAN M NP	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 243	None	AVILA BEACH	CA	93424	0243	00	06000	0	0	None
306759	Non-Physician Medical Practitioner	None	1205228947	0	0	DE GUZMAN, VILBEN MICHAEL M NP	7/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
306760	Non-Physician Medical Practitioner	None	1598709248	0	0	DEVELLE, ROBERT E	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1278 INVERNESS DRIVE	None	PASADENA	CA	91103	1119	00	06000	34.17557351	-118.179061	Los Angeles County
306767	Non-Physician Medical Practitioner	None	1063829505	0	0	DERISSI, DANA A	8/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2606 TORREY PINES RD	UNIT C13	LA JOLLA	CA	92037	3443	00	06000	32.85156857	-117.2470811	San Diego County
306770	Non-Physician Medical Practitioner	None	1194824235	0	0	DURAN, MARTHA A	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7520 ARROYO CIR	None	GILROY	CA	95020	7303	00	06000	37.01225317	-121.5604444	Santa Clara County
306870	Non-Physician Medical Practitioner	None	1760685275	0	0	DZUBUR, VALERIE GAIL	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12 RITTER ST	None	SAN RAFAEL	CA	94912	0000	00	06000	37.97154858	-122.5251877	Marin County
306880	Non-Physician Medical Practitioner	None	1255663613	0	0	DURAN, GRETCHEN M	9/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3873 FOREST HILL AVE	None	OAKLAND	CA	94602	2413	00	06000	37.80447972	-122.2119742	Alameda County
306884	Non-Physician Medical Practitioner	None	1144262395	0	0	DINSAY, JOCYLANE M NP	7/5/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	925 VISTA DEL VALLE RD	None	LA CANADA	CA	91011	4716	00	06000	34.21911151	-118.1991657	Los Angeles County
306902	Non-Physician Medical Practitioner	None	1932578556	0	0	DOOLAN, KAITLIN A	4/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	819 STONEWOOD PLACE	None	VACAVILLE	CA	95687	9445	00	06000	38.36373391	-121.9427267	Solano County
306903	Non-Physician Medical Practitioner	None	1760957674	0	0	DESMOND, CLAIRE M PA-C	6/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
306942	Non-Physician Medical Practitioner	None	1194267070	0	0	DAVYDOV, ANZHELA NP	10/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6086 WENRICH DR	None	SAN DIEGO	CA	92120	3717	00	06000	32.7866455	-117.0674546	San Diego County
306949	Non-Physician Medical Practitioner	None	1518606797	0	0	DANG, QUAN T PA	2/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
307021	Non-Physician Medical Practitioner	None	1083085039	0	0	DILLARD, CINDY B NP	11/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 FREDERICK ST	STE 203	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
307036	Non-Physician Medical Practitioner	None	1588155543	0	0	DENIS, SEBASTIEN A PA-C	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
307106	Non-Physician Medical Practitioner	None	1295891000	0	0	DEMARTINI, MONIQUE KATHLEEN	4/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
307110	Non-Physician Medical Practitioner	None	1700462025	0	0	DETRICK, NATALIA M NP	4/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS AVE	SUITE 301	FRESNO	CA	93701	2168	00	06000	36.74500687	-119.7846885	Fresno County
307125	Non-Physician Medical Practitioner	None	1417488073	0	0	DUENAS, ROSEANNA M	10/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6400 LONE PINE	None	SEBASTOPOL	CA	95472	5623	00	06000	38.36778661	-122.803794	Sonoma County
307149	Non-Physician Medical Practitioner	None	1154426211	0	0	DOHRMANN, MICHELLE CATHERINE	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7520 ARROYO CIR	None	GILROY	CA	95020	7303	00	06000	37.01225317	-121.5604444	Santa Clara County
307158	Non-Physician Medical Practitioner	None	1831860576	0	0	DHANOA, KIRAT K NP	4/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	00	06000	36.330327	-119.351943	Tulare County
307188	Non-Physician Medical Practitioner	None	1043271448	0	0	DALY, SABRA J	2/28/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5562 TAFT AVE	None	OAKLAND	CA	94618	1519	00	06000	37.84287147	-122.248617	Alameda County
307220	Non-Physician Medical Practitioner	None	1023885225	0	0	DURAN, JACOB PA-C	12/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 LOWER RAGSDALE	160	MONTEREY	CA	93940	5748	00	06000	36.5766066	-121.8193801	Monterey County
307228	Non-Physician Medical Practitioner	None	1225561095	0	0	DUNHAM, JONATHAN R	6/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	102 GEORGIA WAY	None	SAN LEANDRO	CA	94577	1833	00	06000	37.73300548	-122.1598697	Alameda County
307247	Non-Physician Medical Practitioner	None	1912914193	0	0	DOSHI, HEMANG J PA	5/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17100 NORWALK BLVD	STE 101	CERRITOS	CA	90703	2750	00	06000	33.87557796	-118.0725386	Los Angeles County
307266	Non-Physician Medical Practitioner	None	1740530328	0	0	DERRICO, RHONE NP	11/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6275 BOULDER HIGHWAY	APT 2192	LAS VEGAS	NV	89122	7692	00	06000	36.08696502	-115.0350308	Clark County
307272	Non-Physician Medical Practitioner	None	1760825574	0	0	DAUGAARD, MELISSA G NP	2/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1355 EAST ST	SUITE 200	REDDING	CA	96001	0801	00	06000	40.58628506	-122.3887911	Shasta County
307274	Non-Physician Medical Practitioner	None	1255799532	0	0	DEBRABANT, LEAH J	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	109 CAMARITAS COURT	None	DANVILLE	CA	94526	5437	00	06000	37.80105575	-121.9659256	Contra Costa County
307278	Non-Physician Medical Practitioner	None	1821623281	0	0	DELAPENA, RINA NP	2/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
307282	Non-Physician Medical Practitioner	None	1275834954	0	0	DE LA CRUZ, XOCHITL	9/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8910 SEVEN MILE LANE	None	CHICO	CA	95928	8902	00	06000	39.63006	-121.904325	Butte County
307295	Non-Physician Medical Practitioner	None	1508053463	0	0	DELGADILLO, PEREZ A	9/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 UNIVERSITY CIR	CSU STANISLAUS, STUDENT	TURLOCK	CA	95382	3200	00	06000	37.52357194	-120.8576678	Stanislaus County
307319	Non-Physician Medical Practitioner	None	1982270542	0	0	DELUCA, ANNE M NP	6/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	715 ALTOS OAKS DR	None	LOS ALTOS	CA	94024	5402	00	06000	37.35934225	-122.0951741	Santa Clara County
307355	Non-Physician Medical Practitioner	None	1710213210	0	0	DARNE, ROSE E	5/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5848 E ADDERLEY DR	None	LONG BEACH	CA	90808	3741	00	06000	33.81110299	-118.1182889	Los Angeles County
307421	Non-Physician Medical Practitioner	None	1851739106	0	0	DOBRINEN, JENNIFER A	8/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	964 N BUSH AVE	None	CLOVIS	CA	93611	7125	00	06000	36.8474605	-119.7194921	Fresno County
307490	Non-Physician Medical Practitioner	None	1770269912	0	0	DIAZ, JUAN PA-C	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	00	06000	34.073505	-117.3505995	San Bernardino County
307509	Non-Physician Medical Practitioner	None	1689085714	0	0	DIAZ, JOSE R NP	6/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14515 FLOMAR DR	None	WHITTIER	CA	90603	1926	00	06000	33.94644689	-118.0183204	Los Angeles County
307547	Non-Physician Medical Practitioner	None	1669729786	0	0	DINKEL, LAURA M	7/22/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
307552	Non-Physician Medical Practitioner	None	1093919862	0	0	DAQUILA, MITZI NUNES	1/14/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	00	06000	33.715035	-117.936993	Orange County
307554	Non-Physician Medical Practitioner	None	1588356414	0	0	DELA PAZ, TONI ROSE NP	10/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
307570	Non-Physician Medical Practitioner	None	1992480800	0	0	DAHDUL, DINA PA	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	00	06000	33.98921547	-118.2242565	Los Angeles County
307622	Non-Physician Medical Practitioner	None	1588286439	0	0	DEGROOD, HAYLEE PA-C	11/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
307650	Non-Physician Medical Practitioner	None	1316949332	0	0	DENTON, MICHAEL S	3/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7541 TALL PINE LN	None	GRANITE BAY	CA	95746	9443	00	06000	38.75903748	-121.1840763	Placer County
307681	Non-Physician Medical Practitioner	None	1407885122	0	0	DRESS-MEADOWS, LYNN	1/1/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	00	06000	39.15305697	-123.2037774	Mendocino County
307712	Non-Physician Medical Practitioner	None	1083394894	0	0	DAGES, JULIA PA-C	2/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8590 RIO SAN DIEGO DR	111	SAN DIEGO	CA	92108	5507	00	06000	32.77472926	-117.1448295	San Diego County
307720	Non-Physician Medical Practitioner	None	1871922195	0	0	DAVIS, HOLLY A NP	1/23/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7070 STERLING POINT CT	None	RENO	NV	89523	6862	00	06000	39.51801029	-119.9021738	Washoe County
307755	Non-Physician Medical Practitioner	None	1477193977	0	0	DOBASHI, CHARLENE NP	6/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28400 MCCALL BLVD	SUITE B10	MENIFEE	CA	92585	9658	00	06000	33.71805454	-117.1672547	Riverside County
307794	Non-Physician Medical Practitioner	None	1811324726	0	0	DENEVAN, ANDREW J PA	3/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
307802	Non-Physician Medical Practitioner	None	1194445478	0	0	DWYER, BRIAN PA	10/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
307878	Non-Physician Medical Practitioner	None	1134340821	0	0	DE-LEVI, STACY	5/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
307900	Non-Physician Medical Practitioner	None	1053744508	0	0	DIAMANT, ERICA Y NP	5/31/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1531 8TH AVE	APT 1	SAN FRANCISCO	CA	94122	3767	00	06000	37.75974414	-122.4649718	San Francisco County
307905	Non-Physician Medical Practitioner	None	1861634701	0	0	DAWSON, DIANA LYNN	12/16/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	521 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0632	00	06000	37.7634502	-122.4579779	San Francisco County
307908	Non-Physician Medical Practitioner	None	1538404629	0	0	DELOS SANTOS, MIREEN Q NP	12/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	218 AVALON DR	None	DALY CITY	CA	94015	4601	00	06000	37.68285231	-122.4911719	San Mateo County
307921	Non-Physician Medical Practitioner	None	1821369943	0	0	DUOSS, KRISTIE A	5/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3275 DUBLIN BLVD APT 329	None	DUBLIN	CA	94568	4613	00	06000	37.70475138	-121.8611045	Alameda County
307929	Non-Physician Medical Practitioner	None	1336432384	0	0	DERNAY, MICHELE	1/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3215 HILTON HEAD DRIVE	None	FAIRFIELD	CA	94534	7804	00	06000	38.29262984	-122.0661285	Solano County
307967	Non-Physician Medical Practitioner	None	1194846691	0	0	DHALIWAL, NAMNEET K	8/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 E STEWART DR	None	ORANGE	CA	92868	0000	00	06000	33.78236558	-117.8648414	Orange County
308000	Non-Physician Medical Practitioner	None	1629634829	0	0	DEERING, BRENDA D PA-C	10/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1066 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	4163	00	06000	36.91746931	-121.7842657	Santa Cruz County
308003	Non-Physician Medical Practitioner	None	1760851679	0	0	DUMONT, VANESSA L	2/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 5TH AVE	APT 3	SAN FRANCISCO	CA	94118	2310	00	06000	37.78202569	-122.4632616	San Francisco County
308115	Non-Physician Medical Practitioner	None	1609117712	0	0	DE LA ROSA, LAURA S NP	1/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	439 S PINE STREET	None	ORANGE	CA	92866	2745	00	06000	33.78151337	-117.8452161	Orange County
308134	Non-Physician Medical Practitioner	None	1386193225	0	0	DOWNING-MAHLI, EMILY NP	9/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	00	06000	34.069509	-118.383743	Los Angeles County
308158	Non-Physician Medical Practitioner	None	1922767896	0	0	DICECCA, EMILY NP	4/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
308187	Non-Physician Medical Practitioner	None	1366823049	0	0	DEOL, JAGDEEP NP	3/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q ST	5TH FL	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
308198	Non-Physician Medical Practitioner	None	1760647465	0	0	DIETERICH, ALISA M NP	8/11/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	967 BIG SUR CT	None	EL DORADO HILLS	CA	95762	4508	00	06000	38.66402806	-121.0762495	El Dorado County
308203	Non-Physician Medical Practitioner	None	1740306711	0	0	DIXSON, LEAH D	5/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6109 W RAMSEY ST	None	BANNING	CA	92220	3051	00	06000	33.92940576	-116.9437965	Riverside County
308204	Non-Physician Medical Practitioner	None	1417676487	0	0	DAROSA, DEBI S NP	12/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
308242	Non-Physician Medical Practitioner	None	1467810309	0	0	DAVID, MARICAR M NP	8/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1106 MABURY ST	None	SANTA ANA	CA	92701	4465	00	06000	33.75508827	-117.8438735	Orange County
308274	Non-Physician Medical Practitioner	None	1114477395	0	0	DIAZ, HILDA NP	4/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
308304	Non-Physician Medical Practitioner	None	1932697067	0	0	DAGHER, REGINA K NP	5/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	211 27TH AVENUE	APT 202	SAN FRANCISCO	CA	94121	1175	00	06000	37.78543612	-122.4873015	San Francisco County
308315	Non-Physician Medical Practitioner	None	1649530791	0	0	DAO, JACKELYNN NP	6/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1379 XAVIER AVE	None	HAYWARD	CA	94545	2039	00	06000	37.64772479	-122.112212	Alameda County
308348	Non-Physician Medical Practitioner	None	1568555894	0	0	DONKIN, JENNIFER N	6/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3168 OLIVE AVE	None	ALTADENA	CA	91001	4259	00	06000	34.19934848	-118.152691	Los Angeles County
308366	Non-Physician Medical Practitioner	None	1518201888	0	0	DUNNE, JESSICA R NP	6/10/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12291 WASHINGTON BLVD	STE 500	WHITTIER	CA	90606	2500	00	06000	33.96734104	-118.0508773	Los Angeles County
308372	Non-Physician Medical Practitioner	None	1023656048	0	0	DUGAN, GEE YEOUN NP	4/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	655 EUCLID AVE	STE 205	NATIONAL CITY	CA	91950	2967	00	06000	32.68353398	-117.082625	San Diego County
308392	Non-Physician Medical Practitioner	None	1962887869	0	0	DADOUR, NATASHA A	9/14/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5068 FRANKLIN AVE	APT 203	LOS ANGELES	CA	90027	6705	00	06000	34.10535328	-118.3001049	Los Angeles County
308400	Non-Physician Medical Practitioner	None	1851048664	0	0	DULL, SARAH R NP	3/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
308401	Non-Physician Medical Practitioner	None	1306847728	0	0	DE LA CRUZ-NOVELO, NAOMIE	9/27/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8856 ARLINGTON AVE	None	RIVERSIDE	CA	92503	1365	00	06000	33.94647572	-117.4674078	Riverside County
308408	Non-Physician Medical Practitioner	None	1376727834	0	0	DUH, YI-JUNG KAREN	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9416 DAINES DR	None	TEMPLE CITY	CA	91780	3112	00	06000	34.09840252	-118.0645077	Los Angeles County
308412	Non-Physician Medical Practitioner	None	1568001477	0	0	DALTON, CASSIDY J PA	4/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34 MARK WEST SPRINGS RD	2ND FLOOR	SANTA ROSA	CA	95403	1436	00	06000	38.49639719	-122.7501553	Sonoma County
308455	Non-Physician Medical Practitioner	None	1871619171	0	0	DEZELAN, MARIANNE K PA-C	6/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
308460	Non-Physician Medical Practitioner	None	1295946697	0	0	DARVISH, PARVANEH	4/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18697 CLUBHOUSE DRIVE	None	YORBA LINDA	CA	92886	7057	00	06000	33.90414287	-117.8105198	Orange County
308486	Non-Physician Medical Practitioner	None	1548748858	0	0	DERIDDER, MARILYN M NP	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1059 S REXFORD LANE	None	ANAHEIM	CA	92808	2333	00	06000	33.85276783	-117.7375669	Orange County
308530	Non-Physician Medical Practitioner	None	1437837598	0	0	DALEN, MARK PA-C	4/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1798 N GAREY AVE	None	POMONA	CA	91767	2918	00	06000	34.076894	-117.7522688	Los Angeles County
308535	Non-Physician Medical Practitioner	None	1477579704	0	0	DIGIOVANNI, MICHAEL L	6/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3909 CALLE ABRIL	None	SAN CLEMENTE	CA	92673	2602	00	06000	33.46436948	-117.657168	Orange County
308579	Non-Physician Medical Practitioner	None	1023409620	0	0	DE JARNETT, CYNTHIA K NP	12/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3280 WASHINGTON ST	None	PLACERVILLE	CA	95667	5838	00	06000	38.72270909	-120.7893981	El Dorado County
308584	Non-Physician Medical Practitioner	None	1710320536	0	0	DANGLA CRUZ, CORNELIA R NP	2/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 E GLEASON STREET	None	MONTEREY PARK	CA	91755	7204	00	06000	34.03542541	-118.1263956	Los Angeles County
308594	Non-Physician Medical Practitioner	None	1063654184	0	0	DENBY, CANDICE AUSTIN	4/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45 CASTRO ST	SUITE 410	SAN FRANCISCO	CA	94114	1010	00	06000	37.76829732	-122.4357056	San Francisco County
308615	Non-Physician Medical Practitioner	None	1174514822	0	0	DIAS, PAMELA JEAN	9/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7373 WEST LN	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
308634	Non-Physician Medical Practitioner	None	1679139943	0	0	DOCKHAM, SHANNON NP	11/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
308669	Non-Physician Medical Practitioner	None	1740724962	0	0	DO, JOCELYN	11/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15331 BALBOA STREET	None	WESTMINSTER	CA	92683	6356	00	06000	33.73986784	-117.9802332	Orange County
308675	Non-Physician Medical Practitioner	None	1851944862	0	0	DANN, SHARON N PA	10/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
308676	Non-Physician Medical Practitioner	None	1457021677	0	0	DUKOVIC, JASMINA PA-C	12/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 440	SAN DIEGO	CA	92037	1212	00	06000	32.882913	-117.226341	San Diego County
308680	Non-Physician Medical Practitioner	None	1003495573	0	0	DE SILVA, JOHANNA PA-C	12/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	289 W. HUNTINGTON DR.	STE 103	ARCADIA	CA	91007	3492	00	06000	34.13549119	-118.0419175	Los Angeles County
308715	Non-Physician Medical Practitioner	None	1245286038	0	0	DEPOLO, JON F	7/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	06000	36.163269	-115.1654465	Clark County
308721	Non-Physician Medical Practitioner	None	1538613906	0	0	DOWD, LAUREN E NP	11/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	00	06000	34.14848408	-118.8208595	Los Angeles County
308735	Non-Physician Medical Practitioner	None	1265219075	0	0	DE CASTRO, CAITLIN C PA-C	4/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	00	06000	38.442978	-122.6999565	Sonoma County
308742	Non-Physician Medical Practitioner	None	1073004792	0	0	DARK, PATRICIA R NP	11/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	06000	29.70724683	-95.4026169	Harris County
308787	Non-Physician Medical Practitioner	None	1245359140	0	0	DANESHVAR, ABRAHAM D	3/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26590 LIDO DRIVE	None	MURRIETA	CA	92563	8001	00	06000	33.55066657	-117.1543741	Riverside County
308809	Non-Physician Medical Practitioner	None	1831433770	0	0	DRURY, JESSICA NP	6/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
308820	Non-Physician Medical Practitioner	None	1720564974	0	0	DUBKO, JUDY S PA	8/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	629 TRACTION AVE	402	LOS ANGELES	CA	90013	1693	00	06000	34.04614269	-118.2369335	Los Angeles County
308857	Non-Physician Medical Practitioner	None	1871244947	0	0	DE MARIA, MICHELLE M NP	11/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
308862	Non-Physician Medical Practitioner	None	1225216674	0	0	DERAKHSHANDEH, SHARAREH	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	146 FALCATO DR	None	MILPITAS	CA	95035	6102	00	06000	37.43622189	-121.8713049	Santa Clara County
308888	Non-Physician Medical Practitioner	None	1730493859	0	0	DE LA MORA, MELISSA M NP	4/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
308890	Non-Physician Medical Practitioner	None	1093816241	0	0	DORAN, BARBARA	10/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	00	06000	38.12173729	-122.6048491	Marin County
308891	Non-Physician Medical Practitioner	None	1275107310	0	0	DEJAM, HALEH NP	5/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWAY	SUITE 205, 230, 250, 275	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
308909	Non-Physician Medical Practitioner	None	1689833675	0	0	DEMASI, MARIE A	2/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40232 JUNCTION DRIVE	None	OAKHURST	CA	93644	0000	00	06000	37.3331485	-119.6588089	Madera County
308925	Non-Physician Medical Practitioner	None	1962153064	0	0	DYE, MONIQUE NP	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	00	06000	35.29325417	-120.667547	San Luis Obispo County
308951	Non-Physician Medical Practitioner	None	1962715060	0	0	DEMONTE, PHYLLIS NP	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
308956	Non-Physician Medical Practitioner	None	1780823526	0	0	DONNELLY, KELLY A F NP	5/11/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 SAN ANTONIO WAY	None	SACRAMENTO	CA	95819	2716	00	06000	38.572596	-121.452075	Sacramento County
309032	Non-Physician Medical Practitioner	None	1164416939	0	0	DE HAAS, DARRYL D	3/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24039 FRIAR ST	None	WOODLAND HILLS	CA	91367	1239	00	06000	34.18475386	-118.6493179	Los Angeles County
309056	Non-Physician Medical Practitioner	None	1891318630	0	0	DUTREMAINE, ANGELA R PA-C	9/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2900 WHIPPLE AVE	STE 205	REDWOOD CITY	CA	94062	2851	00	06000	37.4783072	-122.2551089	San Mateo County
309066	Non-Physician Medical Practitioner	None	1366843484	0	0	DENGLER, JENNIFER M	9/5/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	99587 SRS RD	None	BROOKINGS	OR	97415	9321	00	06000	42.08826055	-124.2008003	Curry County
309079	Non-Physician Medical Practitioner	None	1033288998	0	0	DAVIS, GREGORY DAVID	12/6/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4500 POPLAR	None	LAKE ISABELLA	CA	93240	9722	00	06000	35.63467842	-118.402574	Kern County
309124	Non-Physician Medical Practitioner	None	1306164827	0	0	DELL, ALISSA B NP	1/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2539 SUNRISE DRIVE	None	BISHOP	CA	93514	3142	00	06000	37.35006034	-118.421692	Inyo County
309129	Non-Physician Medical Practitioner	None	1598965741	0	0	DOUGLAS, GERALDINA P NP	3/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18785 BROOKHURST STREET	STE 101	FOUNTAIN VALLEY	CA	92708	7300	00	06000	33.68987636	-117.9542321	Orange County
309131	Non-Physician Medical Practitioner	None	1154334449	0	0	DAHANAYAKE, ANUSHA H	12/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1859 KELTON AVE	None	LOS ANGELES	CA	90025	4501	00	06000	34.04767364	-118.4377786	Los Angeles County
309157	Non-Physician Medical Practitioner	None	1336211333	0	0	DEAN, MAQSUD AHMED	1/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1429 COLUSA HWY	None	YUBA CITY	CA	95993	9456	00	06000	39.14182148	-121.6388115	Sutter County
309176	Non-Physician Medical Practitioner	None	1093027542	0	0	DODSWORTH, THOMAS EDWARD	10/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41 AZALEA AVE	None	FAIRFAX	CA	94930	1527	00	06000	37.98842463	-122.5938269	Marin County
309183	Non-Physician Medical Practitioner	None	1982896221	0	0	DUNCAN, KIMBERLY C NP	3/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	817 WEST ARRELLAGA ST	None	SANTA BARBARA	CA	93101	0000	00	06000	34.41810937	-119.7190916	Santa Barbara County
309245	Non-Physician Medical Practitioner	None	1952445827	0	0	DAW, GINA MARIE	12/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2922 ALDERGROVE CT	None	FULLERTON	CA	92835	4327	00	06000	33.90820069	-117.8697889	Orange County
309258	Non-Physician Medical Practitioner	None	1770904492	0	0	DALLAS, BYRON K NP	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	61 NORTH LEMOORE AVE	None	LEMOORE	CA	93245	2949	00	06000	36.2994506	-119.7808624	Kings County
309267	Non-Physician Medical Practitioner	None	1932664893	0	0	DILLON, JESSICA M NP	3/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1333 GOUGH ST	APT 2C	SAN FRANCISCO	CA	94109	6522	00	06000	37.78587132	-122.4247994	San Francisco County
309275	Non-Physician Medical Practitioner	None	1871026187	0	0	DATINGALING, ANN NP	2/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	239 1/2 S CHURCH LN	None	LOS ANGELES	CA	90049	3000	00	06000	34.06965735	-118.4644366	Los Angeles County
309308	Non-Physician Medical Practitioner	None	1538718267	0	0	DIRTING, MARY G PA	1/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	00	06000	38.74390969	-121.2319271	Placer County
309313	Non-Physician Medical Practitioner	None	1922827989	0	0	DAVIS, CAROLYN C NP	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1080 N. INDIAN CANYON DR	SUITE 201	PALM SPRINGS	CA	92262	4869	00	06000	33.837354	-116.545572	Riverside County
309377	Non-Physician Medical Practitioner	None	1699466102	0	0	DAO, KATHY PA-C	5/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4955 VAN NUYS BLVD	STE 615	SHERMAN OAKS	CA	91403	1839	00	06000	34.160805	-118.4487295	Los Angeles County
309379	Non-Physician Medical Practitioner	None	1477194553	0	0	DARGHALI, TONYA PA	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	00	06000	34.44856821	-118.5794922	Los Angeles County
309399	Non-Physician Medical Practitioner	None	1770838104	0	0	DAM-PEARSON, VI P	8/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8289 RED ELK DRIVE	None	ELK GROVE	CA	95758	7943	00	06000	38.414277	-121.4012205	Sacramento County
309409	Non-Physician Medical Practitioner	None	1437781416	0	0	DEFELICE, ANDREA NP	5/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5525 ETIWANDA AVE	STE 320	TARZANA	CA	91356	3647	00	06000	34.17046451	-118.5308463	Los Angeles County
309446	Non-Physician Medical Practitioner	None	1205168960	0	0	DREW, ROBERT M PA-C	2/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	00	06000	33.82476552	-117.994914	Orange County
309447	Non-Physician Medical Practitioner	None	1972839751	0	0	DAY, MATTHEW PA-C	11/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
309458	Non-Physician Medical Practitioner	None	1275717902	0	0	DOYLE, MELISSA P NP	6/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	131 EAST HOLLY STREET	APT 315	PASADENA	CA	91103	3936	00	06000	34.14765933	-118.1473048	Los Angeles County
309473	Non-Physician Medical Practitioner	None	1386122869	0	0	DOUGLAS, AMANDA N	12/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1908 N BEALE RD	STE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
309483	Non-Physician Medical Practitioner	None	1043931728	0	0	DYER, KELSEY S PA	10/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
309511	Non-Physician Medical Practitioner	None	1750485140	0	0	DAVIS, DEBRA L NP	6/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	06000	39.748041	-104.834673	Adams County
309517	Non-Physician Medical Practitioner	None	1851092415	0	0	DE LEOZ, CHARLOTTEE NP	4/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
309520	Non-Physician Medical Practitioner	None	1932134111	0	0	DELEMOS, CHRISTI D NP	12/1/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 EXP PARKWAY	None	SACRAMENTO	CA	95815	0000	00	06000	38.5759966	-121.4580756	Sacramento County
309524	Non-Physician Medical Practitioner	None	1881232387	0	0	DRISCOLL, KELLEY NP	7/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2010 EAST CARSON STREET	None	LONG BEACH	CA	90807	3040	00	06000	33.83242453	-118.16721	Los Angeles County
309534	Non-Physician Medical Practitioner	None	1003260894	0	0	DWYER, ERIN H	6/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 REDONDO CT	29	SAN DIEGO	CA	92109	7129	00	06000	32.78390984	-117.2536582	San Diego County
309536	Non-Physician Medical Practitioner	None	1982892956	0	0	DE BODA, EDILITA	5/19/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1535 LOMITA BLVD	None	HARBOR CITY	CA	90710	2024	00	06000	33.79784346	-118.303893	Los Angeles County
309545	Non-Physician Medical Practitioner	None	1619618691	0	0	DHALIWAL, GULSHANJIT K PA-C	6/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
309565	Non-Physician Medical Practitioner	None	1356018782	0	0	DUNLAP, DAVID M PA	3/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	00	06000	32.77510996	-117.1277427	San Diego County
309577	Non-Physician Medical Practitioner	None	1114040151	0	0	DUN, CHERYL A NP	5/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1580 CREEKSIDE DR	200	FOLSOM	CA	95630	3886	00	06000	38.668914	-121.148028	Sacramento County
309629	Non-Physician Medical Practitioner	None	1386357358	0	0	DI MARZIO, BIANCA D NP	5/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W LA VETA AVE	STE 200	ORANGE	CA	92868	4301	00	06000	33.78028244	-117.8635552	Orange County
309660	Non-Physician Medical Practitioner	None	1649638842	0	0	DOROSAN, ELMER B NP	12/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8222 MARY ELLEN AVE	None	NORTH HOLLYWOOD	CA	91605	1053	00	06000	34.22054842	-118.4201627	Los Angeles County
309718	Non-Physician Medical Practitioner	None	1235889916	0	0	DAO, SOPHIE T NP	6/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
309775	Non-Physician Medical Practitioner	None	1962065805	0	0	DIEP, AMANDA A PA-C	6/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 ABBOTT ST	SUITE 101	SALINAS	CA	93901	4391	00	06000	36.66192801	-121.6413283	Monterey County
309782	Non-Physician Medical Practitioner	None	1588152326	0	0	DORAN, NICOLE PA	7/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	00	06000	33.93112671	-118.2035532	Los Angeles County
309816	Non-Physician Medical Practitioner	None	1750403044	0	0	DUA, ANISHA	4/12/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9346 CORBIN AVE	None	NORTHRIDGE	CA	91324	2405	00	06000	34.240563	-118.562272	Los Angeles County
309843	Non-Physician Medical Practitioner	None	1629706106	0	0	DEATON-LAMPLEY, TRICIA N NP	2/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
309862	Non-Physician Medical Practitioner	None	1104337054	0	0	DAM, BRIAN T PA-C	10/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2720 N HARBOR BOULEVARD	SUITE 210	FULLERTON	CA	92835	2626	00	06000	33.90126238	-117.9292154	Orange County
309868	Non-Physician Medical Practitioner	None	1043883093	0	0	DIVINE, LILA T	1/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	00	06000	34.07556833	-117.7507835	Los Angeles County
309878	Non-Physician Medical Practitioner	None	1619749041	0	0	DEMESSIE, RAHEL NP	11/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
309887	Non-Physician Medical Practitioner	None	1962098590	0	0	DELACERDA, DANNY PA	12/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24329 CRENSHAW BLVD	STE. A	TORRANCE	CA	90505	5334	00	06000	33.804612	-118.327997	Los Angeles County
309909	Non-Physician Medical Practitioner	None	1184776270	0	0	DONG, BELINDA J	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR BLVD	KAISER PERMANENTE DEPART	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
309932	Non-Physician Medical Practitioner	None	1063173201	0	0	DANKE, ELIZABETH PA	4/4/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	00	06000	40.57278686	-122.3958519	Shasta County
310020	Non-Physician Medical Practitioner	None	1427595925	0	0	DOSHI, HEMA S NP	2/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1519 BONNIE DOONE TERRAN	None	CORONA DEL MAR	CA	92625	1718	00	06000	33.61031095	-117.8832746	Orange County
310074	Non-Physician Medical Practitioner	None	1932776382	0	0	DHILLON, AMANDEEP NP	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS	STE 406	FRESNO	CA	93701	2167	00	06000	36.74500687	-119.7846885	Fresno County
310100	Non-Physician Medical Practitioner	None	1417004987	0	0	DELEON, RICK PA	11/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	00	06000	34.27680789	-119.2480851	Ventura County
310156	Non-Physician Medical Practitioner	None	1598280307	0	0	DOW, ELIZABETH H PA-C	8/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1823 9TH ST	APT 4	SANTA MONICA	CA	90404	4520	00	06000	34.01405009	-118.4831738	Los Angeles County
310234	Non-Physician Medical Practitioner	None	1528537750	0	0	DUPUIS, ALEXANDER	11/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
310238	Non-Physician Medical Practitioner	None	1881112381	0	0	DEMATTEO, NATALIA F NP	9/13/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1112 RHODE ISLAND ST	None	SAN FRANCISCO	CA	94107	3217	00	06000	37.75572232	-122.4017682	San Francisco County
310247	Non-Physician Medical Practitioner	None	1083288914	0	0	DWIGHT, PAUL J PA	2/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
310249	Non-Physician Medical Practitioner	None	1154472256	0	0	DI RAFFAELE, SALVATORE V	7/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1533 BERKLEY ST	APT 2	SANTA MONICA	CA	90406	1968	00	06000	34.03509487	-118.4672277	Los Angeles County
310278	Non-Physician Medical Practitioner	None	1932918034	0	0	DOAN, ASHLEY PA-C	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4343 MARKET ST	None	RIVERSIDE	CA	92501	3500	00	06000	33.97734857	-117.3791849	Riverside County
310320	Non-Physician Medical Practitioner	None	1992253579	0	0	DAMBROSO, CHRISTOPHER	2/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	690 LONG BRIDGE ST	APT 414	SAN FRANCISCO	CA	94158	2402	00	06000	37.77261309	-122.3925455	San Francisco County
310376	Non-Physician Medical Practitioner	None	1366205007	0	0	DAVIDSON, KRISTINA NP	3/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 HERNDON	210 AND 230	FRESNO	CA	93720	3303	00	06000	36.83756048	-119.7609525	Fresno County
310397	Non-Physician Medical Practitioner	None	1366111601	0	0	DAHL, MITCHELL PA-C	4/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
310437	Non-Physician Medical Practitioner	None	1285306456	0	0	DUNCAN, DENISE D NP	8/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44725 10TH ST WEST	170	LANCASTER	CA	93534	4936	00	06000	34.695693	-118.1480965	Los Angeles County
310470	Non-Physician Medical Practitioner	None	1104680453	0	0	DONALDSON, JENNIFER	4/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310495	Non-Physician Medical Practitioner	None	1477734283	0	0	DRURY, RYAN A	2/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4580 CALIFORNIA AVE	None	BAKERSFIELD	CA	93309	1104	00	06000	35.36605632	-119.0531502	Kern County
310508	Non-Physician Medical Practitioner	None	1780758896	0	0	DENG, WEI NP	4/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	689 WOODHAMS RD	None	SANTA CLARA	CA	95051	5659	00	06000	37.33464713	-121.9800271	Santa Clara County
310533	Non-Physician Medical Practitioner	None	1114086840	0	0	DEL ROSARIO, BERNARD	6/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17424 EAST PARK	None	CHINO HILLS	CA	91709	6372	00	06000	33.93713948	-117.6712044	San Bernardino County
310536	Non-Physician Medical Practitioner	None	1922305671	0	0	DOMINGUEZ, TINA L PA-C	8/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2303 CAMINO RAMON	SUITE 150	SAN RAMON	CA	94583	1392	00	06000	37.77552084	-121.9658366	Contra Costa County
310548	Non-Physician Medical Practitioner	None	1356500037	0	0	DAVID, DIANNE M	12/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1713 HEARTNUT WAY	None	HUGHSON	CA	95326	9283	00	06000	37.60589884	-120.8742832	Stanislaus County
310556	Non-Physician Medical Practitioner	None	1154436269	0	0	DURBIN, HARILD E JR	12/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	34320 CHURCH RD	None	LOUISVILLE	NE	68037	3127	00	06000	40.96305	-96.2203275	Cass County
310558	Non-Physician Medical Practitioner	None	1194574129	0	0	DANIELS, ANNA K NP	10/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 MEDICAL CENTER DR.	None	WEST HILLS	CA	91307	1902	00	06000	34.20289797	-118.6294006	Los Angeles County
310588	Non-Physician Medical Practitioner	None	1477626521	0	0	DIAMREYAN, FLORA E NP	5/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10630 TOWN CENTER DR	STE 110	RANCHO CUCAMONGA	CA	91730	6806	00	06000	34.11112305	-117.5729644	San Bernardino County
310606	Non-Physician Medical Practitioner	None	1326420217	0	0	DIAZ, CARMELO O PA-C	3/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4900 COMMERCE DR	None	BAKERSFIELD	CA	93309	0418	00	06000	35.3696013	-119.0558857	Kern County
310620	Non-Physician Medical Practitioner	None	1558587360	0	0	DAUGHERTY, CAROL LYNN	7/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3004 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1637	00	06000	34.03050638	-118.2071956	Los Angeles County
310636	Non-Physician Medical Practitioner	None	1013938968	0	0	DEKKERS-O'HARE, INGRID	10/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	460 N ELM ST	None	ESCONDIDO	CA	92025	3002	00	06000	33.12850258	-117.0729169	San Diego County
310686	Non-Physician Medical Practitioner	None	1497931125	0	0	DOAN, NGAN N	10/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	00	06000	33.94354395	-117.394926	Riverside County
310753	Non-Physician Medical Practitioner	None	1295275048	0	0	DIMAYA, CHARLOTTE N NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	00	06000	37.35228637	-121.9754073	Santa Clara County
310759	Non-Physician Medical Practitioner	None	1932837648	0	0	DUNN, LAUREN NP	11/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4631 TELLER AVE	100	NEWPORT BEACH	CA	92660	8105	00	06000	33.66641504	-117.857408	Orange County
310769	Non-Physician Medical Practitioner	None	1962970939	0	0	DAHM, JENNA T NP	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
310777	Non-Physician Medical Practitioner	None	1003230798	0	0	DINH, DUY H	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2108 RUDOLPH DR	None	SIMI VALLEY	CA	93065	5050	00	06000	34.25198959	-118.7564035	Ventura County
310812	Non-Physician Medical Practitioner	None	1871060046	0	0	DINH, KIM T	11/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13042 PARKVIEW DR	None	BALDWIN PARK	CA	91706	3673	00	06000	34.07656071	-117.991648	Los Angeles County
310865	Non-Physician Medical Practitioner	None	1801264874	0	0	DUBRALL, LILLIAN M NP	4/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
310904	Non-Physician Medical Practitioner	None	1013544691	0	0	DY JUANCO, SEAN M PA-C	1/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	00	06000	37.79071145	-122.4308506	San Francisco County
310910	Non-Physician Medical Practitioner	None	1891147286	0	0	DUQUE-GOMEZ, YENIFER PA-C	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1374 E ALLUVIAL AVE	None	FRESNO	CA	93720	2608	00	06000	36.84475352	-119.758806	Fresno County
310918	Non-Physician Medical Practitioner	None	1508341751	0	0	DELIRIO, JOHN PAUL PA	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2205 W. BEVERLY BLVD.	None	MONTEBELLO	CA	90640	2301	00	06000	34.02075854	-118.1232344	Los Angeles County
310923	Non-Physician Medical Practitioner	None	1639647084	0	0	DELANEY, DANNIELLE	9/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
310930	Non-Physician Medical Practitioner	None	1104027093	0	0	DAVIDSON, GARY M	5/12/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29303 KILAMANJARO CT	None	CANYON COUNTRY	CA	91387	6241	00	06000	34.43761675	-118.3841558	Los Angeles County
310944	Non-Physician Medical Practitioner	None	1669617015	0	0	DIMODICA, LISA LIANE	2/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47 SANTA ROSA ST	None	SAN LUIS OBISPO	CA	93405	5816	00	06000	35.29269342	-120.6675725	San Luis Obispo County
310966	Non-Physician Medical Practitioner	None	1821535055	0	0	DJEUSSOUNG, ARIANE NP	2/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
310996	Non-Physician Medical Practitioner	None	1811426349	0	0	DIAZ, ANARELLA C NP	10/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29594 MASTERS DR	None	MURRIETA	CA	92563	5858	00	06000	33.56558195	-117.1436161	Riverside County
311002	Non-Physician Medical Practitioner	None	1932451663	0	0	DODD, LAUREN L PA-C	4/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3131 DOVER DR	None	SANTA CRUZ	CA	95065	1709	00	06000	36.98952203	-121.9720731	Santa Cruz County
311010	Non-Physician Medical Practitioner	None	1992752695	0	0	DE SAN JOSE, MAY A NP	4/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	33844 AUGUSTA CIRCLE	None	YUCAIPA	CA	92399	6953	00	06000	34.04058857	-117.0656568	San Bernardino County
311014	Non-Physician Medical Practitioner	None	1740621515	0	0	DAVIS, AMANDA E NP	7/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3120 MIDDLE BASS ISLAND	None	WEST SACRAMENTO	CA	95691	5847	00	06000	38.540745	-121.565437	Yolo County
311069	Non-Physician Medical Practitioner	None	1003180498	0	0	DE JESUS, GERARDO M NP	10/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1714 N BUSH ST	None	SANTA ANA	CA	92706	2812	00	06000	33.76058786	-117.866405	Orange County
311075	Non-Physician Medical Practitioner	None	1427431204	0	0	DEJESUS, MELISSA S NP	1/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11964 KIOWA AVE	STE 14	LOS ANGELES	CA	90049	5983	00	06000	34.04719661	-118.4673055	Los Angeles County
311095	Non-Physician Medical Practitioner	None	1871693622	0	0	D, CAMPBELL A	5/15/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 DOUGLAS BLVD	SUITE 405	ROSEVILLE	CA	95661	3844	00	06000	38.74393533	-121.2327358	Placer County
311162	Non-Physician Medical Practitioner	None	1942699574	0	0	DEL ROSARIO, RUSSELL S NP	2/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	61 IRON HORSE LANE	None	WALNUT CREEK	CA	94597	6913	00	06000	37.93098047	-122.0547645	Contra Costa County
311199	Non-Physician Medical Practitioner	None	1255741906	0	0	DOTY, KRISTY N NP	8/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5414 MENSEN DR	None	BAKERSFIELD	CA	93313	9410	00	06000	35.29014168	-119.0630728	Kern County
311210	Non-Physician Medical Practitioner	None	1093989402	0	0	DALIZU, ALICE A NP	10/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	767 N FAIR OAKS AVE	STE 6	SUNNYVALE	CA	94085	3136	00	06000	37.39254521	-122.0138678	Santa Clara County
311253	Non-Physician Medical Practitioner	None	1417263658	0	0	DEGUZMAN, RHIAN E	4/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	828 W GRETCHEN WAY	None	ANAHEIM	CA	92805	1719	00	06000	33.84351156	-117.9279373	Orange County
311255	Non-Physician Medical Practitioner	None	1659541738	0	0	DUARTE, GLORIA LYNN NP	6/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27976 WINTERGROVE WAY	None	MURRIETA	CA	92563	5067	00	06000	33.58058275	-117.1723298	Riverside County
311268	Non-Physician Medical Practitioner	None	1962790014	0	0	DIGNITY HEALTH MEDICAL FOUNDATION	12/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2250 HAYES ST STE 302	None	SAN FRANCISCO	CA	94117	1078	00	06000	37.77302042	-122.45342	San Francisco County
311271	Non-Physician Medical Practitioner	None	1245327766	0	0	DEAN, TRUDIE B PA	12/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	599 INLAND CENTER DR	STE 105	SAN BERNARDINO	CA	92408	1819	00	06000	34.0904396	-117.2957326	San Bernardino County
311315	Non-Physician Medical Practitioner	None	1649290719	0	0	DEGRAAF OLSON, WILMAJOAN	10/27/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	942 STATION HOUSE LN	None	ROCKLIN	CA	95765	5464	00	06000	38.82760352	-121.2836739	Placer County
311325	Non-Physician Medical Practitioner	None	1861795320	0	0	DIGNITY HEALTH MEDICAL FOUNDATION	12/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 J ST	SUITE 270	SACRAMENTO	CA	95819	3624	00	06000	38.570652	-121.4535465	Sacramento County
311350	Non-Physician Medical Practitioner	None	1245872282	0	0	DULAY, MICHAEL R PA-C	7/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
311370	Non-Physician Medical Practitioner	None	1053413898	0	0	DIAZ, ANGELA A	4/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1235 S EVANWOOD AVE	None	WEST COVINA	CA	91790	4051	00	06000	34.05839861	-117.9444385	Los Angeles County
311418	Non-Physician Medical Practitioner	None	1316277700	0	0	DIAZ, MONICA	3/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9403 LOCH AVON DR	None	PICO RIVERA	CA	90660	2816	00	06000	33.99473299	-118.080103	Los Angeles County
311428	Non-Physician Medical Practitioner	None	1033743380	0	0	DE MESA, JOANNA VIOLET E NP	10/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	00	06000	37.69819004	-122.0873124	Alameda County
311474	Non-Physician Medical Practitioner	None	1205970357	0	0	DONNELLY, ROSE MARIE NP	11/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34131 DATE PALM DR	F-2	CATHEDRAL CITY	CA	92234	6884	00	06000	33.80013	-116.4581675	Riverside County
311586	Non-Physician Medical Practitioner	None	1932117512	0	0	DOWDEN, STEPHANIE J NP	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2034 MORGAN WAY	None	YUBA CITY	CA	95993	9284	00	06000	39.10644239	-121.6543471	Sutter County
311660	Non-Physician Medical Practitioner	None	1457964504	0	0	DAVID, MARICHU G NP	3/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	00	06000	38.578716	-121.416228	Sacramento County
311666	Non-Physician Medical Practitioner	None	1568909489	0	0	DU, ALICE PA-C	5/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	00	06000	37.7634502	-122.4579779	San Francisco County
311676	Non-Physician Medical Practitioner	None	1184269516	0	0	DICKENS, LILLY K NP	6/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4663 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3943	00	06000	37.04973619	-122.0157773	Santa Cruz County
311695	Non-Physician Medical Practitioner	None	1134759582	0	0	DHILLON, AMRIT PAL PA	1/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
311701	Non-Physician Medical Practitioner	None	1063865996	0	0	DAY, ROBERT NP	1/14/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311736	Non-Physician Medical Practitioner	None	1578692141	0	0	DELGADO, JANET M NP	11/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3636 W LA VIDA AVE	None	VISALIA	CA	93277	7115	00	06000	36.304209	-119.3312835	Tulare County
311780	Non-Physician Medical Practitioner	None	1750708434	0	0	DA CUNHA, MARIA LUISA B NP	12/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
311834	Non-Physician Medical Practitioner	None	1487964730	0	0	DODGE, HEATHER L	6/11/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2208 GATEWAY OAKS	APT 391	SACRAMENTO	CA	95833	3204	00	06000	38.606868	-121.5140085	Sacramento County
311838	Non-Physician Medical Practitioner	None	1629211834	0	0	DAMATO, LAUREN M NP	2/23/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24634 ST DENNIS COURT	None	VALENCIA	CA	91355	3500	00	06000	34.4032345	-118.5653827	Los Angeles County
311870	Non-Physician Medical Practitioner	None	1932239696	0	0	DONA, DAVID	7/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
311874	Non-Physician Medical Practitioner	None	1659409431	0	0	DOETSCH, JANE M NP	5/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3310 LYNWOOD DR	None	HIGHLAND	CA	92346	1872	00	06000	34.14567634	-117.2150134	San Bernardino County
311875	Non-Physician Medical Practitioner	None	1669139044	0	0	DANESHZADEH, JORDAN P PA-C	7/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S VINCENT AVE	SUITE 205	WEST COVINA	CA	91790	6712	00	06000	34.0662144	-117.9274205	Los Angeles County
311916	Non-Physician Medical Practitioner	None	1578600193	0	0	DANIELS, DONALD T	8/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21951 HORIZON CRT	None	TEHACHAPI	CA	93561	9294	00	06000	35.13801251	-118.6233951	Kern County
311940	Non-Physician Medical Practitioner	None	1609315746	0	0	DAWES, TRACY ANN C NP	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12021 JACARANDA AVE	SUITE 101	HESPERIA	CA	92345	4978	00	06000	34.46963618	-117.263267	San Bernardino County
311950	Non-Physician Medical Practitioner	None	1376820266	0	0	DYER, TRACI L PA	1/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24910 LAS BRISAS ROAD	STE 106	MURRIETA	CA	92562	4010	00	06000	33.57522424	-117.1828078	Riverside County
311965	Non-Physician Medical Practitioner	None	1093189466	0	0	DEANE, DANA CNM	12/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 W AVE J	None	LANCASTER	CA	93534	2814	00	06000	34.68938848	-118.158354	Los Angeles County
311991	Non-Physician Medical Practitioner	None	1023601192	0	0	DUARTE, ANA G NP	10/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2061 ROSS AVE	B	EL CENTRO	CA	92243	3687	00	06000	32.7814167	-115.579257	Imperial County
312052	Non-Physician Medical Practitioner	None	1295325819	0	0	DEHAHN, KRISTIN C NP	2/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	00	06000	34.42739162	-119.7253175	Santa Barbara County
312057	Non-Physician Medical Practitioner	None	1639776503	0	0	DINH, NATHAN T PA	10/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
312067	Non-Physician Medical Practitioner	None	1922648393	0	0	DINGLER, BRITTANY J PA	4/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
312072	Non-Physician Medical Practitioner	None	1154940286	0	0	DONNELS, KASSANDRA M CNM	10/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MILVIA ST	None	BERKELEY	CA	94704	2636	00	06000	37.86338897	-122.2698455	Alameda County
312083	Non-Physician Medical Practitioner	None	1346559572	0	0	DHARIA, MEETAL R NP	3/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
312090	Non-Physician Medical Practitioner	None	1427360999	0	0	DEVIVO, RYAN F DO	10/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 N MICHIGAN AVE	UNIT 6	PASADENA	CA	91106	5103	00	06000	34.14743452	-118.12545	Los Angeles County
312102	Non-Physician Medical Practitioner	None	1790278190	0	0	DANIEL, JESSICA J PA	7/18/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4000 CIVIC CENTER	SUITE 209	SAN RAFAEL	CA	94903	4171	00	06000	38.0041783	-122.538861	Marin County
312122	Non-Physician Medical Practitioner	None	1386095768	0	0	D'ANGELO, RACHELLE NP	7/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3581 PALMER DR	STE 602	CAMERON PARK	CA	95682	8238	00	06000	38.66109103	-120.9649544	El Dorado County
312169	Non-Physician Medical Practitioner	None	1740392026	0	0	DESBY, JENNIFER ELAINE	10/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 AVOCADO AVE	SUITE 703	NEWPORT BEACH	CA	92660	7720	00	06000	33.61235015	-117.8704573	Orange County
312180	Non-Physician Medical Practitioner	None	1487075008	0	0	DAMMIN, CAITLIN N PA-C	6/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	57463 29 PALMS HWY	201	YUCCA VALLEY	CA	92284	2925	00	06000	34.12447835	-116.4106891	San Bernardino County
312198	Non-Physician Medical Practitioner	None	1740794437	0	0	DINH, DUNG X PA	6/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1569 LEXANN AVE	STE 120	SAN JOSE	CA	95121	1793	00	06000	37.30790568	-121.8141983	Santa Clara County
312213	Non-Physician Medical Practitioner	None	1891290383	0	0	DILLEN, REBECCA A NP	5/29/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 E AVE	None	CORONADO	CA	92118	1732	00	06000	32.69376263	-117.1781523	San Diego County
312270	Non-Physician Medical Practitioner	None	1881435865	0	0	DO, TRA PA	4/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	STE 6100,6300,7200,7300	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
312286	Non-Physician Medical Practitioner	None	1730532961	0	0	DHILLON, JASDEEP K NP	7/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2006 SHAW AVE	None	CLOVIS	CA	93611	4192	00	06000	36.80848025	-119.6771991	Fresno County
312332	Non-Physician Medical Practitioner	None	1841630019	0	0	DANG, KHOA A NP	9/8/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16426 EMPIRE LAKES CT	None	FONTANA	CA	92336	5836	00	06000	34.13913292	-117.4465778	San Bernardino County
312361	Non-Physician Medical Practitioner	None	1659887024	0	0	DE JOYA-REEVE, ANNE MARIE J NP	5/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
312362	Non-Physician Medical Practitioner	None	1265915524	0	0	DASTRUP, ERICA M CNP	3/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
312408	Non-Physician Medical Practitioner	None	1831453109	0	0	DICKSON-HUMPHRIES, TANIA PA-C	11/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	00	06000	38.91229842	-119.9978133	El Dorado County
312413	Non-Physician Medical Practitioner	None	1710759238	0	0	DECATUR, ALYSSA L NP	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
312414	Non-Physician Medical Practitioner	None	1154809044	0	0	DAVIDSON, GREGORY S PA-C	3/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	00	06000	33.481134	-117.1060515	Riverside County
312445	Non-Physician Medical Practitioner	None	1891949681	0	0	DABAS, RAJENDER SINGH	2/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1308 NORTH MARIPOSA AVE	None	LOS ANGELES	CA	90027	5810	00	06000	34.09558317	-118.2994096	Los Angeles County
312480	Non-Physician Medical Practitioner	None	1881095107	0	0	DIFRONZO, MICHAEL	11/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1264 GREYCREST PLACE	None	DIAMOND BAR	CA	91765	4355	00	06000	33.99791822	-117.7936774	Los Angeles County
312502	Non-Physician Medical Practitioner	None	1639764368	0	0	DIAZ, JANET NP	12/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
312505	Non-Physician Medical Practitioner	None	1154432789	0	0	DUBOIS, BETH E	3/1/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 ALHAMBRA BLVD	#230	SACRAMENTO	CA	95816	5238	00	06000	38.570076	-121.4657145	Sacramento County
312569	Non-Physician Medical Practitioner	None	1346550381	0	0	DSPAIN, JOHN M	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1418 YARROW LN	None	BEAUMONT	CA	92223	8633	00	06000	33.94374067	-116.9589192	Riverside County
312608	Non-Physician Medical Practitioner	None	1982128260	0	0	DO, AMY	2/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8356 FERN AVE	None	ROSEMEAD	CA	91770	3231	00	06000	34.05900348	-118.0864485	Los Angeles County
312618	Non-Physician Medical Practitioner	None	1164941456	0	0	DOLMETSCH, JEANETTE E PA-C	9/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 MAIN ST	None	SOLEDAD	CA	93960	2533	00	06000	36.43281182	-121.3243597	Monterey County
312620	Non-Physician Medical Practitioner	None	1609415728	0	0	DESIMONE, ANGELIKA Z NP	3/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	00	06000	36.98793933	-121.9782322	Santa Cruz County
312638	Non-Physician Medical Practitioner	None	1184285439	0	0	DORN, ESTELA C NP	4/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	47110 WASHINGTON ST	STE 203	LA QUINTA	CA	92253	2186	00	06000	33.70698194	-116.2929821	Riverside County
312642	Non-Physician Medical Practitioner	None	1003450214	0	0	DE JESUS, CHRISTIANA PA	1/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	770 MAGNOLIA AVE	STE 2A	CORONA	CA	92879	3122	00	06000	33.85936872	-117.5534605	Riverside County
312648	Non-Physician Medical Practitioner	None	1467926295	0	0	DEMASCO, MICHAEL PA	10/24/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	00	06000	33.1857	-117.290538	San Diego County
312672	Non-Physician Medical Practitioner	None	1649932864	0	0	DENG, WINNIE PA-C	10/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	00	06000	33.5580705	-117.1835458	Riverside County
312677	Non-Physician Medical Practitioner	None	1114624954	0	0	DURAN, FERNANDO B PA	12/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	00	06000	37.9611947	-121.3009489	San Joaquin County
312749	Non-Physician Medical Practitioner	None	1700934627	0	0	DEBELLA, PATRICIA NP	4/4/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	727 TURTLE CREST DR	None	IRVINE	CA	92603	1015	00	06000	33.631105	-117.8376247	Orange County
312756	Non-Physician Medical Practitioner	None	1043928500	0	0	DANG, JULIE PA	5/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 W LUGONIA AVE	STE 120	REDLANDS	CA	92374	9704	00	06000	34.07027851	-117.218421	San Bernardino County
312789	Non-Physician Medical Practitioner	None	1134852650	0	0	DANIELS, ADAM R NP	7/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8670 WILSHIRE BLVD	STE 200	BEVERLY HILLS	CA	90211	2930	00	06000	34.06629779	-118.3807407	Los Angeles County
312860	Non-Physician Medical Practitioner	None	1396401592	0	0	DIFFINE, BRITTNEY M PA-C	4/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.5406159	-117.2658221	San Bernardino County
312869	Non-Physician Medical Practitioner	None	1023507324	0	0	DELEON, ROBERT PA-C	12/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1125 E 17TH ST	SUITE N-452	SANTA ANA	CA	92701	2201	00	06000	33.76004145	-117.854838	Orange County
312876	Non-Physician Medical Practitioner	None	1124185293	0	0	DE LA RIVA, GABRIELA	3/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 W MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
312913	Non-Physician Medical Practitioner	None	1093166472	0	0	DIAB, LAUREN A PA-C	12/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13031 WHEELER PL	None	SANTA ANA	CA	92705	1846	00	06000	33.77269795	-117.8240164	Orange County
312915	Non-Physician Medical Practitioner	None	1609369115	0	0	DE FREITAS, PEDRO H RN MA	8/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 CHURN CREEK RD	STE E5	REDDING	CA	96003	4004	00	06000	40.58819665	-122.3510235	Shasta County
312940	Non-Physician Medical Practitioner	None	1386284115	0	0	DEBENEDICTIS, DANIELLE I PA	5/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312970	Non-Physician Medical Practitioner	None	1801839188	0	0	DUFFY, MICHAEL J	11/3/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19351 SEAHORSE LANE	STE 205	HUNTINGTON BEACH	CA	92648	2444	00	06000	33.682185	-117.9955555	Orange County
312974	Non-Physician Medical Practitioner	None	1578039590	0	0	DO, STEVE PA	5/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	00	06000	33.89815111	-117.8419708	Orange County
312976	Non-Physician Medical Practitioner	None	1659946499	0	0	DANISH, HANA PA	9/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
312991	Non-Physician Medical Practitioner	None	1477601318	0	0	DALE, NATALIE D	5/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7435 ROUNDHILL PLACE	None	RANCHO CUCAMONGA	CA	91739	8828	00	06000	34.11853042	-117.5346509	San Bernardino County
312996	Non-Physician Medical Practitioner	None	1629216452	0	0	DADE, TARA C	3/2/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1565 E 38TH STREET	None	OAKLAND	CA	94602	1244	00	06000	37.80324368	-122.2237295	Alameda County
313081	Non-Physician Medical Practitioner	None	1417549205	0	0	DOMINGO, LEONARDO R CNP	1/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
313084	Non-Physician Medical Practitioner	None	1972016640	0	0	DU, TIFFANY PA	8/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313085	Non-Physician Medical Practitioner	None	1295193035	0	0	DHANDI, PARAMJIT K NP	3/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5916 MCDONIE AVE	None	WOODLAND HILLS	CA	91367	5532	00	06000	34.17820989	-118.5723273	Los Angeles County
313095	Non-Physician Medical Practitioner	None	1952123648	0	0	DUONG, LILI PA-C	3/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 UNIVERSITY AVE	STE 220	SACRAMENTO	CA	95825	6525	00	06000	38.568402	-121.418019	Sacramento County
313100	Non-Physician Medical Practitioner	None	1033441795	0	0	DEBRULER, MARSHALL R	3/10/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2415 STARLIGHT GLEN	None	ESCONDIDO	CA	92026	3855	00	06000	33.16673543	-117.1365576	San Diego County
313123	Non-Physician Medical Practitioner	None	1013449206	0	0	DELA ROSA, MARIA ELENA NP	8/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
313150	Non-Physician Medical Practitioner	None	1629636816	0	0	DALSIMER, CECILIA K PA	11/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
313180	Non-Physician Medical Practitioner	None	1861179384	0	0	DIMAPILIS, CATHERINE B NP	8/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36955 COOK ST	STE 102	PALM DESERT	CA	92211	6084	00	06000	33.77893112	-116.355881	Riverside County
313255	Non-Physician Medical Practitioner	None	1619370871	0	0	DOERKSEN, KATHRYN A	6/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9852 E GRAYSON RD	None	DENAIR	CA	95316	9537	00	06000	37.56562155	-120.812958	Stanislaus County
313280	Non-Physician Medical Practitioner	None	1568131811	0	0	DHILLON, GURPREET S NP	12/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	782 EAST HARDING WAY	None	STOCKTON	CA	95204	6101	00	06000	37.96910043	-121.284224	San Joaquin County
313299	Non-Physician Medical Practitioner	None	1588040299	0	0	DY, DAVE J C NP	10/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1905 CALI LIN CT	None	TURLOCK	CA	95380	9593	00	06000	37.51034884	-120.8758775	Stanislaus County
313310	Non-Physician Medical Practitioner	None	1346219631	0	0	DAVIS, DEANNA S PA	9/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
313315	Non-Physician Medical Practitioner	None	1326768110	0	0	DRAGOS, ERIK PA	4/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	347 ANDRIEUX ST	None	SONOMA	CA	95476	6811	00	06000	38.28843573	-122.4651035	Sonoma County
313317	Non-Physician Medical Practitioner	None	1013123157	0	0	DRESS, KAREN M PA-C	12/23/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29826 HAUN ROAD	SUITE 203	MENIFEE	CA	92586	6547	00	06000	33.68719818	-117.1748757	Riverside County
313364	Non-Physician Medical Practitioner	None	1518593300	0	0	DUCA, ALESSIA V NP	11/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1181 MT. VERNON AVE	None	COLTON	CA	92324	4208	00	06000	34.04939078	-117.3092664	San Bernardino County
313402	Non-Physician Medical Practitioner	None	1528342607	0	0	DAUZ, JOHNNY D NP	5/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7974 HAVEN AVE	STE 250	RANCHO CUCAMONGA	CA	91730	3063	00	06000	34.10875445	-117.5759905	San Bernardino County
313487	Non-Physician Medical Practitioner	None	1639591142	0	0	DURAN, ELAIZA J	2/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 MAGNOLIA STREET	None	ATWATER	CA	95301	4774	00	06000	37.36328918	-120.6017202	Merced County
313525	Non-Physician Medical Practitioner	None	1912190638	0	0	DEHARO, JILL J	10/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	128 E FLORAL DR	None	MONTEREY PARK	CA	91755	6628	00	06000	34.03828705	-118.1283469	Los Angeles County
313541	Non-Physician Medical Practitioner	None	1417396904	0	0	DYKES, ANGELA E NP	7/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10 WHISPERING WOODS DR	None	N AUGUSTA	SC	29880	8906	00	06000	33.60730925	-81.99523844	Edgefield County
313560	Non-Physician Medical Practitioner	None	1386408631	0	0	DIECK, ANNA PA	7/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
313604	Non-Physician Medical Practitioner	None	1912417122	0	0	DI TOTA, MADDALENA PA	6/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1223 16TH STREET 3RD FLO	SUITE 3400 POD D	SANTA MONICA	CA	90404	1279	00	06000	34.02773198	-118.4862675	Los Angeles County
313631	Non-Physician Medical Practitioner	None	1487118105	0	0	DEKLEUVER, RODNEY G PA-C	7/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	00	06000	38.442978	-122.6999565	Sonoma County
313674	Non-Physician Medical Practitioner	None	1689392045	0	0	D'ANTONIO, ASHLEY	9/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18419 HIGHWAY 18	STE 6	APPLE VALLEY	CA	92307	2333	00	06000	34.53946944	-117.2621779	San Bernardino County
313720	Non-Physician Medical Practitioner	None	1013007285	0	0	DAINS, BRUCE G	4/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7009 MARGARET CT	None	BAKERSFIELD	CA	93309	4339	00	06000	35.32999649	-119.0810835	Kern County
313730	Non-Physician Medical Practitioner	None	1922518711	0	0	DO, NICOLE NP	3/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10142 GLADBECK AVE	None	LOS ANGELES	CA	91324	1315	00	06000	34.25453209	-118.5392466	Los Angeles County
313733	Non-Physician Medical Practitioner	None	1093882367	0	0	DEGUTES, SUSAN MARY	6/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
313758	Non-Physician Medical Practitioner	None	1437520616	0	0	DHILLON, AJITPAL S	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3129 BEVERLY AVE	None	CLOVIS	CA	93619	5100	00	06000	36.81266431	-119.651896	Fresno County
313760	Non-Physician Medical Practitioner	None	1578986840	0	0	DOKKO, DOROTHY NP	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5058 ANGELES CREST HWY	None	LA CANADA	CA	91011	2368	00	06000	34.214553	-118.2000315	Los Angeles County
313811	Non-Physician Medical Practitioner	None	1427298124	0	0	DUGGAN, AMY	5/6/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 ALHAMBRA BLVD	SUITE 420	SACRAMENTO	CA	95816	5238	00	06000	38.570076	-121.4657145	Sacramento County
313880	Non-Physician Medical Practitioner	None	1144670373	0	0	DAO TRAN, ANH K	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 LAKEWOOD AVE	APT 190	MODESTO	CA	95355	3589	00	06000	37.665792	-120.9394025	Stanislaus County
313906	Non-Physician Medical Practitioner	None	1477149011	0	0	DELGADO, VERONICA NP	5/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4500 BROCKTON AVE	STE 319	RIVERSIDE	CA	92501	4090	00	06000	33.97785263	-117.3836152	Riverside County
313920	Non-Physician Medical Practitioner	None	1831605690	0	0	DETURA, ERIN M	9/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	827 6TH ST	None	SANTA MONICA	CA	90403	1476	00	06000	34.02547275	-118.5020203	Los Angeles County
313933	Non-Physician Medical Practitioner	None	1558500397	0	0	DIAZ, MOLLY M	5/25/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11149 CANYON MEADOWS DR	None	WHITTIER	CA	90601	1777	00	06000	34.01287977	-118.0390223	Los Angeles County
313956	Non-Physician Medical Practitioner	None	1629802970	0	0	DABRANCA, MADALYNN A NP	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
313968	Non-Physician Medical Practitioner	None	1134405020	0	0	DUBELMAN, JESSICA	6/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7660 BEVERLY BLVD	APT 150	LOS ANGELES	CA	90036	2739	00	06000	34.07611353	-118.3568424	Los Angeles County
313976	Non-Physician Medical Practitioner	None	1720124423	0	0	DAY, LEWIS C	11/7/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
313979	Non-Physician Medical Practitioner	None	1558539700	0	0	DOBLER, ERIN ALYSON	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT 148	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
314026	Non-Physician Medical Practitioner	None	1558963660	0	0	DEOL, SHIVJOT PA-C	6/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
314072	Non-Physician Medical Practitioner	None	1447563275	0	0	DAVIS, JESSICA L NP	5/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1050 ISLAND AVE	UNIT 325	SAN DIEGO	CA	92101	7261	00	06000	32.71047051	-117.155115	San Diego County
314087	Non-Physician Medical Practitioner	None	1164880449	0	0	DEBRABANT, CODY L	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1335 BROWNING ST	UNIT A	REDDING	CA	96003	5308	00	06000	40.58838288	-122.3428667	Shasta County
314094	Non-Physician Medical Practitioner	None	1497180277	0	0	DE GUZMAN, LISA GLORINDA	9/19/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3611 MARTIN LUTHER KING	102	LYNWOOD	CA	90262	2685	00	06000	33.93182471	-118.203307	Los Angeles County
314111	Non-Physician Medical Practitioner	None	1275039703	0	0	DEWHIRST, BRIAN J PA-C	11/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
314136	Non-Physician Medical Practitioner	None	1801024377	0	0	DIAZ, VIRGINIA	7/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 W HIGHWAY 246	102	BUELLTON	CA	93427	9458	00	06000	34.61509504	-120.1976393	Santa Barbara County
314139	Non-Physician Medical Practitioner	None	1104475441	0	0	DAM, NHI T PA	5/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
314151	Non-Physician Medical Practitioner	None	1679201404	0	0	DEWEES, JACOB R NP	9/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
314167	Non-Physician Medical Practitioner	None	1669926283	0	0	DILLINGER, LORA E NP	11/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2773 HARRIS STREET	SUITE B	EUREKA	CA	95503	4866	00	06000	40.78052829	-124.1363953	Humboldt County
314178	Non-Physician Medical Practitioner	None	1265843692	0	0	D'ANGELO, JESSICA M NP	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
314183	Non-Physician Medical Practitioner	None	1275083990	0	0	DOBRE, MARIANA G	12/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2127 THURIN ST	None	COSTA MESA	CA	92627	1936	00	06000	33.65186719	-117.9140608	Orange County
314184	Non-Physician Medical Practitioner	None	1386212504	0	0	DARIA, MARY KRISTINE	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	06000	36.28701289	-115.2877045	Clark County
314206	Non-Physician Medical Practitioner	None	1124498092	0	0	DE LEON, FRANCES M NP	10/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
314209	Non-Physician Medical Practitioner	None	1578572376	0	0	DEWEESE, NINA	4/9/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2801 K ST	SUITE 502	SACRAMENTO	CA	95816	5120	00	06000	38.572947	-121.46904	Sacramento County
314233	Non-Physician Medical Practitioner	None	1285641902	0	0	DAVALOS, MICHAEL A	12/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25898 BETH DRIVE	None	MENIFEE	CA	92584	5011	00	06000	33.66055278	-117.207308	Riverside County
314258	Non-Physician Medical Practitioner	None	1558970467	0	0	DINH, JULIA H PA-C	1/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
314288	Non-Physician Medical Practitioner	None	1710722756	0	0	DOLSEN, JACQUELINE NP	9/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 WEST CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	00	06000	34.133598	-118.1534895	Los Angeles County
314302	Non-Physician Medical Practitioner	None	1871628461	0	0	DAWES, ELIZABETH S NP	9/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	934 CASTILLEJA COURT	None	LOS ALTOS	CA	94024	5046	00	06000	37.36545792	-122.0885011	Santa Clara County
314352	Non-Physician Medical Practitioner	None	1306478896	0	0	DELARA, KAROLJOHN NP	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5602 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2308	00	06000	32.7481088	-117.0743149	San Diego County
314361	Non-Physician Medical Practitioner	None	1104219203	0	0	DINH, VU N NP	12/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
314384	Non-Physician Medical Practitioner	None	1669554705	0	0	DE LA ROSA, SAUL	7/1/1998	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10308 CHANEY AVE	None	DOWNEY	CA	90241	2824	00	06000	33.94339962	-118.113629	Los Angeles County
314421	Non-Physician Medical Practitioner	None	1265884324	0	0	DERVISHI, ARTA	3/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
314433	Non-Physician Medical Practitioner	None	1982226973	0	0	DINH, KIM H PA-C	12/8/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
314449	Non-Physician Medical Practitioner	None	1134589955	0	0	DWYER, PAUL D PA-C	11/15/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2107 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57493327	-122.4048185	Shasta County
314467	Non-Physician Medical Practitioner	None	1861432833	0	0	DODDRIDGE, SUSAN H	8/23/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11294 SKY COUNTRY DR	None	MIRA LOMA	CA	91752	2141	00	06000	33.97610315	-117.5295161	Riverside County
314495	Non-Physician Medical Practitioner	None	1447516026	0	0	DEL ROSARIO, MICHELLE F PA	8/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
314552	Non-Physician Medical Practitioner	None	1861152357	0	0	DAYRIT, ROBBIN I NP	8/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
314602	Non-Physician Medical Practitioner	None	1811300478	0	0	DARABI, MEHRVASH NP	2/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3252 OVERLAND AVE	APT 2	LOS ANGELES	CA	90034	3543	00	06000	34.02826151	-118.4143212	Los Angeles County
314603	Non-Physician Medical Practitioner	None	1245467992	0	0	DAVID, MARY LOU L NP	11/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22 BLUFF COVE DR	None	ALISO VIEJO	CA	92656	8077	00	06000	33.572529	-117.7320875	Orange County
314631	Non-Physician Medical Practitioner	None	1174868244	0	0	DOMINGUEZ, KAREN JOANNE	11/13/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 CREEKSIDE DR	SUITE 1400	FOLSOM	CA	95630	3444	00	06000	38.669994	-121.147488	Sacramento County
314639	Non-Physician Medical Practitioner	None	1386186153	0	0	DEWYN, GAIL R NP	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4201 TORRANCE BLVD	600	TORRANCE	CA	90503	4523	00	06000	33.8375955	-118.358748	Los Angeles County
314659	Non-Physician Medical Practitioner	None	1821622820	0	0	DODDS, POLLY C NP	8/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	00	06000	37.9611947	-121.3009489	San Joaquin County
314707	Non-Physician Medical Practitioner	None	1265898126	0	0	DAKKAK, NOOR PA-C	7/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1433 N HOLLENBECK AVENUE	SUITE 101	COVINA	CA	91722	1558	00	06000	34.105518	-117.8989985	Los Angeles County
314726	Non-Physician Medical Practitioner	None	1457934390	0	0	DAI, KANG UEI NP	8/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
314746	Non-Physician Medical Practitioner	None	1639595770	0	0	DELGADO, LAUREN A NP	12/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14355 HUSTON ST	STE 236	SHERMAN OAKS	CA	91423	1825	00	06000	34.15943348	-118.4460345	Los Angeles County
314774	Non-Physician Medical Practitioner	None	1841764073	0	0	DOLMAN, REBECCA NP	5/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
314862	Non-Physician Medical Practitioner	None	1558098566	0	0	DE JESUS, JOSEPH NP	8/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	146 N HILL ST	None	ARVIN	CA	93203	1014	00	06000	35.210097	-118.8309345	Kern County
314885	Non-Physician Medical Practitioner	None	1013220458	0	0	DAVE, DEVAL K	8/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4780 VIA DE LA MULA	None	YORBA LINDA	CA	92886	3052	00	06000	33.8924637	-117.7776703	Orange County
314901	Non-Physician Medical Practitioner	None	1144689175	0	0	DACANAY-HERMAN, ROWENA NP	2/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
314917	Non-Physician Medical Practitioner	None	1639137250	0	0	DIETRICH, ERIC J	4/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	119 CORTE TIERRA BELLA	None	SAN CLEMENTE	CA	92673	6418	00	06000	33.46082865	-117.5758465	Orange County
314935	Non-Physician Medical Practitioner	None	1275627358	0	0	DE PRISCO, JOANNE	12/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2898 EAGLE HEIGHTS CT	None	THOUSAND OAKS	CA	91360	1729	00	06000	34.21967593	-118.8835863	Ventura County
314972	Non-Physician Medical Practitioner	None	1104547231	0	0	DE SOLA-SMITH, KAREN M	11/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 E ROMIE LN	SUITE F	SALINAS	CA	93901	4031	00	06000	36.65998191	-121.6461895	Monterey County
315004	Non-Physician Medical Practitioner	None	1528554284	0	0	DICHIGRIKIAN, MARIANNA NP	2/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
315033	Non-Physician Medical Practitioner	None	1619629607	0	0	DROUINEAUD, KIMBERLY D NP	5/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
315042	Non-Physician Medical Practitioner	None	1154979870	0	0	DUONG, KELVIN RN PNP	2/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	00	06000	34.137603	-118.101464	Los Angeles County
315049	Non-Physician Medical Practitioner	None	1922010032	0	0	DEL HOMME, JOSHUA J	3/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
315055	Non-Physician Medical Practitioner	None	1760667687	0	0	DANG, HOANG T	5/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1351 THISTLEWOOD CT	None	SAN JOSE	CA	95121	2427	00	06000	37.30408944	-121.820264	Santa Clara County
315066	Non-Physician Medical Practitioner	None	1619685823	0	0	DINH, KEVIN A PA-C	5/8/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
315069	Non-Physician Medical Practitioner	None	1194580845	0	0	DE LA ROCHA, PATRICIA NP	10/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	623 W DUARTE RD STE 8	None	ARCADIA	CA	91007	7349	00	06000	34.12648672	-118.0522757	Los Angeles County
315083	Non-Physician Medical Practitioner	None	1144704941	0	0	DILMORE, JAMES M NP	4/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
315105	Non-Physician Medical Practitioner	None	1033885371	0	0	DHILLON, NAVJOT K NP	7/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	00	06000	38.420028	-121.40712	Sacramento County
315181	Non-Physician Medical Practitioner	None	1154920205	0	0	DOEPPE, KATELYNN S NP	2/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
315185	Non-Physician Medical Practitioner	None	1366796484	0	0	DYER, ANNA T NP	2/17/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
315198	Non-Physician Medical Practitioner	None	1487156428	0	0	DELFIN, MERDIE K	5/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2600 OVERLAND AVE	#315	LOS ANGELES	CA	90064	3253	00	06000	34.03859489	-118.4222939	Los Angeles County
315232	Non-Physician Medical Practitioner	None	1467016675	0	0	DOURRA, FARAH Z PA	3/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315242	Non-Physician Medical Practitioner	None	1275648842	0	0	DAVIS, MICHELLE R	8/1/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2599 WALNUT AVE	STE 125	SIGNAL HILL	CA	90755	3666	00	06000	33.80337	-118.1720165	Los Angeles County
315262	Non-Physician Medical Practitioner	None	1689337776	0	0	DIORES, JOY NP	2/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 W STEWART DR	None	ORANGE	CA	92868	3849	00	06000	33.78236558	-117.8648414	Orange County
315288	Non-Physician Medical Practitioner	None	1255055422	0	0	DINH, HELEN L PA-C	6/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11629 LOWER AZUSA RD	STE H	EL MONTE	CA	91732	1389	00	06000	34.09050278	-118.0134798	Los Angeles County
315294	Non-Physician Medical Practitioner	None	1386607638	0	0	DUONG, MARY C N NP	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2517 FLORENTINA AVE	None	ALHAMBRA	CA	91803	4216	00	06000	34.06345291	-118.1525674	Los Angeles County
315338	Non-Physician Medical Practitioner	None	1659803310	0	0	DAO, LY-AN T NP	12/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
315383	Non-Physician Medical Practitioner	None	1881701787	0	0	DAVIDSON, JANE	12/31/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
315385	Non-Physician Medical Practitioner	None	1396143731	0	0	DUBON, JUANITA H NP	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15246 RIVER ROCK DRIVE	None	FONTANA	CA	92336	5344	00	06000	34.1495788	-117.472028	San Bernardino County
315440	Non-Physician Medical Practitioner	None	1619202165	0	0	DOHERTY, MONICA M	7/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 ELECTRIC AVE	None	SEAL BEACH	CA	90740	6407	00	06000	33.74190205	-118.1026118	Orange County
315454	Non-Physician Medical Practitioner	None	1235338484	0	0	DEBENEDETTO, MATTHEW PATRICK	12/12/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6121 N THESTA ST	SUITE 114	FRESNO	CA	93710	8603	00	06000	36.82493955	-119.783139	Fresno County
315486	Non-Physician Medical Practitioner	None	1508594318	0	0	DORE, ANGELIQUE NP	2/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
315495	Non-Physician Medical Practitioner	None	1790962108	0	0	DURHAM, EILEEN	2/4/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	SUMC - PEDS PHYSICIAN BI	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315502	Non-Physician Medical Practitioner	None	1720573017	0	0	DE BELEN, SARAH K NP	12/21/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
315551	Non-Physician Medical Practitioner	None	1306394317	0	0	DIMACALI, LAWRENCE MICHAEL PA-C	2/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
315604	Non-Physician Medical Practitioner	None	1932201811	0	0	DEAS, JULIE A NP	5/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
315618	Non-Physician Medical Practitioner	None	1801441589	0	0	DELA CRUZ, KARL J PA	4/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	245 TERRACINA BLVD	SUITE 102	REDLANDS	CA	92373	4865	00	06000	34.03858912	-117.2066515	San Bernardino County
315630	Non-Physician Medical Practitioner	None	1376157776	0	0	DAVIS, NATALIE	2/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS	STE 201	FRESNO	CA	93701	2167	00	06000	36.74500687	-119.7846885	Fresno County
315631	Non-Physician Medical Practitioner	None	1215213384	0	0	DREAGER, EMILY A NP	7/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 SUNBRIGHT DR	None	OCEANSIDE	CA	92056	2500	00	06000	33.23470683	-117.2624963	San Diego County
315641	Non-Physician Medical Practitioner	None	1699960534	0	0	DAVID, ANJALI ROBIN	11/25/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1717 W STETSON AVE	None	HEMET	CA	92545	0000	00	06000	33.72931349	-116.990415	Riverside County
315664	Non-Physician Medical Practitioner	None	1285814632	0	0	DECARO, ROBERT	4/21/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9 PONTE CHARA	None	LAKE ELSINORE	CA	92532	0231	00	06000	33.6868414	-117.2925436	Riverside County
315775	Non-Physician Medical Practitioner	None	1336631407	0	0	DE JESUS-MARANAN, SHEILA NP	11/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	00	06000	34.09817553	-118.293237	Los Angeles County
315788	Non-Physician Medical Practitioner	None	1952975799	0	0	DUFFY, MEGAN	12/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 S GAFFEY ST	None	SAN PEDRO	CA	90731	4628	00	06000	33.729498	-118.292351	Los Angeles County
315862	Non-Physician Medical Practitioner	None	1518022961	0	0	DEFORE, MARTHA ANNE	4/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	00	06000	33.838623	-116.542737	Riverside County
315895	Non-Physician Medical Practitioner	None	1144335597	0	0	DAVIES, KURT J	9/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6709 WUNDERLIN AVE	None	SAN DIEGO	CA	92114	2943	00	06000	32.71451091	-117.0537287	San Diego County
315896	Non-Physician Medical Practitioner	None	1265691349	0	0	DASWANI, BHARTI N	10/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	558 MONTORI COURT	None	PLEASANTON	CA	94566	2130	00	06000	37.64287103	-121.8015055	Alameda County
315900	Non-Physician Medical Practitioner	None	1962136341	0	0	DARWICHE, JENNA PA-C	6/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1210 NEVADA ST	None	REDLANDS	CA	92374	2895	00	06000	34.069554	-117.2174405	San Bernardino County
315935	Non-Physician Medical Practitioner	None	1174294938	0	0	DAVIDSON, DOUGLAS P PA-C	4/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
315943	Non-Physician Medical Practitioner	None	1053516187	0	0	DOAN, DUY T	3/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15955 CLARENDON STREET	None	FOUNTAIN VALLEY	CA	92708	1026	00	06000	33.73136269	-117.9592624	Orange County
315947	Non-Physician Medical Practitioner	None	1649253824	0	0	DUQUETTE, JULIE	1/20/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1630 E HERNDON AVE	None	FRESNO	CA	93720	3305	00	06000	36.83756049	-119.7583515	Fresno County
315956	Non-Physician Medical Practitioner	None	1982429254	0	0	DONAHUE, RACHAEL D PA	12/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
315975	Non-Physician Medical Practitioner	None	1669944534	0	0	DIEP, TIFFANY W NP	3/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4619 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1478	00	06000	34.08871316	-118.073569	Los Angeles County
315979	Non-Physician Medical Practitioner	None	1386463677	0	0	DOMINGO, KATRINA	10/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
316005	Non-Physician Medical Practitioner	None	1780198051	0	0	DHALIWAL, RUBALPREET K NP	11/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS AVE	SUITE 401	FRESNO	CA	93701	2168	00	06000	36.74500687	-119.7846885	Fresno County
316012	Non-Physician Medical Practitioner	None	1841360849	0	0	DUKE, CYNTHIA	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2071 HERNDON AVE	None	CLOVIS	CA	93611	6101	00	06000	36.8375685	-119.6781105	Fresno County
316059	Ordering, Referring, Prescribing	N/A	1003023698	0	0	DIAZ, BERTHA A LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45501	N/A	N/A	N/A	N/A	N/A	10 DOUGLAS DR.	140	MARTINEZ	CA	94553	4078	00	06000	37.99546221	-122.1222474	Contra Costa County
316065	Ordering, Referring, Prescribing	N/A	1003031444	0	0	DAVIS, LORI L OT	3/17/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	2353	N/A	N/A	N/A	N/A	N/A	1330 E COOLEY DRIVE	None	COLTON	CA	92324	3905	00	06000	34.0544745	-117.305721	San Bernardino County
316086	Ordering, Referring, Prescribing	N/A	1003101676	0	0	DAO, TRAM N	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56042	N/A	N/A	N/A	N/A	N/A	1810 FREEDOM BLVD	None	FREEDOM	CA	95019	3000	00	06000	36.93442012	-121.7726139	Santa Cruz County
316091	Ordering, Referring, Prescribing	N/A	1003107616	0	0	DERIJE, JOSEPH A NP	8/25/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95005123	N/A	N/A	N/A	N/A	N/A	1402 BAILEY AVE	None	NEEDLES	CA	92363	3104	00	06000	34.832781	-114.618349	San Bernardino County
316093	Ordering, Referring, Prescribing	N/A	1003105040	0	0	DIAZ, CLAUDIA S LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25420	N/A	N/A	N/A	N/A	N/A	759 SOUTH VAN NESS AVE	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
316101	Ordering, Referring, Prescribing	N/A	1003112418	0	0	DOMBROWER, INGRID MD	8/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A111870	N/A	N/A	N/A	N/A	N/A	524 W VISTA WAY	None	VISTA	CA	92083	5704	00	06000	33.19635191	-117.2517899	San Diego County
316109	Ordering, Referring, Prescribing	N/A	1003129834	0	0	DOAN, DORA OD	12/14/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	13927	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
316126	Ordering, Referring, Prescribing	N/A	1003158833	0	0	DOBRIN, CASSANDRA LCSW	9/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17175	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
316272	Ordering, Referring, Prescribing	N/A	1003350943	0	0	DEVINE, JAIMIE	9/24/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005572	N/A	N/A	N/A	N/A	N/A	5442 SYCUAN RD	None	EL CAJON	CA	92019	1816	00	06000	32.78885903	-116.8320996	San Diego County
316308	Ordering, Referring, Prescribing	N/A	1003397852	0	0	DANG, LINH N PHARMD	9/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76877	N/A	N/A	N/A	N/A	N/A	7929 NORTH LOWER SACRAME	None	STOCKTON	CA	95210	0000	00	06000	0	0	None
316332	Ordering, Referring, Prescribing	N/A	1003433699	0	0	DONGMO FOTSING, LAURENA N MD MPH	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183988	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
316376	Ordering, Referring, Prescribing	N/A	1003497421	0	0	DINH, VAN DO	5/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21545	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	None	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
316377	Ordering, Referring, Prescribing	N/A	1003513516	0	0	DARA, MEGHNA M DDS	9/17/2024	Taxonomy not applicable	NA	n/a	000	Unknown	DDS110795	N/A	N/A	N/A	N/A	N/A	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	00	06000	33.95462085	-118.1838426	Los Angeles County
316393	Ordering, Referring, Prescribing	N/A	1003538802	0	0	DUARTE, LYANNE D NP	7/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021735	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
316415	Ordering, Referring, Prescribing	N/A	1003649732	0	0	DAMIAN LANGARICA, JASMINE RDH	9/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	34318	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
316481	Ordering, Referring, Prescribing	N/A	1003988031	0	0	DU, NIKKI PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57398	N/A	N/A	N/A	N/A	N/A	9449 IMPERIAL HWY	D332	DOWNEY	CA	90242	2814	00	06000	33.91714048	-118.1262915	Los Angeles County
316503	Ordering, Referring, Prescribing	N/A	1013037787	0	0	DSA, SHEFALI LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47239	N/A	N/A	N/A	N/A	N/A	100 W WALNUT ST	SUITE 375	PASADENA	CA	91124	0001	00	06000	34.14963648	-118.1522925	Los Angeles County
316516	Ordering, Referring, Prescribing	N/A	1013070234	0	0	DUONG, HAN V MD	7/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88951	N/A	N/A	N/A	N/A	N/A	8632 VALLEY BLVD	D	ROSEMEAD	CA	91770	1740	00	06000	34.08053148	-118.0812235	Los Angeles County
316541	Ordering, Referring, Prescribing	N/A	1013101872	0	0	DAVIS, VANESSA C LCSW	6/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66247	N/A	N/A	N/A	N/A	N/A	1000 S MAIN ST	None	SALINAS	CA	93901	2352	00	06000	36.66226091	-121.6578913	Monterey County
316616	Ordering, Referring, Prescribing	N/A	1013229384	0	0	DAVIDOFF, JULIA MD	12/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134646	N/A	N/A	N/A	N/A	N/A	679 S NEW HAMPSHIRE AVE	None	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
316641	Ordering, Referring, Prescribing	N/A	1013292093	0	0	DZVONICK, BRYAN M	11/7/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	487	N/A	N/A	N/A	N/A	N/A	6860 BROCKTON AVE	SUITE 6	RIVERSIDE	CA	92506	3816	00	06000	33.948999	-117.396722	Riverside County
316645	Ordering, Referring, Prescribing	N/A	1013296326	0	0	DEDMORE, SUZANNE W NP	5/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20520	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIR	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
316650	Ordering, Referring, Prescribing	N/A	1013299981	0	0	DOCTOLERO, RYAN T PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61950	N/A	N/A	N/A	N/A	N/A	10787 CAMINO RUIZ	None	SAN DIEGO	CA	92126	2304	00	06000	32.91489	-117.1438035	San Diego County
316685	Ordering, Referring, Prescribing	N/A	1013350073	0	0	DETERS, BENJAMIN J DO	7/15/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13848	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
316714	Ordering, Referring, Prescribing	N/A	1013391044	0	0	DE LA CRUZ, JENNIFER K LMFT	5/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105151	N/A	N/A	N/A	N/A	N/A	380 COALINGA PLAZA	None	COALINGA	CA	93210	1703	00	06000	36.14092846	-120.3621704	Fresno County
316725	Ordering, Referring, Prescribing	N/A	1013413210	0	0	DAO, TRAM DO	9/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19108	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
316772	Ordering, Referring, Prescribing	N/A	1013484773	0	0	DAVIS, SHOSHANA	11/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127212	N/A	N/A	N/A	N/A	N/A	103 MORRIS STREET	J	SEBASTOPOL	CA	95472	3863	00	06000	38.40347434	-122.819185	Sonoma County
316790	Ordering, Referring, Prescribing	N/A	1013521566	0	0	DESMARAIS-ZALOB, SIMON P LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93313	N/A	N/A	N/A	N/A	N/A	5100 BUSINESS CENTER DR	None	FAIRFIELD	CA	94534	1658	00	06000	38.21678793	-122.1438857	Solano County
316803	Ordering, Referring, Prescribing	N/A	1013546472	0	0	DURNEY, SARAH MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	5329	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
316834	Ordering, Referring, Prescribing	N/A	1013671403	0	0	DELGADILLO, BROOKE RN	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95061799	N/A	N/A	N/A	N/A	N/A	8324 WESTMAN AVE	None	WHITTIER	CA	90606	3314	00	06000	33.96655278	-118.0667766	Los Angeles County
316843	Ordering, Referring, Prescribing	N/A	1013743244	0	0	DIAZ, JORDAN M PA-C	11/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65406	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
316877	Ordering, Referring, Prescribing	N/A	1023038130	0	0	DE LA FUENTE, LISA R	5/1/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0515547	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
316881	Ordering, Referring, Prescribing	N/A	1023079753	0	0	DU, LINDA T PHARMD	6/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49447	N/A	N/A	N/A	N/A	N/A	565 W CAPITOL EXP	None	SAN JOSE	CA	95136	3914	00	06000	37.27611	-121.8538125	Santa Clara County
316889	Ordering, Referring, Prescribing	N/A	1023106754	0	0	DERFLINGER, JEFFREY PHD	3/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16346	N/A	N/A	N/A	N/A	N/A	800 N ECKHOFF ST	None	ORANGE	CA	92868	1008	00	06000	33.79960624	-117.8741126	Orange County
316897	Ordering, Referring, Prescribing	N/A	1023129970	0	0	DUPLANTIER, TRACY A	9/4/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	14557	N/A	N/A	N/A	N/A	N/A	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
316912	Ordering, Referring, Prescribing	N/A	1023143245	0	0	DEWITTE, TIFFANY	4/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29826	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	MANTECA	CA	95202	2222	00	06000	37.96681769	-121.2881382	San Joaquin County
316936	Ordering, Referring, Prescribing	N/A	1023193646	0	0	DHARMA, KALAMANI MD	7/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40393	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
316942	Ordering, Referring, Prescribing	N/A	1023203502	0	0	DAVIS-MCBRYAN, JOLEIGH A LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98828	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
316975	Ordering, Referring, Prescribing	N/A	1023290673	0	0	DRAPER, AARON W	2/20/2019	Taxonomy not applicable	NA	n/a	000	Unknown	50757	N/A	N/A	N/A	N/A	N/A	5795 N FIRST ST	None	FRESNO	CA	93710	6203	00	06000	36.82267128	-119.7724044	Fresno County
316988	Ordering, Referring, Prescribing	N/A	1023308525	0	0	DENMAN, MANOELA F MD	7/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158775	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD.	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
317027	Ordering, Referring, Prescribing	N/A	1023401122	0	0	DARAKJIAN, ARA G MD	8/16/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140748	N/A	N/A	N/A	N/A	N/A	2370 BUHNE STREET	None	EUREKA	CA	95501	3237	00	06000	40.78592834	-124.1412805	Humboldt County
317037	Ordering, Referring, Prescribing	N/A	1023406675	0	0	DEVINE-COOTER, SARAH A NP	3/30/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	808812	N/A	N/A	N/A	N/A	N/A	29099 HOSPITAL RD	STE 200	LAKE ARROWHEAD	CA	92352	9706	00	06000	34.26652661	-117.1690546	San Bernardino County
317039	Ordering, Referring, Prescribing	N/A	1023408739	0	0	DAVARAN, BREANNA P LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117932	N/A	N/A	N/A	N/A	N/A	10 DOUGLAS DRIVE	140	MARTINEZ	CA	94553	4078	00	06000	37.99546221	-122.1222474	Contra Costa County
317079	Ordering, Referring, Prescribing	N/A	1023469335	0	0	DEAN, CHELSEA MD	10/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158203	N/A	N/A	N/A	N/A	N/A	628 W MICHELTORENA ST	None	SANTA BARBARA	CA	93101	4131	00	06000	34.41910081	-119.7158618	Santa Barbara County
317081	Ordering, Referring, Prescribing	N/A	1023480159	0	0	DOMINGUEZ, ISAAC PA-C	3/28/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA52837	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	SUITE K	SACRAMENTO	CA	95820	4756	00	06000	38.526282	-121.471398	Sacramento County
317105	Ordering, Referring, Prescribing	N/A	1023508363	0	0	DUONG, MOLLY OD	11/30/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34200	N/A	N/A	N/A	N/A	N/A	437 N. EUCLID AVENUE	None	ONTARIO	CA	91762	3456	00	06000	34.067988	-117.6521805	San Bernardino County
317123	Ordering, Referring, Prescribing	N/A	1023538105	0	0	DHALIWAL, HARMANDEEP S MD	5/13/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A162512	N/A	N/A	N/A	N/A	N/A	5810 JAMESON CT	None	CARMICHAEL	CA	95608	0881	00	06000	38.650878	-121.329036	Sacramento County
317125	Ordering, Referring, Prescribing	N/A	1023543212	0	0	DE LA TORRE, PERLA LCSW	11/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104015	N/A	N/A	N/A	N/A	N/A	2880 STORY RD	10	SAN JOSE	CA	95127	3942	00	06000	37.3537019	-121.8227358	Santa Clara County
317133	Ordering, Referring, Prescribing	N/A	1023559226	0	0	DO, NICHOLAS L PHARMD	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75725	N/A	N/A	N/A	N/A	N/A	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	00	06000	37.48948529	-122.2232468	San Mateo County
317142	Ordering, Referring, Prescribing	N/A	1023567013	0	0	DARAMOLA, ADENIYI N	6/22/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	75166	N/A	N/A	N/A	N/A	N/A	16137 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10653119	-117.453131	San Bernardino County
317165	Ordering, Referring, Prescribing	N/A	1023601192	0	0	DUARTE, ANA NP	5/16/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016468	N/A	N/A	N/A	N/A	N/A	900 MAIN ST	None	BRAWLEY	CA	92227	2630	00	06000	32.9785797	-115.5285802	Imperial County
317195	Ordering, Referring, Prescribing	N/A	1023674660	0	0	DAVIS, ALEXANDER B CNP	9/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027223	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
317207	Ordering, Referring, Prescribing	N/A	1023705464	0	0	DAHLIN, KELSEY G LCSW	5/4/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101329	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
317215	Ordering, Referring, Prescribing	N/A	1023750148	0	0	DIAZ, YANETE LCSW	10/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111204	N/A	N/A	N/A	N/A	N/A	525 N. CABRILLO PARK DRI	None	SANTA ANA	CA	92701	0000	00	06000	33.75047365	-117.8404984	Orange County
317227	Ordering, Referring, Prescribing	N/A	1023783289	0	0	DU, JIANGYAN PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84741	N/A	N/A	N/A	N/A	N/A	3801 HOWE ST	None	OAKLAND	CA	94611	5312	00	06000	37.8242732	-122.2568561	Alameda County
317244	Ordering, Referring, Prescribing	N/A	1023899408	0	0	DANGI, VIKAS DDS	9/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109452	N/A	N/A	N/A	N/A	N/A	1000 SKYLINE BLVD	STE B	AVENAL	CA	93204	1850	00	06000	36.00790722	-120.1216067	Kings County
317247	Ordering, Referring, Prescribing	N/A	1033113535	0	0	DIETZ, SUZANNE NP	2/9/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	6504	N/A	N/A	N/A	N/A	N/A	2200 TYDD ST	None	EUREKA	CA	95501	1284	00	06000	40.80241902	-124.1462268	Humboldt County
317248	Ordering, Referring, Prescribing	N/A	1033131941	0	0	DAWUD, RENDA S MD	10/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	C177173	N/A	N/A	N/A	N/A	N/A	2201 MISSION AVE	#200	OCEANSIDE	CA	92058	2313	00	06000	33.20742226	-117.3612486	San Diego County
317264	Ordering, Referring, Prescribing	N/A	1033178538	0	0	DOMEYER, EVAN L DO	3/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	44533	N/A	N/A	N/A	N/A	N/A	4050 COON RAPIDS BLVD NW	None	MINNEAPOLIS	MN	55433	2522	00	06000	45.18395809	-93.36860464	Anoka County
317304	Ordering, Referring, Prescribing	N/A	1033269188	0	0	DAVIS, NADEZHDA R CNP	12/19/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013388	N/A	N/A	N/A	N/A	N/A	2640 INDUSTRY WAY	SUITE B	LYNWOOD	CA	90262	4284	00	06000	33.92359693	-118.2252816	Los Angeles County
317328	Ordering, Referring, Prescribing	N/A	1033307327	0	0	DAVIS, MELANIE M	5/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28965	N/A	N/A	N/A	N/A	N/A	1850 SAN BENITO ST	None	HOLIISTER	CA	95023	4805	00	06000	36.83239256	-121.4017251	San Benito County
317351	Ordering, Referring, Prescribing	N/A	1033357892	0	0	DIZON, EUNICE A	4/19/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D56282	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
317377	Ordering, Referring, Prescribing	N/A	1033402987	0	0	DUQUESNEL, JOSEPH E LMFT	3/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24762	N/A	N/A	N/A	N/A	N/A	1119 E CUMBERLAND RD	None	ORANGE	CA	92865	3505	00	06000	33.82538372	-117.842042	Orange County
317486	Ordering, Referring, Prescribing	N/A	1033551353	0	0	DAO, AMY L PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69681	N/A	N/A	N/A	N/A	N/A	3570 ATLANTIC AVE	None	LONG BEACH	CA	90807	4516	00	06000	33.821568	-118.185003	Los Angeles County
317500	Ordering, Referring, Prescribing	N/A	1033570643	0	0	DUODU-ADDO, DOROTHY Y LCSW	1/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87643	N/A	N/A	N/A	N/A	N/A	3631 CRENSHAW BLVD	109	LOS ANGELES	CA	90016	2358	00	06000	34.023177	-118.3351475	Los Angeles County
317565	Ordering, Referring, Prescribing	N/A	1033667670	0	0	DOMINGUEZ, MARIA LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116894	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	STE 300	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
317594	Ordering, Referring, Prescribing	N/A	1033704572	0	0	DEFILIPPO, OLIVIA T	9/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018608	N/A	N/A	N/A	N/A	N/A	4631 TELLER AVE	100	NEWPORT BEACH	CA	92660	1801	00	06000	33.66641504	-117.857408	Orange County
317595	Ordering, Referring, Prescribing	N/A	1033708797	0	0	DOLOWICH, ELISA NP	1/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95016369	N/A	N/A	N/A	N/A	N/A	2299 MOWRY AVE	None	FREMONT	CA	94538	1621	00	06000	37.55671415	-121.9817758	Alameda County
317617	Ordering, Referring, Prescribing	N/A	1033754155	0	0	DELALLANA, ANGELICA NP	12/4/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013429	N/A	N/A	N/A	N/A	N/A	803 E ROSECRANS AVE	None	EAST RANCHO DOMIN	CA	90221	2145	00	06000	33.9035073	-118.2153406	Los Angeles County
317623	Ordering, Referring, Prescribing	N/A	1033778576	0	0	DE GUZMAN, CATHRYN	8/15/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	56870	N/A	N/A	N/A	N/A	N/A	91275 66TH ST	SUITE 500	MECCA	CA	92254	1251	00	06000	33.5692685	-116.0743905	Riverside County
317635	Ordering, Referring, Prescribing	N/A	1033794987	0	0	DAO, TRI T PHARMD	1/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83153	N/A	N/A	N/A	N/A	N/A	25850 THE OLD RD	None	VALENCIA	CA	91381	1710	00	06000	34.3908174	-118.5734984	Los Angeles County
317652	Ordering, Referring, Prescribing	N/A	1033931811	0	0	DALY, NOELLE PA-C	11/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65380	N/A	N/A	N/A	N/A	N/A	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
317660	Ordering, Referring, Prescribing	N/A	1033979943	0	0	DHARIWAL, SAMREEN PA	11/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65407	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
317699	Ordering, Referring, Prescribing	N/A	1043338411	0	0	DE LA ROSA, MONICA G LCSW	6/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80811	N/A	N/A	N/A	N/A	N/A	2500 S C STREET	SUITE D	OXNARD	CA	93033	4574	00	06000	34.17646093	-119.1812737	Ventura County
317748	Ordering, Referring, Prescribing	N/A	1043422520	0	0	DUONG, KATIE V	9/10/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D55174	N/A	N/A	N/A	N/A	N/A	1000 VALE TERRACE DR	None	VISTA	CA	92084	5218	00	06000	33.20904502	-117.2286439	San Diego County
317786	Ordering, Referring, Prescribing	N/A	1043510456	0	0	DERREJA, LAYLA PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH64845	N/A	N/A	N/A	N/A	N/A	7373 WEST LANE	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
317788	Ordering, Referring, Prescribing	N/A	1043505829	0	0	DEATON, CHRISTINA C LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96976	N/A	N/A	N/A	N/A	N/A	41945 BIG BEAR BLVD	# 222	BIG BEAR LAKE	CA	92315	1927	00	06000	34.24334115	-116.8869688	San Bernardino County
317802	Ordering, Referring, Prescribing	N/A	1043553118	0	0	DOMINGOS, JAMIE N LMFT	11/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128993	N/A	N/A	N/A	N/A	N/A	1340 ARNOLD DRIVE	SUITE 225	MARTINEZ	CA	94553	0000	00	06000	37.99250264	-122.0983907	Contra Costa County
317829	Ordering, Referring, Prescribing	N/A	1043598469	0	0	DIGGLES, KIMBERLY R LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93650	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	APT 104	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
317839	Ordering, Referring, Prescribing	N/A	1043609647	0	0	DUFF, PATRICIA A	3/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP21063	N/A	N/A	N/A	N/A	N/A	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
317888	Ordering, Referring, Prescribing	N/A	1043674716	0	0	DORUK CAMSARI, DENIZ MD	9/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170131	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
317916	Ordering, Referring, Prescribing	N/A	1043725930	0	0	DIBSY, MOLLY P LCSW	2/7/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107745	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
317918	Ordering, Referring, Prescribing	N/A	1043726979	0	0	DOMINGUEZ, LAURA S LMFT	1/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123964	N/A	N/A	N/A	N/A	N/A	2009 PALO VERDE AVE	A	LONG BEACH	CA	90815	3322	00	06000	33.792597	-118.1080155	Los Angeles County
317953	Ordering, Referring, Prescribing	N/A	1043772171	0	0	DOSANJH, AMRIT K MD MPH	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL1056	N/A	N/A	N/A	N/A	N/A	747 52ND ST	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
317965	Ordering, Referring, Prescribing	N/A	1043789514	0	0	DAO, TRAM ANH N	12/17/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	103321	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY ST	None	GILROY	CA	95020	5826	00	06000	37.00852861	-121.5694352	Santa Clara County
317997	Ordering, Referring, Prescribing	N/A	1043857287	0	0	DENG, CATHERINE V PHARMD	1/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81139	N/A	N/A	N/A	N/A	N/A	1380 HOWARD STREET	ROOM 130	SAN FRANCISCO	CA	94103	2638	00	06000	37.77424669	-122.4141502	San Francisco County
318018	Ordering, Referring, Prescribing	N/A	1043886583	0	0	DEL AGUILA, MARJORIE B RN PHN	4/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RN306798	N/A	N/A	N/A	N/A	N/A	44900 DIVISION ST	None	LANCASTER	CA	93535	2501	00	06000	34.6991613	-118.1303393	Los Angeles County
318019	Ordering, Referring, Prescribing	N/A	1043892391	0	0	DIAB, MAHDI MD MPH	12/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191988	N/A	N/A	N/A	N/A	N/A	7245 NAVAJO RD	D330	SAN DIEGO	CA	92119	1632	00	06000	32.80430948	-117.0400479	San Diego County
318043	Ordering, Referring, Prescribing	N/A	1043980980	0	0	DIAZ, OSCAR A NP	9/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018402	N/A	N/A	N/A	N/A	N/A	15451 SAN FERNANDO MISSI	None	MISSION HILLS	CA	91345	1368	00	06000	34.27201722	-118.4684783	Los Angeles County
318049	Ordering, Referring, Prescribing	N/A	1053002360	0	0	DAVIES-UPPAL, ALLISON	7/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026125	N/A	N/A	N/A	N/A	N/A	2630 FIRST AVENUE	None	SAN DIEGO	CA	92103	6529	00	06000	32.73288727	-117.1639712	San Diego County
318060	Ordering, Referring, Prescribing	N/A	1053046953	0	0	DEL CAMPO, JENINA M NP	6/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021161	N/A	N/A	N/A	N/A	N/A	23161 MILL CREEK DR	230	LAGUNA HILLS	CA	92653	7908	00	06000	33.62655796	-117.7352122	Orange County
318095	Ordering, Referring, Prescribing	N/A	1053361238	0	0	DHILLON, SARTAJ K MD	7/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53571	N/A	N/A	N/A	N/A	N/A	229 W CHERRY AVE	None	PORTERVILLE	CA	93257	3401	00	06000	36.06917549	-119.0215574	Tulare County
318100	Ordering, Referring, Prescribing	N/A	1053402651	0	0	DO, TRI D MD	9/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70135	N/A	N/A	N/A	N/A	N/A	1563 MISSION ST	5TH FLOOR	SAN FRANCISCO	CA	94103	2543	00	06000	37.77327874	-122.4183559	San Francisco County
318152	Ordering, Referring, Prescribing	N/A	1053485789	0	0	DE LA O II, ABRAN L	10/20/1989	Taxonomy not applicable	NA	n/a	099	DENTIST	D26979	N/A	N/A	N/A	N/A	N/A	650 S ZEDIKER AVE	BLDG 3	PARLIER	CA	93648	2667	00	06000	36.60500164	-119.5210273	Fresno County
318193	Ordering, Referring, Prescribing	N/A	1053544239	0	0	DE LA CERNA, FELICE PHD	10/8/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29246	N/A	N/A	N/A	N/A	N/A	1735 MISSION ST	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
318205	Ordering, Referring, Prescribing	N/A	1053562439	0	0	DOSSETT, EMILY C MD	11/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89429	N/A	N/A	N/A	N/A	N/A	8300 S VERMONT AVE	FIRST FLOOR	LOS ANGELES	CA	90044	3493	00	06000	33.963021	-118.291474	Los Angeles County
318223	Ordering, Referring, Prescribing	N/A	1053611137	0	0	DIXON, CAROL	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	45014	N/A	N/A	N/A	N/A	N/A	1110 W ALAMEDA AVE	None	BURBANK	CA	91506	2806	00	06000	34.16282395	-118.3142996	Los Angeles County
318227	Ordering, Referring, Prescribing	N/A	1053617449	0	0	DO, DAVID PHARMD	8/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	53557	N/A	N/A	N/A	N/A	N/A	989 SUNRISE AVE	None	ROSEVILLE	CA	95661	4506	00	06000	38.73110774	-121.272042	Placer County
318293	Ordering, Referring, Prescribing	N/A	1053722041	0	0	DUARTE, DIANA M LMFT	1/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119083	N/A	N/A	N/A	N/A	N/A	1910 OLYMPIC BLVD.	SUITE 365	WALNUT CREEK	CA	94596	5096	00	06000	37.89453628	-122.0662326	Contra Costa County
318296	Ordering, Referring, Prescribing	N/A	1053722835	0	0	DENEAU, TIFFANY H LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88304	N/A	N/A	N/A	N/A	N/A	2151 COLLEGE AVE	None	BAKERSFIELD	CA	93305	4113	00	06000	35.3830369	-118.9680991	Kern County
318299	Ordering, Referring, Prescribing	N/A	1053726166	0	0	DIAMANTINE, AMY LMFT	7/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	79991	N/A	N/A	N/A	N/A	N/A	2400 WASHINGTON AVE	None	REDDING	CA	96001	2802	00	06000	40.577499	-122.371478	Shasta County
318328	Ordering, Referring, Prescribing	N/A	1053760561	0	0	DELAO, GABRIELLA L LMFT	1/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130811	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
318331	Ordering, Referring, Prescribing	N/A	1053760777	0	0	DELLAQUILA, BRIANNA LMFT	2/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119225	N/A	N/A	N/A	N/A	N/A	300 BRADFORD ST	None	REDWOOD CITY	CA	94063	1530	00	06000	37.48767403	-122.2323005	San Mateo County
318366	Ordering, Referring, Prescribing	N/A	1053802579	0	0	DAFNEY, KADIATOU NP	10/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008242	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
318383	Ordering, Referring, Prescribing	N/A	1053822577	0	0	DAVID, ERIC LMFT	5/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125832	N/A	N/A	N/A	N/A	N/A	550 W VISTA WAY	STE 407	VISTA	CA	92083	5732	00	06000	33.19564771	-117.2534095	San Diego County
318393	Ordering, Referring, Prescribing	N/A	1053841338	0	0	DINH, ELLE L	5/26/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	101365	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
318405	Ordering, Referring, Prescribing	N/A	1053863423	0	0	DIEP, STEVEN PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75566	N/A	N/A	N/A	N/A	N/A	3601 BELFORD ST	None	SAN DIEGO	CA	92111	4240	00	06000	32.8096232	-117.1648356	San Diego County
318474	Ordering, Referring, Prescribing	N/A	1063040764	0	0	DHANANI, SADIYA MD	7/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184145	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
318497	Ordering, Referring, Prescribing	N/A	1063099620	0	0	DOREY, RYAN W MD	11/7/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184094	N/A	N/A	N/A	N/A	N/A	3544 30TH STREET	None	SAN DIEGO	CA	92104	4120	00	06000	32.742936	-117.130118	San Diego County
318504	Ordering, Referring, Prescribing	N/A	1063131209	0	0	DOBRZYN, TAMARA CCC-SLP	12/12/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP34498	N/A	N/A	N/A	N/A	N/A	126 HIDDEN VALLEY DR	None	LAKE ARIEL	PA	18436	9103	00	06000	41.49461195	-75.4265534	Wayne County
318585	Ordering, Referring, Prescribing	N/A	1063542439	0	0	DACANAY, GRACE J OD	7/2/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12589	N/A	N/A	N/A	N/A	N/A	15909 EAST MAIN STREET	None	LA PUENTE	CA	91744	4720	00	06000	34.02017089	-117.951122	Los Angeles County
318589	Ordering, Referring, Prescribing	N/A	1063546711	0	0	DE OCAMPO, HEDWIG M LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46182	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PLUG	SUITE 200	SAN MATEO	CA	94403	0501	00	06000	37.54524373	-122.3205511	San Mateo County
318671	Ordering, Referring, Prescribing	N/A	1063700664	0	0	DAO, QUYNH	3/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20686	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
318672	Ordering, Referring, Prescribing	N/A	1063704377	0	0	DASH, DEEPAK P	8/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	58276	N/A	N/A	N/A	N/A	N/A	6498 PONY EXPRESS TRAIL	None	POLLOCK PINES	CA	95726	1111	00	06000	38.76303894	-120.5771593	El Dorado County
318697	Ordering, Referring, Prescribing	N/A	1063757433	0	0	DAVIS, LASHANDRA K LCSW	2/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LSW94076	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVE	B	LOS ANGELES	CA	90014	2211	00	06000	34.04323075	-118.2485358	Los Angeles County
318716	Ordering, Referring, Prescribing	N/A	1063775302	0	0	DAVIS, JOANNA	9/26/2023	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM686	N/A	N/A	N/A	N/A	N/A	1908 N. BEALE RD	SUITE E	MARYSVILLE	CA	95901	6937	00	06000	39.1278388	-121.5457994	Yuba County
318734	Ordering, Referring, Prescribing	N/A	1063795391	0	0	DIMAYACYAC, BONIFACIO G PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63837	N/A	N/A	N/A	N/A	N/A	2424 N BRAWLEY AVE	None	FRESNO	CA	93722	5109	00	06000	36.772461	-119.8623015	Fresno County
318768	Ordering, Referring, Prescribing	N/A	1063829505	0	0	DERISSI, DANA A PA-C	10/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA51577	N/A	N/A	N/A	N/A	N/A	525 E. MAIN STREET	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
318806	Ordering, Referring, Prescribing	N/A	1063886869	0	0	DAVIDSON, JACOB A MD	3/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL230	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
318845	Ordering, Referring, Prescribing	N/A	1063941920	0	0	DO, AMANDA PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75567	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	MOB, 3RD FLOOR, DEPT 362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
318847	Ordering, Referring, Prescribing	N/A	1063939718	0	0	DIAZ, DALIA M LCSW	2/17/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100058	N/A	N/A	N/A	N/A	N/A	12440 E. FIRESTONE BLVD.	SUITE 316	NORWALK	CA	90650	4326	00	06000	33.90523023	-118.0681168	Los Angeles County
318861	Ordering, Referring, Prescribing	N/A	1063960185	0	0	DASHA, GINBAR PHARMD	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74712	N/A	N/A	N/A	N/A	N/A	100635 FOLSOM BLVD	None	RANCHO CORDOVA	CA	95670	4828	00	06000	38.59344007	-121.2941519	Sacramento County
318876	Ordering, Referring, Prescribing	N/A	1063998151	0	0	DESANTIAGO, ADRIANNA G LMFT	5/22/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147045	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD.	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
318900	Ordering, Referring, Prescribing	N/A	1073027991	0	0	DAVIS, BRANDON E	3/26/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	101463	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	00	06000	34.06255157	-118.2397077	Los Angeles County
318947	Ordering, Referring, Prescribing	N/A	1073101564	0	0	DINGBAUM, ELIZABETH A PA-C	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59243	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVE	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
319031	Ordering, Referring, Prescribing	N/A	1073596185	0	0	DE LEON, MELANIE R	9/3/1993	Taxonomy not applicable	NA	n/a	099	DENTIST	D41247	N/A	N/A	N/A	N/A	N/A	200 C ST	None	PATTERSON	CA	95363	2701	00	06000	37.46733509	-121.1258615	Stanislaus County
319097	Ordering, Referring, Prescribing	N/A	1073760443	0	0	DONATI, VANESSA L MSW LCSW	2/19/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100109	N/A	N/A	N/A	N/A	N/A	429 N. SAN ANTONIO ROAD	None	SANTA BARBARA	CA	93110	1399	00	06000	34.44573228	-119.7804008	Santa Barbara County
319105	Ordering, Referring, Prescribing	N/A	1073793022	0	0	DEENEY, KERRY LCSW	12/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25671	N/A	N/A	N/A	N/A	N/A	408 S BEACH BLVD	111	ANAHEIM	CA	92804	1853	00	06000	33.82709101	-117.9932293	Orange County
319146	Ordering, Referring, Prescribing	N/A	1073870911	0	0	DIAZ-HENRIQUEZ, CLAUDIA LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116902	N/A	N/A	N/A	N/A	N/A	335 EAST AVE I	None	LANCASTER	CA	93535	1916	00	06000	34.7041113	-118.1247548	Los Angeles County
319158	Ordering, Referring, Prescribing	N/A	1073896049	0	0	DAVIS, RUKKA K LCSW	8/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77727	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
319220	Ordering, Referring, Prescribing	N/A	1073987160	0	0	DANG, PAUL P PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73825	N/A	N/A	N/A	N/A	N/A	20261 HWY 18	None	APPLE VALLEY	CA	92307	0005	00	06000	34.52556433	-117.2198711	San Bernardino County
319223	Ordering, Referring, Prescribing	N/A	1073994802	0	0	DUONG, HEIDI PHARMD	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	46526	N/A	N/A	N/A	N/A	N/A	940 N TUSTIN AVE	None	ORANGE	CA	92867	5956	00	06000	33.84993037	-117.8378183	Orange
319234	Ordering, Referring, Prescribing	N/A	1083012520	0	0	DHALIWAL, SATVIR K	1/28/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64258	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
319237	Ordering, Referring, Prescribing	N/A	1083009914	0	0	DOMINGO, EDWARD BALBINO C	2/5/2020	Taxonomy not applicable	NA	n/a	000	Unknown	59921	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
319266	Ordering, Referring, Prescribing	N/A	1083044390	0	0	DEEMAN, MARY PHARMD	3/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	70218	N/A	N/A	N/A	N/A	N/A	4550 E CHAPMAN AVE	None	ORANGE	CA	92869	4109	00	06000	33.78771649	-117.804402	Orange County
319294	Ordering, Referring, Prescribing	N/A	1083089437	0	0	DHALIWAL, SUKHDEEP K CNP	3/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95002651	N/A	N/A	N/A	N/A	N/A	2740 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.70101129	-119.7908643	Fresno County
319296	Ordering, Referring, Prescribing	N/A	1083090914	0	0	DUBE, SHYAMOLIKA MSW LCSW	7/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95525	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
319313	Ordering, Referring, Prescribing	N/A	1083117865	0	0	DIEP, KEVIN DO	1/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17657	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
319318	Ordering, Referring, Prescribing	N/A	1083125207	0	0	DONATH, MICHAEL A MD	9/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177661	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1438	00	06000	34.32450186	-118.4456317	Los Angeles County
319319	Ordering, Referring, Prescribing	N/A	1083127989	0	0	DUONG, NICOLETTE PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77014	N/A	N/A	N/A	N/A	N/A	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	00	06000	37.93684848	-122.361345	Contra Costa County
319327	Ordering, Referring, Prescribing	N/A	1083138093	0	0	DIEP, SUSAN T PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74994	N/A	N/A	N/A	N/A	N/A	11523 BASYE ST	None	EL MONTE	CA	91732	2130	00	06000	34.08076788	-118.0209133	Los Angeles County
319328	Ordering, Referring, Prescribing	N/A	1083131098	0	0	DUARTE ZECENA, TATIANA LCSW	11/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127519	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
319358	Ordering, Referring, Prescribing	N/A	1083183552	0	0	DUBROVSKY, ALANNA MD	5/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186648	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
319365	Ordering, Referring, Prescribing	N/A	1083195085	0	0	DHALL, SUKHWINDER S	9/26/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103982	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
319369	Ordering, Referring, Prescribing	N/A	1083195721	0	0	DAVIS, BRANDON E PHARMD	12/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85653	N/A	N/A	N/A	N/A	N/A	2303 NILES POINT	None	BAKERSFIELD	CA	93306	1000	00	06000	35.3757297	-118.9662182	Kern County
319404	Ordering, Referring, Prescribing	N/A	1083276737	0	0	DUONG, LUCY PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81011	N/A	N/A	N/A	N/A	N/A	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	9173	00	06000	33.9040752	-118.1328995	Los Angeles County
319433	Ordering, Referring, Prescribing	N/A	1083360879	0	0	DHAKA, ROHIT	10/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	85916	N/A	N/A	N/A	N/A	N/A	1823 COMMERCENTER W	None	SAN BERNARDINO	CA	92408	3300	00	06000	34.06823081	-117.2861363	San Bernardino County
319452	Ordering, Referring, Prescribing	N/A	1083464424	0	0	DIZON, FRANCIS PHD	9/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LEP4239	N/A	N/A	N/A	N/A	N/A	25631 PETER A. HARTMAN W	None	MISSION VIEJO	CA	92691	3142	00	06000	33.62124061	-117.6834434	Orange County
319457	Ordering, Referring, Prescribing	N/A	1083475511	0	0	DUVALL, ARIEL PT	5/23/2023	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT37897	N/A	N/A	N/A	N/A	N/A	162 S MAIN ST	None	BISHOP	CA	93514	3415	00	06000	37.3608019	-118.3951979	Inyo County
319464	Ordering, Referring, Prescribing	N/A	1083658470	0	0	DAVIS, JAY M MD	12/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G30021	N/A	N/A	N/A	N/A	N/A	1 HARPST STREET,	STUDENT HEALTH CENTER	ARCATA	CA	95521	8299	00	06000	40.87420204	-124.0791833	Humboldt County
319473	Ordering, Referring, Prescribing	N/A	1083701304	0	0	DAVALOS, VERONICA LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20761	N/A	N/A	N/A	N/A	N/A	800 N ECKHOFF ST	None	ORANGE	CA	92868	1008	00	06000	33.79960624	-117.8741126	Orange County
319477	Ordering, Referring, Prescribing	N/A	1083709380	0	0	DADKHAH, BETIA LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44160	N/A	N/A	N/A	N/A	N/A	2495 W MARCH LN	125	STOCKTON	CA	95207	8251	00	06000	37.98503238	-121.3384819	San Joaquin County
319516	Ordering, Referring, Prescribing	N/A	1083789622	0	0	DAVIES, CHRISTINE LMFT	8/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT30912	N/A	N/A	N/A	N/A	N/A	4995 MURPHY CANYON RD FL	201	SAN DIEGO	CA	92123	4365	00	06000	32.82981762	-117.1200317	San Diego County
319529	Ordering, Referring, Prescribing	N/A	1083825673	0	0	DVALERY, RENE F LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46693	N/A	N/A	N/A	N/A	N/A	1596 WRIGHT STREET	SUITE 201	SANTA ROSA	CA	95404	2928	00	06000	38.455677	-122.7091005	Sonoma County
319542	Ordering, Referring, Prescribing	N/A	1083862635	0	0	DANG NGUYEN, PHILLIP P PHARMD	6/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57194	N/A	N/A	N/A	N/A	N/A	9433 BOLSA AVE	SUITE B	WESTMINSTER	CA	92683	5964	00	06000	33.74498152	-117.964368	Orange County
319544	Ordering, Referring, Prescribing	N/A	1083864078	0	0	DONNELL, KATHERINE P LMFT	4/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84304	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DR	None	SAN BRUNO	CA	94066	2304	00	06000	37.63134914	-122.4260472	San Mateo County
319556	Ordering, Referring, Prescribing	N/A	1083892020	0	0	DELGADO, JOHN J MD	1/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63783	N/A	N/A	N/A	N/A	N/A	721 RIVER DRIVE	STE A	FORT BRAGG	CA	95437	5403	00	06000	39.43204627	-123.801581	Mendocino County
319571	Ordering, Referring, Prescribing	N/A	1083918064	0	0	DRUMHELLER, AMANDA LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83242	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
319576	Ordering, Referring, Prescribing	N/A	1083926257	0	0	DINWIDDIE, LORI PSYD	6/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28005	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	SUITE 126	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
319619	Ordering, Referring, Prescribing	N/A	1083994719	0	0	DIESH, LAURA D	8/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43554	N/A	N/A	N/A	N/A	N/A	643 SANTA CRUZ AVE	None	MENLO PARK	CA	94025	4502	00	06000	37.45242157	-122.183849	San Mateo County
319632	Ordering, Referring, Prescribing	N/A	1093002164	0	0	DIEDERICH, CRISTINA N PHARMD	3/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	49085	N/A	N/A	N/A	N/A	N/A	189 NIBLICK RD	None	PASO ROBLES	CA	93446	4845	00	06000	35.61505753	-120.6811935	San Luis Obispo County
319675	Ordering, Referring, Prescribing	N/A	1093091985	0	0	DUNCAN, JESSICA PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	55870	N/A	N/A	N/A	N/A	N/A	2245 S EUCLID AVE	None	ONTARIO	CA	91762	6519	00	06000	34.032942	-117.6499755	San Bernardino County
319682	Ordering, Referring, Prescribing	N/A	1093097297	0	0	DEVJANI, GEETA LMFT	3/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT110871	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1269	00	06000	37.54524373	-122.3205511	San Mateo County
319687	Ordering, Referring, Prescribing	N/A	1093107294	0	0	DAVIS, TONIA N CCC-SLP	11/15/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	25987	N/A	N/A	N/A	N/A	N/A	3416 AMERICAN RIVER DR	SUITE B	SACRAMENTO	CA	95864	5753	00	06000	38.569212	-121.3840755	Sacramento County
319698	Ordering, Referring, Prescribing	N/A	1093130890	0	0	DAVIS, JENNIFER M LMFT	9/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134686	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	None	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
319708	Ordering, Referring, Prescribing	N/A	1093144594	0	0	DEERING, TIFFANY PHARMD	3/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59958	N/A	N/A	N/A	N/A	N/A	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	00	06000	38.00450116	-122.5540001	Marin County
319734	Ordering, Referring, Prescribing	N/A	1093179921	0	0	DOMPOR-TRAN, TU-PHUONG T MD	5/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152730	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
319755	Ordering, Referring, Prescribing	N/A	1093206658	0	0	DARWISH, MALIK MD	7/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174088	N/A	N/A	N/A	N/A	N/A	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
319840	Ordering, Referring, Prescribing	N/A	1093359622	0	0	DIDOMIZIO, FUMIKO I LCSW	6/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115846	N/A	N/A	N/A	N/A	N/A	888 7TH STREET	UNIT 51	SAN FRANCISCO	CA	94107	1585	00	06000	37.77084995	-122.4005113	San Francisco County
319848	Ordering, Referring, Prescribing	N/A	1093379752	0	0	DOUGLASS, NATASHA N NP	5/1/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011294	N/A	N/A	N/A	N/A	N/A	1114 6TH ST	None	MODESTO	CA	95354	2203	00	06000	37.63901905	-121.0057149	Stanislaus County
319872	Ordering, Referring, Prescribing	N/A	1093467185	0	0	DECHANNES, MADELEINE LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143849	N/A	N/A	N/A	N/A	N/A	18050 VANOWEN ST	None	RESEDA	CA	91335	5638	00	06000	34.19384052	-118.526904	Los Angeles County
319921	Ordering, Referring, Prescribing	N/A	1093837064	0	0	DE LEON,MARIA C	6/4/1992	Taxonomy not applicable	NA	n/a	099	DENTIST	D38414	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
319956	Ordering, Referring, Prescribing	N/A	1093893307	0	0	DRISCOLL, CORNELIUS J LCSW	5/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20816	N/A	N/A	N/A	N/A	N/A	769 BLAINE ST.	STE B	RIVERSIDE	CA	92507	3970	00	06000	33.98300646	-117.327555	Riverside County
320043	Ordering, Referring, Prescribing	N/A	1104056498	0	0	DUBOSE, JOHN MD	6/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C161450	N/A	N/A	N/A	N/A	N/A	5325 BRODER BLVD	None	DUBLIN	CA	94568	3309	00	06000	37.71593563	-121.8841457	Alameda County
320104	Ordering, Referring, Prescribing	N/A	1104182179	0	0	DUBIN, ARIEL K MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129009	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
320109	Ordering, Referring, Prescribing	N/A	1104194943	0	0	DINH, DEREK PHARMD	8/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47369	N/A	N/A	N/A	N/A	N/A	2627 PACIFIC AVE	None	LONG BEACH	CA	90806	2610	00	06000	33.80511396	-118.1937379	Los Angeles County
320142	Ordering, Referring, Prescribing	N/A	1104233063	0	0	DELGADO, CAITLIN E LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101174	N/A	N/A	N/A	N/A	N/A	5445 LAUREL HILLS DR.	None	SACRAMENTO	CA	95841	3105	00	06000	38.662227	-121.3378965	Sacramento County
320157	Ordering, Referring, Prescribing	N/A	1104258672	0	0	DAMERJIAN, VANIA LMFT	12/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84936	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	0617	00	06000	34.219566	-119.1539365	Ventura County
320164	Ordering, Referring, Prescribing	N/A	1104268747	0	0	DIGIROLAMO, MELISSA	11/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99484	N/A	N/A	N/A	N/A	N/A	625 FAIR OAKS AVE	SUITE 300	SOUTH PASADENA	CA	91030	2630	00	06000	34.117947	-118.1503575	Los Angeles County
320168	Ordering, Referring, Prescribing	N/A	1104272525	0	0	DUH, NICOLE MD	10/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151398	N/A	N/A	N/A	N/A	N/A	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
320176	Ordering, Referring, Prescribing	N/A	1104295468	0	0	DANG, MINA N PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH73415	N/A	N/A	N/A	N/A	N/A	5030 HAMNER AVE	None	EASTVALE	CA	91752	1009	00	06000	33.996744	-117.555534	Riverside County
320196	Ordering, Referring, Prescribing	N/A	1104328228	0	0	DELGADILLO, ELIANA P LCSW	1/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75226	N/A	N/A	N/A	N/A	N/A	2690 CIENEGA RD	None	HOLLISTER	CA	95023	9687	00	06000	36.82375129	-121.4010426	San Benito County
320204	Ordering, Referring, Prescribing	N/A	1104336486	0	0	DOAN, JEAN-LUC T PA	2/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	55634	N/A	N/A	N/A	N/A	N/A	10717 CAMINO RUIZ	258	SAN DIEGO	CA	92126	2360	00	06000	32.91373261	-117.1437822	San Diego County
320288	Ordering, Referring, Prescribing	N/A	1104486208	0	0	DONALDSON, BREAHN F MD	3/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177144	N/A	N/A	N/A	N/A	N/A	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	00	06000	34.05456946	-118.3824636	Los Angeles County
320293	Ordering, Referring, Prescribing	N/A	1104488642	0	0	DONALDSON, MEREDITH	1/3/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57640	N/A	N/A	N/A	N/A	N/A	16167 SISKIYOU RD	SUITE A	APPLE VALLEY	CA	92307	0837	00	06000	34.54496692	-117.2664417	San Bernardino County
320294	Ordering, Referring, Prescribing	N/A	1104510973	0	0	DORAME, ANGIE PA-C	11/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65411	N/A	N/A	N/A	N/A	N/A	740 E ALMOND AVE	None	MADERA	CA	93637	5617	00	06000	36.94545502	-120.0492446	Madera County
320295	Ordering, Referring, Prescribing	N/A	1104518414	0	0	DANCEL, MARY J	6/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62189	N/A	N/A	N/A	N/A	N/A	2300 MACDONALD AVE	None	RICHMOND	CA	94804	1821	00	06000	37.93565285	-122.3471161	Contra Costa County
320362	Ordering, Referring, Prescribing	N/A	1104959279	0	0	DIAZ, SOFIA C PHD	4/16/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22343	N/A	N/A	N/A	N/A	N/A	410 ARDEN AVE STE 201	STE 201	GLENDALE	CA	91203	4006	00	06000	34.15842441	-118.2618749	Los Angeles County
320393	Ordering, Referring, Prescribing	N/A	1114015872	0	0	DOWLING, MARY K NP	6/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	13391	N/A	N/A	N/A	N/A	N/A	6500 SOQUEL DRIVE	ROOM 912	APTOS	CA	95003	3119	00	06000	36.985284	-121.924638	Santa Cruz County
320422	Ordering, Referring, Prescribing	N/A	1114061421	0	0	DELEAVER-RUSSELL, MARGO P MD	5/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C38896	N/A	N/A	N/A	N/A	N/A	3831 HUGHES AVE	601	LOS ANGELES	CA	90232	2715	00	06000	34.02243278	-118.3981492	Los Angeles County
320429	Ordering, Referring, Prescribing	N/A	1114067584	0	0	DOVER, DONNA LCSW	2/5/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71009	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
320434	Ordering, Referring, Prescribing	N/A	1114090529	0	0	DELUCCA, GINA M PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51223	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
320468	Ordering, Referring, Prescribing	N/A	1114150703	0	0	DHALIWAL, MANJOT	6/24/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA20477	N/A	N/A	N/A	N/A	N/A	655 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49504475	-119.264496	Kern County
320490	Ordering, Referring, Prescribing	N/A	1114203825	0	0	DO, VONG H PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55973	N/A	N/A	N/A	N/A	N/A	2551 W MAIN ST	None	ALHAMBRA	CA	91801	1652	00	06000	34.09530369	-118.1513792	Los Angeles County
320544	Ordering, Referring, Prescribing	N/A	1114303344	0	0	DAYRIT, NICOLE M	12/2/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D64958	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
320588	Ordering, Referring, Prescribing	N/A	1114370970	0	0	DAVIS, TIA M LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111542	N/A	N/A	N/A	N/A	N/A	1445 VETERANS MEMORIAL C	None	YUBA CITY	CA	95993	3011	00	06000	39.14469836	-121.6380819	Sutter County
320621	Ordering, Referring, Prescribing	N/A	1114423811	0	0	DAVIS, GRAHAM MD	4/30/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187421	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LN	None	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
320649	Ordering, Referring, Prescribing	N/A	1114466679	0	0	DOERING, JARROD P	2/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54210	N/A	N/A	N/A	N/A	N/A	1200 W MAIN STREET	None	TURLOCK	CA	95380	5107	00	06000	37.4926695	-120.862917	Stanislaus County
320660	Ordering, Referring, Prescribing	N/A	1114475753	0	0	DAVID, NAOMI LMFT	8/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119846	N/A	N/A	N/A	N/A	N/A	175 W COURT ST	None	WOODLAND	CA	95695	2913	00	06000	38.67889514	-121.7923678	Yolo County
320675	Ordering, Referring, Prescribing	N/A	1114525789	0	0	DIBLE, GRACE P	12/21/2020	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	09000360A	N/A	N/A	N/A	N/A	N/A	1229 ORANGE ST	None	INDIANAPOLIS	IN	46203	1932	00	06000	39.74977894	-86.13748694	Marion County
320702	Ordering, Referring, Prescribing	N/A	1114574951	0	0	DIKE-NWOGUH, NWANNEKA PA	8/23/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57117	N/A	N/A	N/A	N/A	N/A	8233 E STOCKTON BLVD	D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
320714	Ordering, Referring, Prescribing	N/A	1114610540	0	0	DIAZ, VILMA PA-C	6/14/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64650	N/A	N/A	N/A	N/A	N/A	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
320728	Ordering, Referring, Prescribing	N/A	1114682663	0	0	DIMEN, DENNIS NEAL NP	2/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016762	N/A	N/A	N/A	N/A	N/A	7000 MICHAEL CANLIS WAY	None	FRENCH CAMP	CA	95231	9781	00	06000	37.8826497	-121.2974852	San Joaquin County
320754	Ordering, Referring, Prescribing	N/A	1114792850	0	0	DHILLON, BALWINDER NP	8/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026851	N/A	N/A	N/A	N/A	N/A	3800 MALL VIEW RD	None	BAKERSFIELD	CA	93306	3029	00	06000	35.39391297	-118.9503991	Kern County
320791	Ordering, Referring, Prescribing	N/A	1124106901	0	0	DEBARE, ROBERT S MD	9/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G70958	N/A	N/A	N/A	N/A	N/A	3075 ADELINE ST	STE 280	BERKELEY	CA	94703	2576	00	06000	37.85258905	-122.2697614	Alameda County
320801	Ordering, Referring, Prescribing	N/A	1124107602	0	0	DOUTHITT, JOHN A	7/24/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA18660	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
320807	Ordering, Referring, Prescribing	N/A	1124114020	0	0	DANICO, BRYCETON N LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20979	N/A	N/A	N/A	N/A	N/A	2080 S E ST	None	SAN BERNARDINO	CA	92408	2773	00	06000	34.06448311	-117.2895975	San Bernardino County
320846	Ordering, Referring, Prescribing	N/A	1124189972	0	0	DOMINGUEZ, ARTHUR M PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH38775	N/A	N/A	N/A	N/A	N/A	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	00	06000	34.06477215	-117.9845382	Los Angeles County
320874	Ordering, Referring, Prescribing	N/A	1124241559	0	0	DECASTRO, JACQUELINE G MD	4/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A101754	N/A	N/A	N/A	N/A	N/A	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	00	06000	36.33611794	-119.6460191	Kings County
320889	Ordering, Referring, Prescribing	N/A	1124276191	0	0	DOMINGUEZ, MARK A LMFT	10/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LMFT135452	N/A	N/A	N/A	N/A	N/A	1321 STINE RD	None	BAKERSFIELD	CA	93309	4176	00	06000	35.34206978	-119.049523	Kern County
320910	Ordering, Referring, Prescribing	N/A	1124314224	0	0	DEBERRY, DAWN D NP	7/25/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP18869	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
320933	Ordering, Referring, Prescribing	N/A	1124352042	0	0	DORSEY, KELLY K PHD	11/19/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28679	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
320936	Ordering, Referring, Prescribing	N/A	1124369533	0	0	DIGHIERA, DIANE LCSW	6/3/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW77512	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
320942	Ordering, Referring, Prescribing	N/A	1124376322	0	0	DAVIS, RENEE M LCSW	11/12/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86667	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD.	None	WHITTIER	CA	90631	2515	00	06000	33.94349601	-118.0106968	Los Angeles County
320954	Ordering, Referring, Prescribing	N/A	1124392386	0	0	DINH, DIEP T PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH49849	N/A	N/A	N/A	N/A	N/A	17900 NEWHOPE ST	None	FOUNTAIN VALLEY	CA	92708	5422	00	06000	33.70347	-117.9311985	Orange County
320957	Ordering, Referring, Prescribing	N/A	1124398060	0	0	DAO, ANH T PHARMD	11/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	66432	N/A	N/A	N/A	N/A	N/A	14516 BROOKHURST ST	None	WESTMINSTER	CA	92683	5750	00	06000	33.75189794	-117.9548401	Orange County
320962	Ordering, Referring, Prescribing	N/A	1124408513	0	0	DAI, ALLEN PHARMD	12/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72250	N/A	N/A	N/A	N/A	N/A	4080 SAN PABLO AVE	None	HERCULES	CA	94547	3903	00	06000	38.01370523	-122.2728505	Contra Costa County
320979	Ordering, Referring, Prescribing	N/A	1124432505	0	0	DROBNY, MICHELLE DO	7/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17434	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	96001	1441	00	06000	40.5857177	-122.3870781	Shasta County
320983	Ordering, Referring, Prescribing	N/A	1124433321	0	0	DIEP, LE PHARMD	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	70440	N/A	N/A	N/A	N/A	N/A	179 BRANHAM LN	None	SAN JOSE	CA	95136	2300	00	06000	37.26610604	-121.8332166	Santa Clara County
320997	Ordering, Referring, Prescribing	N/A	1124462544	0	0	DAMLE, NEHA MD	7/19/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135928	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY 4TH FLOOR	SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
321025	Ordering, Referring, Prescribing	N/A	1124493242	0	0	DUONG, YUNG D PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64478	N/A	N/A	N/A	N/A	N/A	101 TOWN CENTER PKWY	None	SANTEE	CA	92071	5899	00	06000	32.84028083	-116.9886045	San Diego County
321028	Ordering, Referring, Prescribing	N/A	1124503529	0	0	DANG, VY PHARMD	9/28/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79487	N/A	N/A	N/A	N/A	N/A	2449 W KETTLEMAN LN	None	LODI	CA	95242	4124	00	06000	38.117124	-121.3058115	San Joaquin County
321094	Ordering, Referring, Prescribing	N/A	1124589163	0	0	DUNN, DOMINIQUE L CNP	3/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011512	N/A	N/A	N/A	N/A	N/A	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90209	0000	00	06000	34.07671715	-118.3799413	Los Angeles County
321181	Ordering, Referring, Prescribing	N/A	1134181142	0	0	DONG-MATSUDA, SUZIE X PSYD	8/8/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	LCSW20779	N/A	N/A	N/A	N/A	N/A	9862 CHAPMAN AVE	B	GARDEN GROVE	CA	92841	2726	00	06000	33.78849558	-117.9607338	Orange County
321215	Ordering, Referring, Prescribing	N/A	1134248255	0	0	DICKERSON, CHRISHONE LCSW	7/30/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25184	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
321232	Ordering, Referring, Prescribing	N/A	1134275415	0	0	DELGADO, RICARDO A	3/9/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D35246	N/A	N/A	N/A	N/A	N/A	116 H ST	None	BAKERSFIELD	CA	93304	2910	00	06000	35.35570059	-119.0212668	Kern County
321247	Ordering, Referring, Prescribing	N/A	1134305907	0	0	DROKE, JENELLE M	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50852	N/A	N/A	N/A	N/A	N/A	5416 HOLDENER RD	None	ELMIRA	CA	95625	0551	00	06000	38.3515822	-121.906421	Solano County
321255	Ordering, Referring, Prescribing	N/A	1134326366	0	0	DAMASCO, LEO MD	2/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C183053	N/A	N/A	N/A	N/A	N/A	1315 S ADAMS ST	None	FORT WORTH	TX	76104	4404	00	06000	32.72994159	-97.33672572	Tarrant County
321260	Ordering, Referring, Prescribing	N/A	1134342041	0	0	DEMANDANTE, MILAGROS F MD	11/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90143	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
321261	Ordering, Referring, Prescribing	N/A	1134340821	0	0	DE-LEVI, STACY	8/27/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA17399	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
321262	Ordering, Referring, Prescribing	N/A	1134351000	0	0	DEWESTER, KRISTIN LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	94584	N/A	N/A	N/A	N/A	N/A	6203 SAN IGNACIO AVE	150	SAN JOSE	CA	95119	1371	00	06000	37.23598537	-121.7783065	Santa Clara County
321268	Ordering, Referring, Prescribing	N/A	1134355969	0	0	D'ALESSANDRO, MA DEL CONSU B	6/15/2009	Taxonomy not applicable	NA	n/a	099	DENTIST	D41071	N/A	N/A	N/A	N/A	N/A	7843 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2523	00	06000	34.213581	-118.3878055	Los Angeles County
321286	Ordering, Referring, Prescribing	N/A	1134404585	0	0	DIAZ, JOSE L PHARMD	1/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	63858	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
321299	Ordering, Referring, Prescribing	N/A	1134406044	0	0	DOAN, ELLIE PHARMD	6/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58387	N/A	N/A	N/A	N/A	N/A	24031-A MARGUERTIE PARKW	SUITE A	MISSION VIEJO	CA	92692	1929	00	06000	33.61421128	-117.654341	Orange County
321308	Ordering, Referring, Prescribing	N/A	1134433394	0	0	DAMES, KILA T LMFT	9/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128304	N/A	N/A	N/A	N/A	N/A	1303 W WALNUT PKWY	None	COMPTON	CA	90220	5030	00	06000	33.87724562	-118.2446904	Los Angeles County
321324	Ordering, Referring, Prescribing	N/A	1134482912	0	0	DU, LISA LCSW	4/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100901	N/A	N/A	N/A	N/A	N/A	321 CASSIDY ST	None	OCEANSIDE	CA	92054	5314	00	06000	33.17461079	-117.3631765	San Diego County
321348	Ordering, Referring, Prescribing	N/A	1134513609	0	0	DO, HARRY T DO	5/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17175	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
321470	Ordering, Referring, Prescribing	N/A	1134703382	0	0	DAVID, JOYCE LCSW	2/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121046	N/A	N/A	N/A	N/A	N/A	10717 CAMINO RUIZ	SUITE 207	SAN DIEGO	CA	92126	2360	00	06000	32.91373261	-117.1437822	San Diego County
321471	Ordering, Referring, Prescribing	N/A	1134712151	0	0	DE JESUS, VERNADINE LMFT	11/20/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT151496	N/A	N/A	N/A	N/A	N/A	4401 CRENSHAW BLVD	SUITE 300	LOS ANGELES	CA	90043	1227	00	06000	34.00339495	-118.3318951	Los Angeles County
321529	Ordering, Referring, Prescribing	N/A	1134970254	0	0	DAVIS, LINDA	3/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029596	N/A	N/A	N/A	N/A	N/A	475 BRUCE STREET	None	YREKA	CA	96097	3464	00	06000	41.71860037	-122.6467317	Siskiyou County
321546	Ordering, Referring, Prescribing	N/A	1144217506	0	0	DESAI, KOMAL A MD	6/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71331	N/A	N/A	N/A	N/A	N/A	1600 E BELLE TER	None	BAKERSFIELD	CA	93307	3871	00	06000	35.34672702	-118.9837495	Kern County
321552	Ordering, Referring, Prescribing	N/A	1144248410	0	0	DE JESUS, VIOLETA M MD	7/23/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48057	N/A	N/A	N/A	N/A	N/A	5870 ARLINGTON AVE	None	RIVERSIDE	CA	92504	2037	00	06000	33.94592702	-117.4313099	Riverside County
321574	Ordering, Referring, Prescribing	N/A	1144326612	0	0	DAUR, LANCE R LMFT	4/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38709	N/A	N/A	N/A	N/A	N/A	401 CIVIC CENTER DRIVE,	None	SANTA ANA	CA	92701	3640	00	06000	33.75157353	-117.870921	Orange County
321594	Ordering, Referring, Prescribing	N/A	1144365891	0	0	DREADEN, RITA S NP	2/9/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	238207	N/A	N/A	N/A	N/A	N/A	795 FLETCHER LANE	None	HAYWARD	CA	94544	1008	00	06000	37.66549609	-122.080513	Alameda County
321620	Ordering, Referring, Prescribing	N/A	1144401159	0	0	DEL ALTO, INES LCSW	2/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75265	N/A	N/A	N/A	N/A	N/A	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
321625	Ordering, Referring, Prescribing	N/A	1144430075	0	0	DEL BEL, PAUL T	4/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21977	N/A	N/A	N/A	N/A	N/A	3730 HOPYARD RD	103	PLEASANTON	CA	94588	8562	00	06000	37.68061724	-121.9038915	Alameda County
321637	Ordering, Referring, Prescribing	N/A	1144459140	0	0	DANIEL, ABREY KALA L	10/16/2009	Taxonomy not applicable	NA	n/a	099	DENTIST	D58397	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
321655	Ordering, Referring, Prescribing	N/A	1144505850	0	0	DOAN, TAM PHARMD	1/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51129	N/A	N/A	N/A	N/A	N/A	143 N MAIN STREET	None	MILPITAS	CA	95035	1389	00	06000	37.43224087	-121.9073351	Santa Clara County
321688	Ordering, Referring, Prescribing	N/A	1144572876	0	0	DATU, MELISSA NP	2/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95003243	N/A	N/A	N/A	N/A	N/A	2277 NAPA VALLEJO HWY	None	NAPA	CA	94558	6236	00	06000	38.272905	-122.276601	Napa County
321689	Ordering, Referring, Prescribing	N/A	1144573585	0	0	DILLON, LEAH J LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112430	N/A	N/A	N/A	N/A	N/A	4025 W 226TH ST	None	TORRANCE	CA	90505	2340	00	06000	33.82360754	-118.3560922	Los Angeles County
321695	Ordering, Referring, Prescribing	N/A	1144582677	0	0	DE ROULHAC, JOSEPH G LMFT	7/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92536	N/A	N/A	N/A	N/A	N/A	2321 VISTA MADERA	None	SANTA BARBARA	CA	93101	3932	00	06000	34.42557452	-119.7288495	Santa Barbara County
321715	Ordering, Referring, Prescribing	N/A	1144616251	0	0	DE LA CRUZ, LAURA A NP	7/6/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009407	N/A	N/A	N/A	N/A	N/A	1469 HUMBOLDT RD	SUITE 200	CHICO	CA	95928	9203	00	06000	39.73527137	-121.8156849	Butte County
321730	Ordering, Referring, Prescribing	N/A	1144629890	0	0	DUECK, ALICIA LCSW	6/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95867	N/A	N/A	N/A	N/A	N/A	77 CASA ST	None	SAN LUIS OBISPO	CA	93405	5803	00	06000	35.29306786	-120.6650709	San Luis Obispo County
321773	Ordering, Referring, Prescribing	N/A	1144689175	0	0	DACANAY-HERMAN, ROWENA S NP	8/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	767460	N/A	N/A	N/A	N/A	N/A	2743 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	4624	00	06000	32.66109542	-117.0920417	San Diego County
321801	Ordering, Referring, Prescribing	N/A	1144726415	0	0	DEBBOLD, ERIC M MD	3/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164068	N/A	N/A	N/A	N/A	N/A	545 LAUREL ST	None	SAN DIEGO	CA	92101	1634	00	06000	32.7313635	-117.159705	San Diego County
321803	Ordering, Referring, Prescribing	N/A	1144732231	0	0	DANIELSON, KAILYN J LMFT	12/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117077	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR.	MS 10-270	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
321826	Ordering, Referring, Prescribing	N/A	1144761545	0	0	DELGADO, CINDY M LMFT	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120740	N/A	N/A	N/A	N/A	N/A	1120 W LA VETA AVE	SUITE 660	ORANGE	CA	92868	4231	00	06000	33.78029455	-117.864369	Orange County
321855	Ordering, Referring, Prescribing	N/A	1144802281	0	0	DOAN, NGAN B PHARMD	9/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84136	N/A	N/A	N/A	N/A	N/A	1570 W CAMPBELL AVE	None	CAMPBELL	CA	95008	1528	00	06000	37.28601044	-121.9775527	Santa Clara County
321866	Ordering, Referring, Prescribing	N/A	1144809575	0	0	DEOL, NAVNEET K DO	7/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23192	N/A	N/A	N/A	N/A	N/A	1101 B. GALE WILSON BLV	101C	FAIRFIELD	CA	94533	3700	00	06000	38.26103575	-122.0462501	Solano County
321896	Ordering, Referring, Prescribing	N/A	1144861493	0	0	DHILLON, JASPREET K NP	8/30/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012630	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	100	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
321902	Ordering, Referring, Prescribing	N/A	1144870304	0	0	DONALDSON, DIANDRIA LCSW	8/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117732	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	1500	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
321908	Ordering, Referring, Prescribing	N/A	1144883190	0	0	DIXON, THOMAS MD	9/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	A179768	N/A	N/A	N/A	N/A	N/A	765 THIRD AVE	100	CHULA VISTA	CA	91910	5841	00	06000	32.62545436	-117.0736724	San Diego County
321911	Ordering, Referring, Prescribing	N/A	1144888439	0	0	DEL CID, TYRA LCSW	10/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127017	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVENUE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
321960	Ordering, Referring, Prescribing	N/A	1154078186	0	0	DIRECTO, CHERYL GRACE S CCC-SLP	4/25/2021	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	25771	N/A	N/A	N/A	N/A	N/A	630 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5461	00	06000	34.084494	-117.7191945	Los Angeles County
321985	Ordering, Referring, Prescribing	N/A	1154323715	0	0	DERLET, MIKLA N MD	10/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	A77577	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
321998	Ordering, Referring, Prescribing	N/A	1154360154	0	0	DAVIDSON, WENDY L NP	1/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	NP8632	N/A	N/A	N/A	N/A	N/A	200 SOUTH WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
322013	Ordering, Referring, Prescribing	N/A	1154417244	0	0	DIAZ, LUIS R DC	12/21/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	27597	N/A	N/A	N/A	N/A	N/A	4723 W MAIN ST	None	GUADALUPE	CA	93434	1787	00	06000	34.9576413	-120.5778803	Santa Barbara County
322041	Ordering, Referring, Prescribing	N/A	1154463941	0	0	DILSAVER, STEVEN C MD	4/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G87120	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
322042	Ordering, Referring, Prescribing	N/A	1154462752	0	0	DELGADO, DAVID LCSW	5/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28340	N/A	N/A	N/A	N/A	N/A	776 SOUTH STATE ST.	107	UKIAH	CA	95482	5847	00	06000	39.13987386	-123.2059844	Mendocino County
322044	Ordering, Referring, Prescribing	N/A	1154478303	0	0	DIRKS, CHRISTOPHER LMFT	4/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47601	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	STE 200	SAN MATEO	CA	94403	1269	00	06000	37.54524373	-122.3205511	San Mateo County
322070	Ordering, Referring, Prescribing	N/A	1154516847	0	0	DONATE, REYNA I LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66165	N/A	N/A	N/A	N/A	N/A	144 S L ST	None	DINUBA	CA	93618	2323	00	06000	36.54033313	-119.389607	Tulare County
322083	Ordering, Referring, Prescribing	N/A	1154566842	0	0	DIAZ, XENIA LMFT	1/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC42950	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
322111	Ordering, Referring, Prescribing	N/A	1154607174	0	0	DEBELLIS, MICHAEL H PSYD	9/2/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24336	N/A	N/A	N/A	N/A	N/A	1838 EL CAMINO REAL	SUITE 100	BURLINGAME	CA	94010	3126	00	06000	37.59576691	-122.3841581	San Mateo County
322129	Ordering, Referring, Prescribing	N/A	1154639169	0	0	DIAZ, TANYA PSYD	8/5/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28094	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
322163	Ordering, Referring, Prescribing	N/A	1154707776	0	0	DAVILA, VANESSA LMFT	1/11/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT144328	N/A	N/A	N/A	N/A	N/A	3569 LEXINGTON AVENUE	None	EL MONTE	CA	91731	2607	00	06000	34.0744277	-118.039296	Los Angeles County
322184	Ordering, Referring, Prescribing	N/A	1154740967	0	0	DECKER, ERICA LCSW	10/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86098	N/A	N/A	N/A	N/A	N/A	20 W LUGONIA AVE	None	REDLANDS	CA	92374	2234	00	06000	34.07006848	-117.183051	San Bernardino County
322198	Ordering, Referring, Prescribing	N/A	1154762359	0	0	DO, BICH TRAM N PA	3/26/2020	Taxonomy not applicable	NA	n/a	000	Unknown	55805	N/A	N/A	N/A	N/A	N/A	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	00	06000	33.77387145	-117.9966555	Orange County
322202	Ordering, Referring, Prescribing	N/A	1154768695	0	0	DIXON, MICHAEL A	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83775	N/A	N/A	N/A	N/A	N/A	303 SOUTH C STREE	None	LOMPOC	CA	93436	7305	00	06000	34.63525845	-120.451628	Santa Barbara County
322207	Ordering, Referring, Prescribing	N/A	1154778934	0	0	DANG, JACQUELYN DO	9/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16362	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
322210	Ordering, Referring, Prescribing	N/A	1154779841	0	0	DAVIS, MINDY G LPCC	5/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	11551	N/A	N/A	N/A	N/A	N/A	232 E. GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
322251	Ordering, Referring, Prescribing	N/A	1154850782	0	0	DEWALD, COLIN C PHARMD	3/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75021	N/A	N/A	N/A	N/A	N/A	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	00	06000	38.38851772	-121.9382798	Solano County
322271	Ordering, Referring, Prescribing	N/A	1154837086	0	0	DO CARMO, RAQUEL L LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113085	N/A	N/A	N/A	N/A	N/A	123 W GUTIERREZ ST	None	SANTA BARBARA	CA	93101	3424	00	06000	34.41387023	-119.6962788	Santa Barbara County
322311	Ordering, Referring, Prescribing	N/A	1154957769	0	0	DUMLAO, MAYBEL NP	5/11/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011750	N/A	N/A	N/A	N/A	N/A	1704 W MANCHESTER AVE	#109	LOS ANGELES	CA	90047	3063	00	06000	33.9599425	-118.307079	Los Angeles County
322381	Ordering, Referring, Prescribing	N/A	1164082061	0	0	DOAN, DIANA Q PHARMD	1/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	80544	N/A	N/A	N/A	N/A	N/A	850 WOODSIDE RD	None	REDWOOD CITY	CA	94061	1001	00	06000	37.46555664	-122.2244841	San Mateo County
322385	Ordering, Referring, Prescribing	N/A	1164084646	0	0	DUMPIT, JECEDTHEL PHARMD	9/1/2019	Taxonomy not applicable	NA	n/a	000	Unknown	76851	N/A	N/A	N/A	N/A	N/A	660 S FAIR OAKS AVE	None	SUNNYVALE	CA	94086	7913	00	06000	37.36442862	-122.024102	Santa Clara County
322405	Ordering, Referring, Prescribing	N/A	1164157285	0	0	DIETZE, ALLISON K DDS	12/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	107488	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
322430	Ordering, Referring, Prescribing	N/A	1164299921	0	0	DURON, DANIEL NP	12/11/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028319	N/A	N/A	N/A	N/A	N/A	52 S MAIN ST	None	ANGELS CAMP	CA	95222	9153	00	06000	38.08181342	-120.5580433	Calaveras County
322438	Ordering, Referring, Prescribing	N/A	1164501193	0	0	DOUGLASS, THOMAS W	1/21/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D65057	N/A	N/A	N/A	N/A	N/A	321 VAN DUZEN RD	None	MAD RIVER	CA	95526	9508	00	06000	40.46004463	-123.5301743	Trinity County
322439	Ordering, Referring, Prescribing	N/A	1164505004	0	0	DEWHIRST, JODI L	5/10/2018	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM57	N/A	N/A	N/A	N/A	N/A	63532 29 PALMS HWY	SUITE C	JOSHUA TREE	CA	92252	0000	00	06000	34.13510347	-116.277102	San Bernardino County
322497	Ordering, Referring, Prescribing	N/A	1164601720	0	0	DARDEN, SANDRA C MD	1/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G38798	N/A	N/A	N/A	N/A	N/A	18111 NORDHOFF STREET	None	NORTHRIDGE	CA	91330	8270	00	06000	34.239213	-118.527768	Los Angeles County
322537	Ordering, Referring, Prescribing	N/A	1164687547	0	0	DUMAS, EDGAR LCSW	10/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97346	N/A	N/A	N/A	N/A	N/A	600 S. COMMONWEALTH AVE.	None	LOS ANGELES	CA	90005	4001	00	06000	34.06328086	-118.2856343	Los Angeles County
322572	Ordering, Referring, Prescribing	N/A	1164744520	0	0	DEL BOSQUE, JEFFREY E LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51535	N/A	N/A	N/A	N/A	N/A	125 WEST THOUSAND OAKS B	STE. 500	THOUSAND OAKS	CA	91360	4462	00	06000	34.17854676	-118.8805015	Ventura County
322598	Ordering, Referring, Prescribing	N/A	1164791901	0	0	DU, KIET PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH56619	N/A	N/A	N/A	N/A	N/A	617 WEST 7TH ST	None	LOS ANGELES	CA	90017	3897	00	06000	34.04779593	-118.2573368	Los Angeles County
322611	Ordering, Referring, Prescribing	N/A	1164815643	0	0	DALEY, KAREN P LMFT	7/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106479	N/A	N/A	N/A	N/A	N/A	2818 SAN PABLO AVE.	None	BERKELEY	CA	94702	2204	00	06000	37.85550614	-122.2878659	Alameda County
322615	Ordering, Referring, Prescribing	N/A	1164813796	0	0	DAVIS, REBECCA LMFT	10/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135557	N/A	N/A	N/A	N/A	N/A	17800 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
322653	Ordering, Referring, Prescribing	N/A	1164892600	0	0	DEAK, PATRICK L PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72925	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
322765	Ordering, Referring, Prescribing	N/A	1174077101	0	0	DINH, FRANCIS	6/24/2020	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5690	N/A	N/A	N/A	N/A	N/A	300 N. EUCLID ST	None	FULLERTON	CA	92832	1623	00	06000	33.87250373	-117.9419615	Orange County
322786	Ordering, Referring, Prescribing	N/A	1174116412	0	0	DOTSON, JACQUELINE G NP	8/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026955	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
322891	Ordering, Referring, Prescribing	N/A	1174609614	0	0	DENG, MARIO MD	11/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131427	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
322900	Ordering, Referring, Prescribing	N/A	1174641179	0	0	DODD, APRIL L LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44304	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
322906	Ordering, Referring, Prescribing	N/A	1174652002	0	0	DYER-RUSSELL, MARYELLEN NP	7/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9664	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE.210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
322917	Ordering, Referring, Prescribing	N/A	1174661276	0	0	DHARAMRUP, SHIVIKA PSYD	3/5/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26587	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE	None	BERKELEY	CA	94703	1422	00	06000	37.87060038	-122.2812128	Alameda County
322918	Ordering, Referring, Prescribing	N/A	1174660385	0	0	DELOATCH, CANDYCE MD	1/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125972	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
322920	Ordering, Referring, Prescribing	N/A	1174674071	0	0	DANOVSKY, MICHAEL B PHD	11/12/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15255	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	MB08	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
322942	Ordering, Referring, Prescribing	N/A	1174711576	0	0	DEGENNARO, CATHY D PSYD	12/4/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24645	N/A	N/A	N/A	N/A	N/A	600 S COMMONWEALTH AVE	None	LOS ANGELES	CA	90005	4001	00	06000	34.06328086	-118.2856343	Los Angeles County
322963	Ordering, Referring, Prescribing	N/A	1174753156	0	0	DIAZ, MARIA T	2/7/2013	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	RN0747700	N/A	N/A	N/A	N/A	N/A	1873 COMMERCENTER W	None	SAN BERNARDINO	CA	92408	3303	00	06000	34.067781	-117.286122	San Bernardino County
322980	Ordering, Referring, Prescribing	N/A	1174799449	0	0	DIEBOLD, SARAH C LCSW	4/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29084	N/A	N/A	N/A	N/A	N/A	1556 S SULTANA AVE	None	ONTARIO	CA	91761	4238	00	06000	34.045119	-117.6464565	San Bernardino County
323002	Ordering, Referring, Prescribing	N/A	1174831515	0	0	DEL VIGNA, LAURA LMFT	4/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83510	N/A	N/A	N/A	N/A	N/A	950 W JULIAN ST	None	SAN JOSE	CA	95126	2719	00	06000	37.33352455	-121.9089111	Santa Clara County
323014	Ordering, Referring, Prescribing	N/A	1174858534	0	0	DECLUE, KAREN PA-C	6/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	20524	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
323016	Ordering, Referring, Prescribing	N/A	1174856058	0	0	DUVERNAY, SETH R LMFT	11/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99407	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	SUITE 700	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
323029	Ordering, Referring, Prescribing	N/A	1174879738	0	0	DRALYUK, IRINA MD	5/30/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A136493	N/A	N/A	N/A	N/A	N/A	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	00	06000	33.808185	-118.1850575	Los Angeles County
323042	Ordering, Referring, Prescribing	N/A	1174892855	0	0	DINH, SON H PHARMD	8/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60479	N/A	N/A	N/A	N/A	N/A	210 AMERICAN CANYON RD	None	AMERICAN CANYON	CA	94503	3004	00	06000	38.16545742	-122.2517389	Napa County
323070	Ordering, Referring, Prescribing	N/A	1174926356	0	0	DANG, VINCENT TAI M	3/12/2018	Taxonomy not applicable	NA	n/a	000	Unknown	71562	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	0001	00	06000	43.59860438	-116.1806635	Ada County
323090	Ordering, Referring, Prescribing	N/A	1174950992	0	0	DALY, JOHN P MD	3/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127297	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	0101	00	06000	37.29173129	-121.9584335	Santa Clara County
323160	Ordering, Referring, Prescribing	N/A	1184037202	0	0	DANG, NANCY T OD	7/24/2014	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT14902	N/A	N/A	N/A	N/A	N/A	7761 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92841	4200	00	06000	33.77387145	-117.9966555	Orange County
323163	Ordering, Referring, Prescribing	N/A	1184037996	0	0	DAVENPORT, ZACHARY A LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93386	N/A	N/A	N/A	N/A	N/A	755 SOUTH VAN NESS AVENU	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
323174	Ordering, Referring, Prescribing	N/A	1184054454	0	0	DESAI, MEGHA PHARMD	3/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69390	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
323190	Ordering, Referring, Prescribing	N/A	1184078222	0	0	DANDEKAR, GIOVANNI N MD	6/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151545	N/A	N/A	N/A	N/A	N/A	1503 GRANT RD.	110	MOUNTAIN VIEW	CA	94040	3270	00	06000	37.37672165	-122.0757295	Santa Clara County
323212	Ordering, Referring, Prescribing	N/A	1184100752	0	0	DUEL, DANIEL A MD	11/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164692	N/A	N/A	N/A	N/A	N/A	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	00	06000	34.05373818	-118.3839685	Los Angeles County
323225	Ordering, Referring, Prescribing	N/A	1184121253	0	0	DAY, CHRISTOPHER M MD	6/25/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163862	N/A	N/A	N/A	N/A	N/A	133 WEST MAIN STREET	SUITE 100	EL CAJON	CA	92020	3309	00	06000	32.79492453	-116.9627861	San Diego County
323231	Ordering, Referring, Prescribing	N/A	1184136871	0	0	DUENAS, ISABEL C LMFT	1/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124164	N/A	N/A	N/A	N/A	N/A	50 E FOOTHILL BLVD	STE 300	ARCADIA	CA	91006	2314	00	06000	34.15096965	-118.0295442	Los Angeles County
323239	Ordering, Referring, Prescribing	N/A	1184150633	0	0	DAVIS, WILLIAM B MD	10/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160799	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
323246	Ordering, Referring, Prescribing	N/A	1184155285	0	0	DIEU, HOLLY MD MPH	10/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159955	N/A	N/A	N/A	N/A	N/A	2251 WEST ROSECRANS AVEN	SUITE 18-21	COMPTON	CA	90222	3859	00	06000	33.90273823	-118.2557598	Los Angeles County
323295	Ordering, Referring, Prescribing	N/A	1184249955	0	0	DOLOKSARIBU, PRISCILLA I LCSW	11/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW119351	N/A	N/A	N/A	N/A	N/A	5300 ANGELES VISTA BLVD	None	LOS ANGELES	CA	90043	1648	00	06000	33.99473949	-118.34271	Los Angeles County
323308	Ordering, Referring, Prescribing	N/A	1184268708	0	0	DINH, LE T PA	1/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA57743	N/A	N/A	N/A	N/A	N/A	1578 COLORADO BLVD	13	LOS ANGELES	CA	90041	1451	00	06000	34.13947661	-118.2009328	Los Angeles County
323313	Ordering, Referring, Prescribing	N/A	1184280505	0	0	DAHLBERG, HELEN	10/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57322	N/A	N/A	N/A	N/A	N/A	430 PALORA AVE.	G	YUBA CITY	CA	95991	0000	00	06000	39.1281222	-121.633371	Sutter County
323334	Ordering, Referring, Prescribing	N/A	1184346538	0	0	DOLKAR, SONAM NP	9/12/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022533	N/A	N/A	N/A	N/A	N/A	837 ADDISON ST	None	BERKELEY	CA	94710	2047	00	06000	37.86680859	-122.2969443	Alameda County
323336	Ordering, Referring, Prescribing	N/A	1184352239	0	0	DURAN, MARIANNE M PHARMD	8/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86375	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
323373	Ordering, Referring, Prescribing	N/A	1184493835	0	0	DIAZ, ROSA NP	12/31/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033456	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD	2000	LOS ANGELES	CA	90010	2501	00	06000	34.06170677	-118.302787	Los Angeles County
323413	Ordering, Referring, Prescribing	N/A	1184755852	0	0	DAVALOS, CHRISTIAN C LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52340	N/A	N/A	N/A	N/A	N/A	327 SOUTH K STREET	, ,	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
323414	Ordering, Referring, Prescribing	N/A	1184753121	0	0	DONLON, DEBORAH MD	3/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80414	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
323424	Ordering, Referring, Prescribing	N/A	1184765265	0	0	DUKE, JESSICA A LMFT	2/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC53194	N/A	N/A	N/A	N/A	N/A	720 WOOD STREET	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
323572	Ordering, Referring, Prescribing	N/A	1194035444	0	0	DI DONATO, JENNIFER N LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT95063	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	None	MISSION VIEJO	CA	92691	6441	00	06000	33.56536541	-117.670334	Orange County
323573	Ordering, Referring, Prescribing	N/A	1194038836	0	0	DINH, WENDY H PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64778	N/A	N/A	N/A	N/A	N/A	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	00	06000	33.9040752	-118.1328995	Los Angeles County
323578	Ordering, Referring, Prescribing	N/A	1194051102	0	0	DHESI, CHANDRAJIT LCSW	6/5/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25935	N/A	N/A	N/A	N/A	N/A	555 STEVENSON ST	None	SAN FRANCISCO	CA	94103	1606	00	06000	37.78070506	-122.41099	San Francisco County
323659	Ordering, Referring, Prescribing	N/A	1194192575	0	0	DATASTANYAN, ANI LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114348	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
323695	Ordering, Referring, Prescribing	N/A	1194248476	0	0	DONNEY, PHILIP LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90093	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
323721	Ordering, Referring, Prescribing	N/A	1194299651	0	0	DOWD, LISA RN PHN	1/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	601448	N/A	N/A	N/A	N/A	N/A	1620 HUNTINGTON DR	None	DUARTE	CA	91010	2534	00	06000	34.13958538	-117.9704802	Los Angeles County
323769	Ordering, Referring, Prescribing	N/A	1194445262	0	0	DIAZ, GISELE LPCC	9/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC14775	N/A	N/A	N/A	N/A	N/A	5348 UNIVERSITY AVE	SUITE 108	SAN DIEGO	CA	92105	8025	00	06000	32.74909257	-117.0811685	San Diego County
323782	Ordering, Referring, Prescribing	N/A	1194492033	0	0	D'AGOSTINO-CHAVEZ, MIRANDA J LCSW	10/8/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111927	N/A	N/A	N/A	N/A	N/A	265 S. ANITA DR.	None	ORANGE	CA	92868	3355	00	06000	33.78499409	-117.8811837	Orange County
323813	Ordering, Referring, Prescribing	N/A	1194809426	0	0	DUH, JENNIFER LCSW	11/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25609	N/A	N/A	N/A	N/A	N/A	245 S FETTERLY AVE	None	LOS ANGELES	CA	90022	0000	00	06000	34.03404953	-118.1609476	Los Angeles County
323822	Ordering, Referring, Prescribing	N/A	1194841106	0	0	DE LA TORRE, CHRISTY M LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41368	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2112	00	06000	34.11219143	-118.1709685	Los Angeles County
323908	Ordering, Referring, Prescribing	N/A	1194976449	0	0	DEAN, SHANNON LMFT	9/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86026	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
323918	Ordering, Referring, Prescribing	N/A	1194999334	0	0	DORIAN, PETER J	3/18/2015	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	244	N/A	N/A	N/A	N/A	N/A	5180 N FRESNO ST	STE 102	FRESNO	CA	93710	6853	00	06000	36.81188402	-119.7813379	Fresno County
323921	Ordering, Referring, Prescribing	N/A	1205024445	0	0	DAVIS-PRICKETT, JILL M NP	9/4/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	325446	N/A	N/A	N/A	N/A	N/A	5500 CAMPANILE DRIVE	None	SAN DIEGO	CA	92182	4701	00	06000	32.77590585	-117.0722922	San Diego County
323925	Ordering, Referring, Prescribing	N/A	1205035813	0	0	DIGIOVANNI, DEBORAH	8/20/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45761	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
323926	Ordering, Referring, Prescribing	N/A	1205034287	0	0	DANIEL, EMAD H MD	11/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123454	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
323932	Ordering, Referring, Prescribing	N/A	1205046166	0	0	DIAZ, RELINDIS L LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44102	N/A	N/A	N/A	N/A	N/A	951 BLANCO CIR	B	SALINAS	CA	93901	4451	00	06000	36.65589725	-121.6366313	Monterey County
323952	Ordering, Referring, Prescribing	N/A	1205091402	0	0	DOUGHTY, JAMES A NP	3/27/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	424247	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	FL 29	LOS ANGELES	CA	90017	1644	00	06000	34.05611213	-118.2570905	Los Angeles County
323977	Ordering, Referring, Prescribing	N/A	1205126521	0	0	DONATI, THOMAS G LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT86494	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	150	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
324014	Ordering, Referring, Prescribing	N/A	1205211372	0	0	DIB, DANIELLA LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120008	N/A	N/A	N/A	N/A	N/A	21455 BIRCH STREET	201	HAYWARD	CA	94541	2165	00	06000	37.68159734	-122.0935159	Alameda County
324055	Ordering, Referring, Prescribing	N/A	1205279486	0	0	DAWES, SARAH LCSW	11/9/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110988	N/A	N/A	N/A	N/A	N/A	3576 ARLINGTON AVE	106	RIVERSIDE	CA	92506	3943	00	06000	33.94625192	-117.3913739	Riverside County
324068	Ordering, Referring, Prescribing	N/A	1205303450	0	0	DURAN, LORENA LCSW	10/23/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25926	N/A	N/A	N/A	N/A	N/A	14535 E. WHITTIER BLVD.	None	WHITTIER	CA	90605	2130	00	06000	33.9531254	-118.0149338	Los Angeles County
324088	Ordering, Referring, Prescribing	N/A	1205318805	0	0	DESAI, DHARTI M PHARMD	9/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76924	N/A	N/A	N/A	N/A	N/A	1020 29TH ST STE 140	None	SACRAMENTO	CA	95816	5173	00	06000	38.572803	-121.4685	Sacramento County
324146	Ordering, Referring, Prescribing	N/A	1205418142	0	0	DAINS, MACKENZIE S	5/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021087	N/A	N/A	N/A	N/A	N/A	10121 PINE AVE	None	TRUCKEE	CA	96161	4835	00	06000	39.3245308	-120.2013097	Nevada County
324157	Ordering, Referring, Prescribing	N/A	1205446424	0	0	DUDZIAK, TEAL A NP	1/21/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013743	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
324214	Ordering, Referring, Prescribing	N/A	1205675691	0	0	DEWANE, KATHERINE A MD	12/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL17255	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
324230	Ordering, Referring, Prescribing	N/A	1205846581	0	0	DWIGHT, AILEEN C LCSW	8/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23448	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS ROAD	SUITE 200	CONCORD	CA	94520	5823	00	06000	37.96956948	-122.0507563	Contra Costa County
324233	Ordering, Referring, Prescribing	N/A	1205904406	0	0	DE LUCA, RENE S	9/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104311	N/A	N/A	N/A	N/A	N/A	3491 KURTZ ST	None	SAN DIEGO	CA	92110	4430	00	06000	32.7557948	-117.209639	San Diego County
324240	Ordering, Referring, Prescribing	N/A	1205917887	0	0	DING, SHAO-ZHENG	8/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92756	N/A	N/A	N/A	N/A	N/A	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	00	06000	34.098921	-118.287374	Los Angeles County
324243	Ordering, Referring, Prescribing	N/A	1205921046	0	0	DUONG, HANH PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54820	N/A	N/A	N/A	N/A	N/A	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	00	06000	38.72827776	-121.2904066	Placer County
324250	Ordering, Referring, Prescribing	N/A	1205941481	0	0	DRAKE, DAVID MD	10/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C166230	N/A	N/A	N/A	N/A	N/A	49169 RD 426	None	MADERA	CA	93644	8702	00	06000	37.3300998	-119.650508	Madera
324269	Ordering, Referring, Prescribing	N/A	1205966082	0	0	DINICOLA, DAVID D MD	6/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	G52579	N/A	N/A	N/A	N/A	N/A	9990 COUNTY FARM RD	None	RIVERSIDE	CA	92503	3542	00	06000	33.9201112	-117.4577963	Riverside County
324272	Ordering, Referring, Prescribing	N/A	1205976685	0	0	DELCARMEN, GLENN R MD	4/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G64209	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	GOLETA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
324279	Ordering, Referring, Prescribing	N/A	1215005350	0	0	DOWNS, FAWN K LCSW	12/2/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17649	N/A	N/A	N/A	N/A	N/A	3282 ADELINE STREET	None	BERKELEY	CA	94703	2439	00	06000	37.84898491	-122.2715711	Alameda County
324286	Ordering, Referring, Prescribing	N/A	1215008818	0	0	DAVIDSON SNYDER, JOANNE T LMFT	3/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	33512	N/A	N/A	N/A	N/A	N/A	2132 N REFUGIO RD	None	SANTA YNEZ	CA	93460	9332	00	06000	34.64560756	-120.0971375	Santa Barbara County
324293	Ordering, Referring, Prescribing	N/A	1215015508	0	0	DENNIS, TSHEKEDI G MD	4/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A96369	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	LOS ANGELES	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
324301	Ordering, Referring, Prescribing	N/A	1215040563	0	0	DE ZUBIRIA, RODRIGO MD	2/15/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70728	N/A	N/A	N/A	N/A	N/A	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	00	06000	37.36678073	-120.576731	Merced County
324308	Ordering, Referring, Prescribing	N/A	1215058334	0	0	DEANDA, ABRAM LPCC	6/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7810	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
324337	Ordering, Referring, Prescribing	N/A	1215099890	0	0	DAVIDSON, DEBORAH J	2/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0283551	N/A	N/A	N/A	N/A	N/A	1833 FILLMORE ST	FL 3	SAN FRANCISCO	CA	94115	3181	00	06000	37.78652252	-122.4333821	San Francisco County
324370	Ordering, Referring, Prescribing	N/A	1215191507	0	0	DAVIS, KRISTIN S LMFT	5/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99319	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	#200	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
324375	Ordering, Referring, Prescribing	N/A	1215195110	0	0	DINH, BAO-ANH PHARMD	8/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	50019	N/A	N/A	N/A	N/A	N/A	1071 EL CAMINO REAL	None	REDWOOD CITY	CA	94063	0088	00	06000	37.48446	-122.230134	San Mateo County
324383	Ordering, Referring, Prescribing	N/A	1215205737	0	0	DUONG, AMY C PHARMD	10/10/2018	Taxonomy not applicable	NA	n/a	000	Unknown	52857	N/A	N/A	N/A	N/A	N/A	500 TULLY RD	None	SAN JOSE	CA	95111	1917	00	06000	37.30579894	-121.8506333	Santa Clara County
324449	Ordering, Referring, Prescribing	N/A	1215309794	0	0	DAVIS, BARBARA LCSW	4/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107846	N/A	N/A	N/A	N/A	N/A	590 ANTELOPE BLVD	A40	RED BLUFF	CA	96080	2474	00	06000	40.18602075	-122.2057399	Tehama County
324500	Ordering, Referring, Prescribing	N/A	1215379276	0	0	DARAMOLA, OLUWAYESMISI O NP	8/26/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0683982	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
324541	Ordering, Referring, Prescribing	N/A	1215468327	0	0	DARVISH, RYAN MD	6/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167192	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
324566	Ordering, Referring, Prescribing	N/A	1215493325	0	0	DURAN, JUAN G LMFT	4/25/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT146570	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH RD	K	SANTA FE SPRINGS	CA	90670	3675	00	06000	33.94630253	-118.0832082	Los Angeles County
324573	Ordering, Referring, Prescribing	N/A	1215497656	0	0	DO, MINH-QUAN MD DO	8/30/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20239	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
324625	Ordering, Referring, Prescribing	N/A	1215611777	0	0	DESMUKE, PHILLIP M RN	7/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95085336	N/A	N/A	N/A	N/A	N/A	637 S BALDWIN AVE	A	ARCADIA	CA	91007	3332	00	06000	34.13301223	-118.0545564	Los Angeles County
324647	Ordering, Referring, Prescribing	N/A	1215676085	0	0	DARZI, MARIAM PA	7/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61333	N/A	N/A	N/A	N/A	N/A	165 S. FIRST ST	None	EL CAJON	CA	92019	4795	00	06000	32.794002	-116.944563	San Diego County
324697	Ordering, Referring, Prescribing	N/A	1225119464	0	0	DAMERLA, HANUMANTHARAO MD	11/2/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A69165	N/A	N/A	N/A	N/A	N/A	1900 NORTH SYCAMORE CANY	None	SAN DIMAS	CA	91773	1220	00	06000	34.13204802	-117.7975027	Los Angeles County
324706	Ordering, Referring, Prescribing	N/A	1225152879	0	0	DELICH, KELLY L LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48963	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
324721	Ordering, Referring, Prescribing	N/A	1225160021	0	0	DAGENAIS, DEBORAH J LMFT	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44366	N/A	N/A	N/A	N/A	N/A	1900 SYCAMORE CANYON ROA	None	SAN DIMAS	CA	91773	1299	00	06000	34.13204802	-117.7975027	Los Angeles County
324790	Ordering, Referring, Prescribing	N/A	1225302516	0	0	DAVE, DATTESH R MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147311	N/A	N/A	N/A	N/A	N/A	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	1084	00	06000	38.602089	-121.3925895	Sacramento County
324795	Ordering, Referring, Prescribing	N/A	1225314891	0	0	DEMARE, HEBE	7/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38876	N/A	N/A	N/A	N/A	N/A	5731 W SLAUSON AVE	220	CULVER CITY	CA	90230	6537	00	06000	33.98898953	-118.3818077	Los Angeles County
324805	Ordering, Referring, Prescribing	N/A	1225319791	0	0	DENNIS, BRITTANEY LCSW	11/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72499	N/A	N/A	N/A	N/A	N/A	8300 S VERMONT AVE	1ST FLOOR	LOS ANGELES	CA	90044	3493	00	06000	33.963021	-118.291474	Los Angeles County
324841	Ordering, Referring, Prescribing	N/A	1225398878	0	0	DE LA SERNA, FRANCISCO R LMFT	12/13/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96335	N/A	N/A	N/A	N/A	N/A	3333 SKYPARK DR	220	TORRANCE	CA	90505	5035	00	06000	33.81036565	-118.3466218	Los Angeles County
324891	Ordering, Referring, Prescribing	N/A	1225472764	0	0	DAUGIRDAS, ANDREA MD	3/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138810	N/A	N/A	N/A	N/A	N/A	3220 MISSION AVE	SUITE 1	OCEANSIDE	CA	92058	1351	00	06000	33.2141644	-117.3472638	San Diego County
324899	Ordering, Referring, Prescribing	N/A	1225484975	0	0	DAVIS, DAVID D NP	5/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004297	N/A	N/A	N/A	N/A	N/A	3554 W MT WHITNEY	None	RIVERDALE	CA	93656	0000	00	06000	36.43083157	-119.8619557	Fresno County
324953	Ordering, Referring, Prescribing	N/A	1225553589	0	0	DURAN, JESSICA P LMFT	11/20/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115409	N/A	N/A	N/A	N/A	N/A	849 E. 6TH STREET	None	LOS ANGELES	CA	90021	1026	00	06000	34.03994957	-118.2414778	Los Angeles County
324986	Ordering, Referring, Prescribing	N/A	1225598477	0	0	DOLLAR, KRISTA R MD	5/3/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178314	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
325064	Ordering, Referring, Prescribing	N/A	1235181637	0	0	DALIDA, LILIAN M MD	1/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A36653	N/A	N/A	N/A	N/A	N/A	6833 STOCKTON BLVD	485	SACRAMENTO	CA	95823	2376	00	06000	38.502684	-121.430124	Sacramento County
325078	Ordering, Referring, Prescribing	N/A	1235219254	0	0	DEL ROSARIO, MARIE T PA-C	11/20/2017	Taxonomy not applicable	NA	n/a	000	Unknown	17066	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
325080	Ordering, Referring, Prescribing	N/A	1235230384	0	0	DILLON, TIMOTHY J NP	4/8/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9957	N/A	N/A	N/A	N/A	N/A	2344 6TH ST	None	BERKELEY	CA	94710	2412	00	06000	37.86198466	-122.295766	Alameda County
325097	Ordering, Referring, Prescribing	N/A	1235267980	0	0	DYAB, OMAR J	8/27/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D58950	N/A	N/A	N/A	N/A	N/A	343 OAK ST	None	RED BLUFF	CA	96080	3304	00	06000	40.17616563	-122.2349564	Tehama County
325123	Ordering, Referring, Prescribing	N/A	1235328972	0	0	DAFTARI, SHERRY L LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104001	N/A	N/A	N/A	N/A	N/A	9412 BIG HORN BLVD	6	ELK GROVE	CA	95758	1101	00	06000	38.415861	-121.407957	Sacramento County
325135	Ordering, Referring, Prescribing	N/A	1235336215	0	0	DORADEA, JAIME A LCSW	1/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93663	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
325156	Ordering, Referring, Prescribing	N/A	1235383217	0	0	DANI-COX, SONI LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101317	N/A	N/A	N/A	N/A	N/A	3711 LONG BEACH BLVD	6041	LONG BEACH	CA	90807	3315	00	06000	33.824583	-118.1893785	Los Angeles County
325196	Ordering, Referring, Prescribing	N/A	1235440058	0	0	DOYLE, CAROLYN MD	1/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130992	N/A	N/A	N/A	N/A	N/A	1333 WILLOW PASS RD	102	CONCORD	CA	94520	7930	00	06000	37.96924618	-122.051411	Contra Costa County
325208	Ordering, Referring, Prescribing	N/A	1235470402	0	0	DEFOE, HILDA NP	3/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029460	N/A	N/A	N/A	N/A	N/A	470 NOOR AVE	SUITE B #1057	SOUTH SAN FRANCIS	CA	94080	5916	00	06000	37.64110105	-122.4220074	San Mateo County
325215	Ordering, Referring, Prescribing	N/A	1235478710	0	0	DOOLEY, PAUL LMFT	8/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT92603	N/A	N/A	N/A	N/A	N/A	50100 GOLSH RD	None	VALLEY CENTER	CA	92082	5338	00	06000	33.27715948	-116.9618201	San Diego County
325216	Ordering, Referring, Prescribing	N/A	1235480492	0	0	DININO, KERI A PA-C	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA22699	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
325221	Ordering, Referring, Prescribing	N/A	1235489972	0	0	DIAZ, TABITHA E PSYD	11/18/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28990	N/A	N/A	N/A	N/A	N/A	255 W BROADWAY	SUITE 155	GLENDALE	CA	91204	1320	00	06000	34.14687162	-118.2575368	Los Angeles County
325225	Ordering, Referring, Prescribing	N/A	1235488313	0	0	DELGADO, MANUEL R LMFT	2/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106373	N/A	N/A	N/A	N/A	N/A	101 S B ST	None	LOMPOC	CA	93436	6933	00	06000	34.63860089	-120.4503641	Santa Barbara County
325238	Ordering, Referring, Prescribing	N/A	1235515123	0	0	DODD, SARAH PHD	11/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32229	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
325283	Ordering, Referring, Prescribing	N/A	1235578311	0	0	DE CRISTOFERI, DAYNA L LMFT	3/13/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48873	N/A	N/A	N/A	N/A	N/A	18144 SECO ST	None	JAMESTOWN	CA	95327	9737	00	06000	37.95208073	-120.4216785	Tuolumne County
325293	Ordering, Referring, Prescribing	N/A	1235586058	0	0	DANESH, MELISSA MD	4/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172317	N/A	N/A	N/A	N/A	N/A	3301 C STREET	1300	SACRAMENTO	CA	95816	3300	00	06000	38.579877	-121.456143	Sacramento County
325301	Ordering, Referring, Prescribing	N/A	1235614884	0	0	DAO, MAILAN PHARMD	10/2/2018	Taxonomy not applicable	NA	n/a	000	Unknown	61679	N/A	N/A	N/A	N/A	N/A	976 LENZEN AVE	1400	SAN JOSE	CA	95126	2737	00	06000	37.33463902	-121.9121497	Santa Clara County
325311	Ordering, Referring, Prescribing	N/A	1235624255	0	0	DON-PEDRO, DATA O MD	8/10/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174423	N/A	N/A	N/A	N/A	N/A	2811 H ST	None	BAKERSFIELD	CA	93301	1913	00	06000	35.38526604	-119.021172	Kern County
325381	Ordering, Referring, Prescribing	N/A	1235770504	0	0	DOUCETTE, SUSAN M LCSW	12/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91467	N/A	N/A	N/A	N/A	N/A	157 N GLENDORA AVE	None	GLENDORA	CA	91741	3383	00	06000	34.13760029	-117.8655422	Los Angeles County
325386	Ordering, Referring, Prescribing	N/A	1235781279	0	0	DOBBERT, CHLOE J LMFT	4/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132123	N/A	N/A	N/A	N/A	N/A	9445 FAIRWAY VIEW PL	100	RANCHO CUCAMONGA	CA	91730	0929	00	06000	34.08193054	-117.5597308	San Bernardino County
325397	Ordering, Referring, Prescribing	N/A	1235801242	0	0	DECASTRO, BRANDON D PHARMD	9/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85098	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
325404	Ordering, Referring, Prescribing	N/A	1235831678	0	0	DOAN, NHU Y T MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197292	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
325429	Ordering, Referring, Prescribing	N/A	1245044775	0	0	DANG, DAVID PHARMD	2/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	84636	N/A	N/A	N/A	N/A	N/A	500 TULLY RD	None	SAN JOSE	CA	95111	1917	00	06000	37.30579894	-121.8506333	Santa Clara County
325444	Ordering, Referring, Prescribing	N/A	1245091040	0	0	DOUGAN, DANIELLE	7/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64767	N/A	N/A	N/A	N/A	N/A	398 SOUTH GREEN VALLEY R	None	WATSONVILLE	CA	95076	0000	00	06000	36.93055964	-121.7769628	Santa Cruz County
325515	Ordering, Referring, Prescribing	N/A	1245408764	0	0	DO, HAI PA	11/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	19755	N/A	N/A	N/A	N/A	N/A	7600 HOSPITAL	J-1	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
325518	Ordering, Referring, Prescribing	N/A	1245420074	0	0	DALE, KELLY	5/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	17348	N/A	N/A	N/A	N/A	N/A	444 BRUCE STREET	None	YREKA	CA	96097	3450	00	06000	41.71863548	-122.6458755	Siskiyou County
325630	Ordering, Referring, Prescribing	N/A	1245608215	0	0	DIEP, ANITA X PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73082	N/A	N/A	N/A	N/A	N/A	1401 BROADWAY	None	SACRAMENTO	CA	95818	2219	00	06000	38.562516	-121.494375	Sacramento County
325695	Ordering, Referring, Prescribing	N/A	1245723741	0	0	DWARSHUIS, ASHLEY J LCSW	4/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101080	N/A	N/A	N/A	N/A	N/A	2275 ARLINGTON DR.	None	SAN LEANDRO	CA	94578	1132	00	06000	37.70851907	-122.1117036	Alameda County
325745	Ordering, Referring, Prescribing	N/A	1245773670	0	0	DIAZ NAVARRO, LUPITA NP	6/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	783423	N/A	N/A	N/A	N/A	N/A	200 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8344	00	06000	34.065126	-118.446237	Los Angeles County
325749	Ordering, Referring, Prescribing	N/A	1245780014	0	0	DEMERTZIS, KELI M LMFT	7/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133622	N/A	N/A	N/A	N/A	N/A	160 EAST VIRGINIA STREET	None	SAN JOSE	CA	95112	5817	00	06000	37.32582868	-121.8777868	Santa Clara County
325818	Ordering, Referring, Prescribing	N/A	1245896877	0	0	DENG, AUSTIN PA-C	9/20/2019	Taxonomy not applicable	NA	n/a	000	Unknown	57230	N/A	N/A	N/A	N/A	N/A	263 S WEST ST	None	TULARE	CA	93274	3411	00	06000	36.20460711	-119.3668926	Tulare County
325865	Ordering, Referring, Prescribing	N/A	1255058848	0	0	DZIDA, CHANDLER A LCSW	2/21/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121123	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
325877	Ordering, Referring, Prescribing	N/A	1255090379	0	0	DANTE, CAILEY PA-C	5/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61105	N/A	N/A	N/A	N/A	N/A	3798 JANES ROAD	20	ARCATA	CA	95521	4742	00	06000	40.89649119	-124.0930501	Humboldt County
325993	Ordering, Referring, Prescribing	N/A	1255597928	0	0	DEASIS, RUDY F LMFT	7/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52021	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD.,	1ST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
326010	Ordering, Referring, Prescribing	N/A	1255620241	0	0	DOTY, DANIELLE C PHARMD	11/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51500	N/A	N/A	N/A	N/A	N/A	989 SUNRISE AVENUE	None	ROSEVILLE	CA	95661	0000	00	06000	38.73110774	-121.272042	Placer County
326027	Ordering, Referring, Prescribing	N/A	1255649430	0	0	DURAN, GEORGINA V LCSW	1/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93932	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
326031	Ordering, Referring, Prescribing	N/A	1255663613	0	0	DURAN, GRETCHEN M	5/1/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA20814	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
326043	Ordering, Referring, Prescribing	N/A	1255674982	0	0	DOAN, LOUIS A DO	2/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16080	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
326048	Ordering, Referring, Prescribing	N/A	1255693933	0	0	DAVIS, AMBER A LCSW	10/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75174	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DRIVE	3RD FLOOR-142	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
326053	Ordering, Referring, Prescribing	N/A	1255707980	0	0	DE CASAS, CLAUDIA E LCSW	6/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102090	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	0001	00	06000	33.9664185	-118.2477481	Los Angeles County
326074	Ordering, Referring, Prescribing	N/A	1255729760	0	0	DOSS, CHRISTINE L LCSW	8/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64005	N/A	N/A	N/A	N/A	N/A	1902 HOWARD ROAD	None	MADERA	CA	93637	5123	00	06000	36.95265804	-120.0811038	Madera County
326135	Ordering, Referring, Prescribing	N/A	1255833463	0	0	DUPEY, CLAIRE E	9/14/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	104927	N/A	N/A	N/A	N/A	N/A	4050 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.5582775	-117.046881	San Diego County
326175	Ordering, Referring, Prescribing	N/A	1255884763	0	0	DHULIA, UMADEVI PHARMD	1/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	62421	N/A	N/A	N/A	N/A	N/A	1233 E YORBA LINDA BLVD	1233 E YORBA LINDA BLVD	PLACENTIA	CA	92870	3830	00	06000	33.8884683	-117.8406527	Orange County
326198	Ordering, Referring, Prescribing	N/A	1255915716	0	0	DIBIASE, ROBIN NP	10/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95017297	N/A	N/A	N/A	N/A	N/A	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	00	06000	35.24853234	-120.642458	San Luis Obispo County
326201	Ordering, Referring, Prescribing	N/A	1255919650	0	0	DURALI, NASSIM MD	2/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194099	N/A	N/A	N/A	N/A	N/A	1550 SUPERIOR AVENUE COS	None	COSTA MESA	CA	92627	3653	00	06000	33.63305341	-117.9266303	Orange County
326217	Ordering, Referring, Prescribing	N/A	1255953311	0	0	DIAZ, SHERYL LYNN DO	10/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22220	N/A	N/A	N/A	N/A	N/A	3737 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3513	00	06000	33.92872742	-118.2006921	Los Angeles County
326243	Ordering, Referring, Prescribing	N/A	1265005110	0	0	DAVIS, WENDY NP	8/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017988	N/A	N/A	N/A	N/A	N/A	645 ANTELOPE BLVD	STE 24	RED BLUFF	CA	96080	2463	00	06000	40.18587226	-122.2021426	Tehama County
326256	Ordering, Referring, Prescribing	N/A	1265045512	0	0	DANIELIAN, MARIE PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81748	N/A	N/A	N/A	N/A	N/A	5224 COLDWATER CANYON AV	None	VAN NUYS	CA	91401	6146	00	06000	34.165512	-118.4137725	Los Angeles County
326257	Ordering, Referring, Prescribing	N/A	1265048375	0	0	DOERKEN, DAVID LMFT	3/7/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145657	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
326277	Ordering, Referring, Prescribing	N/A	1265094486	0	0	DO, BAO NGOC PHARMD	6/18/2019	Taxonomy not applicable	NA	n/a	000	Unknown	80595	N/A	N/A	N/A	N/A	N/A	5625 GOSFORD RD	None	BAKERSFIELD	CA	93313	4999	00	06000	35.304183	-119.0954835	Kern County
326301	Ordering, Referring, Prescribing	N/A	1265175616	0	0	DUTAN, HEYDI DDS	7/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108928	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	K	SACRAMENTO	CA	95820	4756	00	06000	38.526282	-121.471398	Sacramento County
326311	Ordering, Referring, Prescribing	N/A	1265211155	0	0	DAVIDSON, JILL CNP	9/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027431	N/A	N/A	N/A	N/A	N/A	751 LOMBARDI COURT	None	SANTA ROSA	CA	95407	6798	00	06000	38.427804	-122.7493035	Sonoma County
326318	Ordering, Referring, Prescribing	N/A	1265252464	0	0	DEVILE, MICHELLE	8/30/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031975	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6320	00	06000	34.1015865	-118.328976	Los Angeles County
326333	Ordering, Referring, Prescribing	N/A	1265449607	0	0	DREXLER, BRAD MD	3/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G55235	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
326346	Ordering, Referring, Prescribing	N/A	1265501266	0	0	DE JESUS, ERNESTO PHARMD	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59092	N/A	N/A	N/A	N/A	N/A	13463 WASHINGTON BLVD	None	MARINA DEL REY	CA	90292	5658	00	06000	33.993054	-118.4472405	Los Angeles County
326435	Ordering, Referring, Prescribing	N/A	1265705230	0	0	DO, TRACY PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60560	N/A	N/A	N/A	N/A	N/A	1745 UNIVERSITY	None	RIVERSIDE	CA	92507	0000	00	06000	33.97576049	-117.349551	Riverside County
326450	Ordering, Referring, Prescribing	N/A	1265714208	0	0	DABABNEH, HANNAN M LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86130	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
326451	Ordering, Referring, Prescribing	N/A	1265715882	0	0	DELLER, ELIZABETH	12/11/2017	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	17723	N/A	N/A	N/A	N/A	N/A	5150 E LA PALMA AVE	STE 108	ANAHEIM	CA	92807	2085	00	06000	33.85947351	-117.805545	Orange County
326484	Ordering, Referring, Prescribing	N/A	1265767933	0	0	DONOHUE, JESSICA R LCSW	6/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29604	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
326506	Ordering, Referring, Prescribing	N/A	1265807762	0	0	DE BRIER, LISA A M NP	12/8/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	558601	N/A	N/A	N/A	N/A	N/A	2933 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	4243	00	06000	33.97760919	-117.3651828	Riverside County
326510	Ordering, Referring, Prescribing	N/A	1265811616	0	0	DOCKEN, SHEQUITA NP	9/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015726	N/A	N/A	N/A	N/A	N/A	304 BECKY PEASE	None	KETTLEMAN CITY	CA	93239	0000	00	06000	36.009459	-119.9602025	Kings County
326565	Ordering, Referring, Prescribing	N/A	1265896005	0	0	DINOVITZ, MATTHEW S MD	8/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A169843	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE STE 100	STE 100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
326579	Ordering, Referring, Prescribing	N/A	1265914139	0	0	DRUMMOND, HANNAH M LPCC	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	9915	N/A	N/A	N/A	N/A	N/A	4660 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1638	00	06000	32.82425423	-117.121121	San Diego County
326582	Ordering, Referring, Prescribing	N/A	1265921365	0	0	DAVIS, DEIRDRE MD	10/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165432	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
326593	Ordering, Referring, Prescribing	N/A	1265927578	0	0	DEAN, MOENA OD	9/17/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33955	N/A	N/A	N/A	N/A	N/A	11717 BERNARDO PLAZA COU	STE 105	SAN DIEGO	CA	92128	2419	00	06000	33.01929872	-117.0777714	San Diego County
326605	Ordering, Referring, Prescribing	N/A	1265970875	0	0	DIAZ, VERONICA LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117147	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
326749	Ordering, Referring, Prescribing	N/A	1275338436	0	0	DURLING, REBECCA NP	2/11/2025	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033982	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
326754	Ordering, Referring, Prescribing	N/A	1275395741	0	0	DUBEY, SHREEN	1/17/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028723	N/A	N/A	N/A	N/A	N/A	625 HILBY AVE	None	SEASIDE	CA	93955	5720	00	06000	36.60257396	-121.8495595	Monterey County
326756	Ordering, Referring, Prescribing	N/A	1275357097	0	0	DE LEON, JAMIE ROSE RDH	10/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	37028	N/A	N/A	N/A	N/A	N/A	2835 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	7404	00	06000	32.66005945	-117.0916421	San Diego County
326763	Ordering, Referring, Prescribing	N/A	1275545451	0	0	DUENAS, DEBORAH I LMFT	11/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34067	N/A	N/A	N/A	N/A	N/A	2 FIFER AVE	240	CORTE MADERA	CA	94925	1153	00	06000	37.93844293	-122.5188738	Marin County
326766	Ordering, Referring, Prescribing	N/A	1275561417	0	0	DUONG, HONG MD	6/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A65844	N/A	N/A	N/A	N/A	N/A	11100 WARNER AVE,	116	FOUNTAIN VALLEY	CA	92708	7500	00	06000	33.716291	-117.9355051	Orange County
326791	Ordering, Referring, Prescribing	N/A	1275628893	0	0	DAVENPORT, STACY L LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	23732	N/A	N/A	N/A	N/A	N/A	8058 LEMON AVENUE	None	LA MESA	CA	91941	6439	00	06000	32.76278258	-117.0237823	San Diego County
326872	Ordering, Referring, Prescribing	N/A	1275810442	0	0	DIAZ, CLAUDIA C LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99791	N/A	N/A	N/A	N/A	N/A	302 CHERRY LN	STE 101	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
326915	Ordering, Referring, Prescribing	N/A	1275878159	0	0	DE JESUS, DAISY C LMFT	11/17/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109995	N/A	N/A	N/A	N/A	N/A	43520 DIVISION ST	None	LANCASTER	CA	93535	4089	00	06000	34.673445	-118.130143	Los Angeles County
326935	Ordering, Referring, Prescribing	N/A	1275898868	0	0	DRAKE, LORI DPM	1/9/2024	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5317	N/A	N/A	N/A	N/A	N/A	22044 CEDAR ROAD	None	SONORA	CA	95370	5908	00	06000	37.98532934	-120.3651951	Tuolumne County
326953	Ordering, Referring, Prescribing	N/A	1275901928	0	0	DAVIS, ALYCIA M PSYD	12/4/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30006	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVE	None	LOS ANGELES	CA	90095	7142	00	06000	34.0605595	-118.4499527	Los Angeles County
326962	Ordering, Referring, Prescribing	N/A	1275934242	0	0	DING, MICHELLE X PHARMD	1/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	71991	N/A	N/A	N/A	N/A	N/A	529 MAPLE AVE	None	LOS ANGELES	CA	90013	1511	00	06000	34.04465262	-118.2472846	Los Angeles County
327006	Ordering, Referring, Prescribing	N/A	1275997405	0	0	DE LA OSSA ARRIETA, FARID ANTONIO LCSW	5/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108012	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE	None	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
327067	Ordering, Referring, Prescribing	N/A	1285074740	0	0	DORN, TIA J MD	10/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	C172318	N/A	N/A	N/A	N/A	N/A	7592 BROADWAY	None	LEMON GROVE	CA	91945	1604	00	06000	32.74274487	-117.0345359	San Diego County
327076	Ordering, Referring, Prescribing	N/A	1285085084	0	0	DRAKE, BRANDY L NP	10/25/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	691883	N/A	N/A	N/A	N/A	N/A	320 JAMES ST	None	SHAFTER	CA	93263	2033	00	06000	35.50330762	-119.2772354	Kern County
327077	Ordering, Referring, Prescribing	N/A	1285094342	0	0	DAVIS, BRANDI LMFT	12/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112153	N/A	N/A	N/A	N/A	N/A	5266 HOLLISTER AVE	STE 210	SANTA BARBARA	CA	93111	4040	00	06000	34.43497016	-119.8071895	Santa Barbara County
327111	Ordering, Referring, Prescribing	N/A	1285144253	0	0	DENNIS, MARIAH G LMFT	8/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120732	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
327125	Ordering, Referring, Prescribing	N/A	1285173849	0	0	DOWNING, CHRISTINA B DO	2/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16729	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
327127	Ordering, Referring, Prescribing	N/A	1285174003	0	0	DE OLIVEIRA, JEAN PIERRE R LPCC	9/30/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8570	N/A	N/A	N/A	N/A	N/A	6276 ROBIN COURT	None	PLEASANTON	CA	94588	4454	00	06000	37.68442814	-121.9061133	Alameda County
327137	Ordering, Referring, Prescribing	N/A	1285176180	0	0	DICE, ERIC LCSW	6/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123523	N/A	N/A	N/A	N/A	N/A	3665 KEARNEY VILLA RD	SUITE 101	SAN DIEGO	CA	92123	4711	00	06000	32.80816826	-117.1510112	San Diego County
327142	Ordering, Referring, Prescribing	N/A	1285196832	0	0	DRUTMAN, BRITTANY DO	4/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL1189	N/A	N/A	N/A	N/A	N/A	455 O'CONNOR DR	SUITE 200	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
327144	Ordering, Referring, Prescribing	N/A	1285208579	0	0	DARGA, MARIE N LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52196	N/A	N/A	N/A	N/A	N/A	3125 MYERS ST.	None	RIVERSIDE	CA	92503	5527	00	06000	33.90932558	-117.4428095	Riverside County
327214	Ordering, Referring, Prescribing	N/A	1285362434	0	0	DAM, QUYNH H PHARMD	4/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85164	N/A	N/A	N/A	N/A	N/A	3430 E LA PALMA AVE	BLDG 2 FL-6 RM 6791	ANAHEIM	CA	92806	2020	00	06000	33.852105	-117.8444835	Orange County
327231	Ordering, Referring, Prescribing	N/A	1285465070	0	0	D'ALBERTI, MATTHEW NP	6/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030488	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
327261	Ordering, Referring, Prescribing	N/A	1285684738	0	0	DERENNE, JENNIFER L MD	10/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54949	N/A	N/A	N/A	N/A	N/A	2569 STATE ST	1012	CARLSBAD	CA	92008	1624	00	06000	33.16439191	-117.3526809	San Diego County
327263	Ordering, Referring, Prescribing	N/A	1285711259	0	0	DAVIS, CATHERINE	8/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	6234	N/A	N/A	N/A	N/A	N/A	4555 PRECISSI LANE	None	STOCKTON	CA	95207	0000	00	06000	37.98919284	-121.3152121	San Joaquin County
327285	Ordering, Referring, Prescribing	N/A	1285722942	0	0	DIESELDORFF, JESSICA R	5/28/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0548205	N/A	N/A	N/A	N/A	N/A	398 S GREEN VALLEY RD	None	SAN JOSE	CA	95076	3099	00	06000	36.93055964	-121.7769628	Santa Cruz County
327289	Ordering, Referring, Prescribing	N/A	1285758458	0	0	DAMIANI, CINDY S LMFT	5/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41321	N/A	N/A	N/A	N/A	N/A	1000 S MAIN ST	105	SALINAS	CA	93901	2352	00	06000	36.66226091	-121.6578913	Monterey County
327291	Ordering, Referring, Prescribing	N/A	1285764365	0	0	DANG, LANA PHARMD	1/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	52838	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
327306	Ordering, Referring, Prescribing	N/A	1285801365	0	0	DAVIS, KRISTY L LMFT	12/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129582	N/A	N/A	N/A	N/A	N/A	3400 DOUGLAS BLVD.	SUITE # 225	ROSEVILLE	CA	95661	0000	00	06000	38.74390969	-121.2319271	Placer County
327315	Ordering, Referring, Prescribing	N/A	1285821660	0	0	DANIELS, SARAH M LMFT	7/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49355	N/A	N/A	N/A	N/A	N/A	9601 KIEFER BLVD	None	SACRAMENTO	CA	95827	3818	00	06000	38.54628	-121.3397415	Sacramento County
327318	Ordering, Referring, Prescribing	N/A	1285827642	0	0	DOW, BRIAN M PHD	2/11/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24975	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD.	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
327327	Ordering, Referring, Prescribing	N/A	1285844381	0	0	DIAMOND, MARC J LCSW	5/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21820	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DR.	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
327358	Ordering, Referring, Prescribing	N/A	1285912709	0	0	DANG, LY P PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51765	N/A	N/A	N/A	N/A	N/A	16505 SIERRA LAKES PKWY	None	FONTANA	CA	92336	1256	00	06000	34.13859931	-117.4438742	San Bernardino County
327375	Ordering, Referring, Prescribing	N/A	1285925883	0	0	DOCTOR, NIRAJ S MD	11/13/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123667	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4048	00	06000	35.407179	-119.0208925	Kern County
327387	Ordering, Referring, Prescribing	N/A	1285941898	0	0	DUNNIGAN, RYAN G PSYD	6/15/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27458	N/A	N/A	N/A	N/A	N/A	3270 KERNER BLVD	A	SAN RAFAEL	CA	94901	4840	00	06000	37.96108677	-122.5017451	Marin County
327399	Ordering, Referring, Prescribing	N/A	1285969360	0	0	DEL CID, ROSA P LCSW	4/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21203	N/A	N/A	N/A	N/A	N/A	4205 W. FIGARDEN DRIVE	None	FRESNO	CA	93722	6051	00	06000	36.82930754	-119.8669532	Fresno County
327551	Ordering, Referring, Prescribing	N/A	1295252799	0	0	DORR, AMY M LMFT	3/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138301	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
327553	Ordering, Referring, Prescribing	N/A	1295255495	0	0	DIMAGMALIW, RUTH CHRISTINE T LMFT	7/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119569	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	460	OAKLAND	CA	94607	4033	00	06000	37.80185548	-122.2726866	Alameda County
327554	Ordering, Referring, Prescribing	N/A	1295255826	0	0	DEFLORIMONTE, MICHELLE C NP	3/2/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	714786	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3314	00	06000	38.62757555	-122.8638141	Sonoma County
327567	Ordering, Referring, Prescribing	N/A	1295275048	0	0	DIMAYA, CHARLOTTE N NP	5/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003590	N/A	N/A	N/A	N/A	N/A	5504 MONTEREY HWY	None	SAN JOSE	CA	95138	1529	00	06000	37.2546727	-121.8004013	Santa Clara County
327581	Ordering, Referring, Prescribing	N/A	1295300721	0	0	DUPLECHAIN, LINDSAY LCSW	7/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	123939	N/A	N/A	N/A	N/A	N/A	617 BAYONET CIR	None	MARINA	CA	93933	4600	00	06000	36.66749919	-121.7783765	Monterey County
327633	Ordering, Referring, Prescribing	N/A	1295440998	0	0	DOHM, KRISTEN C PA-C	3/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62554	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
327644	Ordering, Referring, Prescribing	N/A	1295494383	0	0	DELGADO, ANGELA L	9/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018307	N/A	N/A	N/A	N/A	N/A	518 GARDEN ST	None	SANTA BARBARA	CA	93101	0000	00	06000	34.42054634	-119.6928135	Santa Barbara County
327667	Ordering, Referring, Prescribing	N/A	1295746295	0	0	DEMAIO, PATRICIA NP	10/28/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013148	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
327696	Ordering, Referring, Prescribing	N/A	1295828291	0	0	DINGILIAN, JOHN R MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G75774	N/A	N/A	N/A	N/A	N/A	2750 SYCAMORE DR	STE 202	SIMI VALLEY	CA	93065	1500	00	06000	34.28529962	-118.7437672	Ventura County
327702	Ordering, Referring, Prescribing	N/A	1295857217	0	0	DARNELL, JENYN LMFT	5/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42743	N/A	N/A	N/A	N/A	N/A	4250 FOWLER LANE	204	DIAMOND SPRINGS	CA	95619	1987	00	06000	38.69331583	-120.8130299	El Dorado County
327722	Ordering, Referring, Prescribing	N/A	1295879971	0	0	DIAZ-BLANCHARD, SUJEY LCSW	6/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70536	N/A	N/A	N/A	N/A	N/A	5400 E. OLYMPIC BLVD	FIRST FLOOR	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
327726	Ordering, Referring, Prescribing	N/A	1295881738	0	0	DAVIS, JAMES M DC	12/27/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	12649	N/A	N/A	N/A	N/A	N/A	4723 W MAIN ST	STE H	GUADALUPE	CA	93434	1787	00	06000	34.9576413	-120.5778803	Santa Barbara County
327782	Ordering, Referring, Prescribing	N/A	1306016902	0	0	DEXTER, SCOTT R	11/12/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D55242	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
327788	Ordering, Referring, Prescribing	N/A	1306036926	0	0	DANIEL, ASHLEA B NP	9/11/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12833	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
327838	Ordering, Referring, Prescribing	N/A	1306129655	0	0	DRNEK, BRITTANY P LCSW	11/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87298	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	LOS ANGELES	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
327847	Ordering, Referring, Prescribing	N/A	1306146022	0	0	DANG, KHANH PHARMD	3/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	60238	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
327899	Ordering, Referring, Prescribing	N/A	1306226105	0	0	DIGGS, LYNIECE LMFT	8/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120679	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
327906	Ordering, Referring, Prescribing	N/A	1306232921	0	0	DE LEON, ADILENE LCSW	2/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120895	N/A	N/A	N/A	N/A	N/A	12966 EUCLID ST	STE 280	GARDEN GROVE	CA	92840	9202	00	06000	33.77455935	-117.9378298	Orange County
327912	Ordering, Referring, Prescribing	N/A	1306241435	0	0	DOMINGUEZ, ALICIA E LCSW	10/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83413	N/A	N/A	N/A	N/A	N/A	801 E KATELLA AVE	None	ANAHEIM	CA	92805	6614	00	06000	33.80344749	-117.8986365	Orange County
327915	Ordering, Referring, Prescribing	N/A	1306244900	0	0	DARDICK, SARAH LMFT	1/6/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107221	N/A	N/A	N/A	N/A	N/A	1382 BLUE OAKS BLVD	STE 213	ROSEVILLE	CA	95678	7019	00	06000	38.79554586	-121.3118864	Placer County
327922	Ordering, Referring, Prescribing	N/A	1306256292	0	0	DIETZ, ROBIN L MD	8/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A142724	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
327960	Ordering, Referring, Prescribing	N/A	1306318902	0	0	DELEON, OMAR PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80005	N/A	N/A	N/A	N/A	N/A	3830 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3625	00	06000	33.92753236	-118.1975459	Los Angeles County
328005	Ordering, Referring, Prescribing	N/A	1306409792	0	0	DALILI, GOLNOOSH	9/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	79006	N/A	N/A	N/A	N/A	N/A	2795 FLORAL AVE	None	SELMA	CA	93662	2675	00	06000	36.57639181	-119.6264901	Fresno County
328012	Ordering, Referring, Prescribing	N/A	1306428131	0	0	DUFFIELD, GARY LAC	11/1/2021	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18996	N/A	N/A	N/A	N/A	N/A	201 S HARBOR BLVD	None	LA HABRA	CA	90631	5654	00	06000	33.93029897	-117.9331306	Orange County
328018	Ordering, Referring, Prescribing	N/A	1306454640	0	0	DHILLON, AMANDEEP NP	6/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95014736	N/A	N/A	N/A	N/A	N/A	9416 ROAD 238	None	TERRA BELLA	CA	93270	9416	00	06000	35.96072962	-119.0399481	Tulare County
328044	Ordering, Referring, Prescribing	N/A	1306498894	0	0	DAPPOLONIA, MICHAEL S NP	4/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012026	N/A	N/A	N/A	N/A	N/A	1891 EFFIE ST	None	LOS ANGELES	CA	90026	1711	00	06000	34.08461594	-118.2570874	Los Angeles County
328077	Ordering, Referring, Prescribing	N/A	1306602743	0	0	DO, CONNIE PHARMD	6/27/2023	Taxonomy not applicable	NA	n/a	000	Unknown	86339	N/A	N/A	N/A	N/A	N/A	3701 BROADWAY	3RD FLOOR	OAKLAND	CA	94611	5613	00	06000	37.82533768	-122.258094	Alameda County
328089	Ordering, Referring, Prescribing	N/A	1306808464	0	0	DAHMS, ERIC B MD	7/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G80316	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
328139	Ordering, Referring, Prescribing	N/A	1306974936	0	0	DE MONGE, BRENDA LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78635	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
328221	Ordering, Referring, Prescribing	N/A	1316147085	0	0	DOLNAK, DOUGLAS DO	5/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A6059	N/A	N/A	N/A	N/A	N/A	286 EUCLID AVE	102	SAN DIEGO	CA	92114	3610	00	06000	32.70706919	-117.0850896	San Diego County
328222	Ordering, Referring, Prescribing	N/A	1316135890	0	0	DAVIS, DON D LMFT	4/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24281	N/A	N/A	N/A	N/A	N/A	10417 MAIN ST	None	LAMONT	CA	93241	1726	00	06000	35.2601067	-118.9142703	Kern County
328234	Ordering, Referring, Prescribing	N/A	1316170418	0	0	DOZIER-THOMAS, BRITTANY L LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84758	N/A	N/A	N/A	N/A	N/A	18 COUNTY CENTER DR.	None	OROVILLE	CA	95965	3335	00	06000	39.52683587	-121.5716851	Butte County
328284	Ordering, Referring, Prescribing	N/A	1316253974	0	0	DOERING, JOEY CCC-SLP	11/13/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	29647	N/A	N/A	N/A	N/A	N/A	511 S ORCHARD AV	None	UKIAH	CA	95482	3411	00	06000	39.14729048	-123.1987868	Mendocino County
328299	Ordering, Referring, Prescribing	N/A	1316304645	0	0	DHIR, IMEE L	8/28/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95031921	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
328330	Ordering, Referring, Prescribing	N/A	1316330970	0	0	DOSANJH, SHARNJEET NP	12/20/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002234	N/A	N/A	N/A	N/A	N/A	3605 HOSPITAL RD	None	ATWATER	CA	95301	5173	00	06000	37.36678073	-120.576731	Merced County
328332	Ordering, Referring, Prescribing	N/A	1316337181	0	0	DEWITT, JAYANA M NP	3/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004001	N/A	N/A	N/A	N/A	N/A	5575 HOSPITAL DR.	None	ATASCADERO	CA	93422	9342	00	06000	35.49162766	-120.6627516	San Luis Obispo County
328356	Ordering, Referring, Prescribing	N/A	1316384571	0	0	DABIRIZANJANI, SARA DDS	8/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63021	N/A	N/A	N/A	N/A	N/A	134 GRAPEVINE RD	None	VISTA	CA	92083	4004	00	06000	33.191415	-117.2751055	San Diego County
328381	Ordering, Referring, Prescribing	N/A	1316417488	0	0	DINH, CHRISTINA LMFT	11/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT142680	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	None	SAN PABLO	CA	94806	3863	00	06000	37.95651393	-122.3371491	Contra Costa County
328388	Ordering, Referring, Prescribing	N/A	1316426703	0	0	DE PILLIS, SOPHIA I LMFT	10/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122245	N/A	N/A	N/A	N/A	N/A	3748 13TH AVE	None	OAKLAND	CA	94610	2820	00	06000	37.80387053	-122.2294532	Alameda County
328398	Ordering, Referring, Prescribing	N/A	1316440142	0	0	DAVIS, HANK C MD	5/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163732	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT. 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
328400	Ordering, Referring, Prescribing	N/A	1316441132	0	0	DONLON, SHANNON M LCSW	3/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114553	N/A	N/A	N/A	N/A	N/A	3132 JEFFERSON ST.	None	SAN DIEGO	CA	92110	4421	00	06000	32.75567499	-117.203517	San Diego County
328436	Ordering, Referring, Prescribing	N/A	1316489016	0	0	DO, KHANH L PHARMD	2/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66374	N/A	N/A	N/A	N/A	N/A	15010 W WHITESBRIDGE AVE	None	KERMAN	CA	93630	1030	00	06000	36.73495449	-120.060495	Fresno County
328453	Ordering, Referring, Prescribing	N/A	1316504335	0	0	DING, NAN	10/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106178	N/A	N/A	N/A	N/A	N/A	3055 WILSHIRE BLVD., SUI	None	LOS ANGELES	CA	90010	1147	00	06000	34.06185807	-118.2880358	Los Angeles County
328463	Ordering, Referring, Prescribing	N/A	1316523178	0	0	DOAN, LOI DO	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22333	N/A	N/A	N/A	N/A	N/A	722 BAKER ST.	None	COSTA MESA	CA	92626	4320	00	06000	33.68016047	-117.886563	Orange County
328486	Ordering, Referring, Prescribing	N/A	1316577893	0	0	DITTMAN, TAYLOR N NP	2/3/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	825589	N/A	N/A	N/A	N/A	N/A	1035 PLACER STREET	None	REDDING	CA	96001	4245	00	06000	40.58349378	-122.3853903	Shasta County
328489	Ordering, Referring, Prescribing	N/A	1316584162	0	0	DOUGHERTY, RIA LMFT	2/5/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134860	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	210	OXNARD	CA	93036	0617	00	06000	34.219566	-119.1539365	Ventura County
328491	Ordering, Referring, Prescribing	N/A	1316584592	0	0	DUONG, CHRISTINE V PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81182	N/A	N/A	N/A	N/A	N/A	1190 VETERANS BLVD	MEDICINE C	REDWOOD CITY	CA	94063	2037	00	06000	37.48941956	-122.2227204	San Mateo County
328495	Ordering, Referring, Prescribing	N/A	1316574130	0	0	DORR, KASIE C DO	1/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20579	N/A	N/A	N/A	N/A	N/A	31720 TEMECULA PARKWAY S	None	TEMECULA	CA	92592	5892	00	06000	33.4799323	-117.1033702	Riverside County
328528	Ordering, Referring, Prescribing	N/A	1316696743	0	0	DUDANEY, NICOLE MD	2/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL 9356	N/A	N/A	N/A	N/A	N/A	505 S MAIN ST	SUITE 525	ORANGE	CA	92868	4509	00	06000	33.78004808	-117.8672472	Orange County
328529	Ordering, Referring, Prescribing	N/A	1316726300	0	0	DEHRAB, WENDY RDH	4/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	18180	N/A	N/A	N/A	N/A	N/A	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	00	06000	32.7011883	-117.1261025	San Diego County
328531	Ordering, Referring, Prescribing	N/A	1316726821	0	0	DARBOUZE, SEBASTIEN E DDS	2/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	109280	N/A	N/A	N/A	N/A	N/A	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
328549	Ordering, Referring, Prescribing	N/A	1316979891	0	0	DOCK, JAYSON C MD	12/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	52434	N/A	N/A	N/A	N/A	N/A	1455 ST FRANCIS AVE	None	SHAKOPEE	MN	55379	3374	00	06000	44.771976	-93.502944	Scott County
328561	Ordering, Referring, Prescribing	N/A	1326015975	0	0	DAWSON, LINDSEY MD	12/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A93310	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
328644	Ordering, Referring, Prescribing	N/A	1326193640	0	0	DOLAN, MARK F	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	43617	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST STE 259	None	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
328667	Ordering, Referring, Prescribing	N/A	1326239773	0	0	DERMAWAN, JASMINE L	9/13/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D57711	N/A	N/A	N/A	N/A	N/A	3415 MARTIN LUTHER KING	JR BLVD	SACRAMENTO	CA	95817	3648	00	06000	38.54376	-121.4644095	Sacramento County
328709	Ordering, Referring, Prescribing	N/A	1326316357	0	0	DER, JEANETTE	12/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65769	N/A	N/A	N/A	N/A	N/A	1220 W FOOTHILL BLVD	None	AZUSA	CA	91702	2819	00	06000	34.13048487	-117.9261514	Los Angeles County
328724	Ordering, Referring, Prescribing	N/A	1326326570	0	0	DUONG, THAO PA	8/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	22273	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
328758	Ordering, Referring, Prescribing	N/A	1326372608	0	0	DUENAS, RICARDO A PHARMD	7/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	63058	N/A	N/A	N/A	N/A	N/A	3495 SONOMA BLVD	SUITE K	VALLEJO	CA	94590	2950	00	06000	38.12158398	-122.2552773	Solano County
328818	Ordering, Referring, Prescribing	N/A	1326465501	0	0	DYER, ALEXANDRA MD	10/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139313	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
328819	Ordering, Referring, Prescribing	N/A	1326473109	0	0	DAUG, CHARLOTTE S RN PNP	2/11/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF23023	N/A	N/A	N/A	N/A	N/A	1500 N WATERMAN AVE	150	SAN BERNARDINO	CA	92404	5111	00	06000	34.127181	-117.2788055	San Bernardino County
328835	Ordering, Referring, Prescribing	N/A	1326491010	0	0	DIAZ, AMBER R LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117994	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
328908	Ordering, Referring, Prescribing	N/A	1326611898	0	0	DALAEI, MEHRZAD DDS	10/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS106513	N/A	N/A	N/A	N/A	N/A	1116 N EUCLID ST.	None	ANAHEIM	CA	92801	1954	00	06000	33.84782947	-117.941658	Orange County
328923	Ordering, Referring, Prescribing	N/A	1326654815	0	0	DANG, LINH T NP	9/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015482	N/A	N/A	N/A	N/A	N/A	42135 10TH ST W.	SUITE 201	LANCASTER	CA	93534	6093	00	06000	34.648533	-118.1477975	Los Angeles County
328950	Ordering, Referring, Prescribing	N/A	1326713033	0	0	DELOS REYES, BENJAMIN V PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84621	N/A	N/A	N/A	N/A	N/A	310 SYCAMORE AVE	None	VISTA	CA	92083	1094	00	06000	33.16952438	-117.2127924	San Diego County
328960	Ordering, Referring, Prescribing	N/A	1326727298	0	0	DE DIOS, DIODE LCSW	9/8/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110081	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	STE 475	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
328985	Ordering, Referring, Prescribing	N/A	1336111947	0	0	DIAZ, SOCORRO M NP	4/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	338556	N/A	N/A	N/A	N/A	N/A	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	00	06000	36.60784193	-119.4520057	Fresno County
328996	Ordering, Referring, Prescribing	N/A	1336186618	0	0	DE LA OSA, JORGE DDS	5/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	54134	N/A	N/A	N/A	N/A	N/A	3625 MARTIN LUTHER KING	STE 9	LYNWOOD	CA	90262	3509	00	06000	33.93044131	-118.2021564	Los Angeles County
328999	Ordering, Referring, Prescribing	N/A	1336181411	0	0	DE HOYOS, JUAN A MD	4/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G87714	N/A	N/A	N/A	N/A	N/A	5776 STONERIDGE MALL RD	300	PLEASANTON	CA	94588	4522	00	06000	37.69272221	-121.9305836	Alameda County
329005	Ordering, Referring, Prescribing	N/A	1336211333	0	0	DEAN, MAQSUD A PA	1/25/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA16072	N/A	N/A	N/A	N/A	N/A	3730 HIGHWAY 45	None	COLUSA	CA	95932	0000	00	06000	39.2523858	-122.0314922	Colusa County
329017	Ordering, Referring, Prescribing	N/A	1336248830	0	0	DYNE, GODFREY D MD	12/6/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43164	N/A	N/A	N/A	N/A	N/A	816 N MILPAS ST	None	SANTA BARBARA	CA	93103	3031	00	06000	34.42962222	-119.6897926	Santa Barbara County
329041	Ordering, Referring, Prescribing	N/A	1336286210	0	0	DEANE, NOELLE A LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47336	N/A	N/A	N/A	N/A	N/A	9445 FARNHAM ST	None	SAN DIEGO	CA	92123	1399	00	06000	32.83274967	-117.1248508	San Diego County
329071	Ordering, Referring, Prescribing	N/A	1336349091	0	0	DICKERSON, DANIEL L DO	11/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8291	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	208	CERRITOS	CA	90703	2640	00	06000	33.87008991	-118.0991298	Los Angeles County
329132	Ordering, Referring, Prescribing	N/A	1336459387	0	0	DAGUIA, NUBIA NP	11/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20165	N/A	N/A	N/A	N/A	N/A	2526 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	0000	00	06000	40.14934389	-122.2195713	Tehama County
329173	Ordering, Referring, Prescribing	N/A	1336524305	0	0	DASALLA, RUSSEL L	10/1/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64643	N/A	N/A	N/A	N/A	N/A	2680 E RIVERSIDE DR	None	ONTARIO	CA	91761	7307	00	06000	34.018722	-117.594603	San Bernardino County
329183	Ordering, Referring, Prescribing	N/A	1336534833	0	0	DAVID, JORDAN A MD	1/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147994	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
329193	Ordering, Referring, Prescribing	N/A	1336545524	0	0	DATRICE, KRISTINA LCSW	11/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107391	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
329255	Ordering, Referring, Prescribing	N/A	1336649060	0	0	DIZON, KRISTINE GRACE L	10/31/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007409	N/A	N/A	N/A	N/A	N/A	110 N. FOURTH AVE	None	COVINA	CA	91723	1825	00	06000	34.08644652	-117.8944351	Los Angeles County
329290	Ordering, Referring, Prescribing	N/A	1336693019	0	0	DERKHORENIAN, MARAL NP	1/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004328	N/A	N/A	N/A	N/A	N/A	2695 SOUTH 4TH STREET	None	EL CENTRO	CA	92243	6012	00	06000	32.76973509	-115.5520629	Imperial County
329305	Ordering, Referring, Prescribing	N/A	1336720564	0	0	DREHER, GILLIAN L LMFT	3/8/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT153746	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DR.	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
329310	Ordering, Referring, Prescribing	N/A	1336728849	0	0	DIVDAD, PARASTOU PHARMD	1/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80743	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD	200	BEVERLY HILLS	CA	90211	2285	00	06000	34.06736471	-118.3763201	Los Angeles County
329356	Ordering, Referring, Prescribing	N/A	1336865138	0	0	DIAZ, JESSICA PHARMD	10/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87109	N/A	N/A	N/A	N/A	N/A	431 N TUSTIN AVE	STE C	SANTA ANA	CA	92705	3821	00	06000	33.74883544	-117.8340691	Orange County
329362	Ordering, Referring, Prescribing	N/A	1336889146	0	0	DEGRAY, MALLORY E NP	3/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020327	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
329371	Ordering, Referring, Prescribing	N/A	1336986967	0	0	DINH, ASHLEY OD	7/9/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT35791TLG	N/A	N/A	N/A	N/A	N/A	5460 EAST LA PALMA AVE	None	ANAHEIM	CA	92807	2023	00	06000	33.85983003	-117.7966383	Orange County
329385	Ordering, Referring, Prescribing	N/A	1346082922	0	0	DAO, MICHAEL OD	5/30/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35721	N/A	N/A	N/A	N/A	N/A	2280 E CARSON ST	None	LONG BEACH	CA	90807	3044	00	06000	33.83241248	-118.164456	Los Angeles County
329394	Ordering, Referring, Prescribing	N/A	1346244050	0	0	DAMEN, AYMAN MD	2/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48085	N/A	N/A	N/A	N/A	N/A	150 N. LINCOLN WAY	None	GALT	CA	95632	1721	00	06000	38.256615	-121.3007445	Sacramento County
329408	Ordering, Referring, Prescribing	N/A	1346302254	0	0	DEJESUS, ELIZABETH D PHARMD	4/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	40494	N/A	N/A	N/A	N/A	N/A	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
329413	Ordering, Referring, Prescribing	N/A	1346307097	0	0	DAO, LELAND H DO	9/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16238	N/A	N/A	N/A	N/A	N/A	954 15TH STREET	None	SANTA MONICA	CA	90403	3106	00	06000	34.03050634	-118.4914003	Los Angeles County
329438	Ordering, Referring, Prescribing	N/A	1346372273	0	0	DIAZ-WINTERSET, LAURA A PSYD	2/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20158	N/A	N/A	N/A	N/A	N/A	1501 HUGHES WAY	None	LONG BEACH	CA	90810	1876	00	06000	33.82866146	-118.212984	Los Angeles County
329450	Ordering, Referring, Prescribing	N/A	1346381571	0	0	DE SILVA, RAUDERICK S LMFT	2/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45375	N/A	N/A	N/A	N/A	N/A	760 HARRISON STREET	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
329455	Ordering, Referring, Prescribing	N/A	1346378775	0	0	DURAN, CORINA LMFT	12/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115693	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	200	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
329465	Ordering, Referring, Prescribing	N/A	1346410768	0	0	DORIN, SHIRIN A	8/26/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D51194	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
329522	Ordering, Referring, Prescribing	N/A	1346522059	0	0	DUPLANTIER, DAVID PHARMD	8/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	46090	N/A	N/A	N/A	N/A	N/A	2010 ALAMO DRIVE	None	VACAVILLE	CA	95687	6289	00	06000	38.33537552	-121.9692825	Solano County
329567	Ordering, Referring, Prescribing	N/A	1346559572	0	0	DHARIA, MEETAL R NP	9/29/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007994	N/A	N/A	N/A	N/A	N/A	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
329591	Ordering, Referring, Prescribing	N/A	1346634896	0	0	DEOT, DEEPA MD	5/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146953	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL, SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
329614	Ordering, Referring, Prescribing	N/A	1346659075	0	0	DE GUZMAN, SAGIE PHD	3/12/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000814	N/A	N/A	N/A	N/A	N/A	729 S HOBART BLVD	10	LOS ANGELES	CA	90005	2839	00	06000	34.058826	-118.305367	Los Angeles County
329620	Ordering, Referring, Prescribing	N/A	1346676756	0	0	DAMO, ASHLEY S LMFT	4/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123429	N/A	N/A	N/A	N/A	N/A	4205 W FIGARDEN DR	None	FRESNO	CA	93722	6051	00	06000	36.82930754	-119.8669532	Fresno County
329673	Ordering, Referring, Prescribing	N/A	1346757036	0	0	DUNCAN, SARAH LMFT	2/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131297	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
329685	Ordering, Referring, Prescribing	N/A	1346774171	0	0	DANG, HUE K LCSW	11/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98269	N/A	N/A	N/A	N/A	N/A	7899 MISSION GROVE PKWY	SUITE A	RIVERSIDE	CA	92508	5033	00	06000	33.90825056	-117.3278365	Riverside County
329692	Ordering, Referring, Prescribing	N/A	1346790797	0	0	DALAL, MITHIL K PHARMD	9/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75402	N/A	N/A	N/A	N/A	N/A	16020 PERRIS BLVD	None	MORENO VALLEY	CA	92551	4618	00	06000	33.887844	-117.2261435	Riverside County
329774	Ordering, Referring, Prescribing	N/A	1346997467	0	0	DAGAN, CHANEL LMFT	1/14/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152656	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2098	00	06000	34.24628267	-118.5232668	Los Angeles County
329796	Ordering, Referring, Prescribing	N/A	1356096739	0	0	DONAGHE, CHRISTOPHER M NP	2/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95020024	N/A	N/A	N/A	N/A	N/A	1201 INDUSTRIAL ST	None	REDDING	CA	96002	0757	00	06000	40.57469253	-122.349645	Shasta County
329806	Ordering, Referring, Prescribing	N/A	1356169817	0	0	DEMIKHOVSKIY, RAYAN NP	11/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95033107	N/A	N/A	N/A	N/A	N/A	8727 VAN NUYS BLVD	101 & 102	PANORAMA CITY	CA	91402	2451	00	06000	34.22817174	-118.4502885	Los Angeles County
329812	Ordering, Referring, Prescribing	N/A	1356314736	0	0	DRAKE, DANIEL PA-C	2/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	54257	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
329822	Ordering, Referring, Prescribing	N/A	1356341515	0	0	DONG, BETTY J	6/2/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	27874	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVENUE	None	SAN FRANCISCO	CA	94143	0622	00	06000	37.75729541	-122.4066641	San Francisco County
329831	Ordering, Referring, Prescribing	N/A	1356403794	0	0	DINTCHO, ANTHONY S DPM	4/16/2018	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E1225	N/A	N/A	N/A	N/A	N/A	2477 CHESTNUT STREET	None	SAN FRANCISCO	CA	94123	2505	00	06000	37.79976922	-122.4442367	San Francisco County
329899	Ordering, Referring, Prescribing	N/A	1356566236	0	0	DIAZ, JULIO C LCSW	1/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29558	N/A	N/A	N/A	N/A	N/A	209 EAST 7TH STREET	None	MADERA	CA	93638	1288	00	06000	36.96069768	-120.0559841	Madera County
329902	Ordering, Referring, Prescribing	N/A	1356566186	0	0	DIDONATO, BLANCA E	10/9/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18621	N/A	N/A	N/A	N/A	N/A	3850 17TH ST	None	SAN FRANCISCO	CA	94114	2031	00	06000	37.76272129	-122.4318522	San Francisco County
330035	Ordering, Referring, Prescribing	N/A	1356778351	0	0	DELU, HENRY O PHARMD	12/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69449	N/A	N/A	N/A	N/A	N/A	3590 E IMPERIAL HWY	101	LYNWOOD	CA	90262	2655	00	06000	33.93042906	-118.2056035	Los Angeles County
330127	Ordering, Referring, Prescribing	N/A	1356943294	0	0	DAO, LINH P	5/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016664	N/A	N/A	N/A	N/A	N/A	429 S MAIN ST	None	MILPITAS	CA	95035	5318	00	06000	37.42434798	-121.905263	Santa Clara County
330143	Ordering, Referring, Prescribing	N/A	1356978639	0	0	DINH, MICHAEL T MD	11/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL4587	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
330159	Ordering, Referring, Prescribing	N/A	1366008633	0	0	DU, ANNESSA OD	8/29/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34372	N/A	N/A	N/A	N/A	N/A	7217 RESEDA BLVD.	None	RESEDA	CA	91335	3046	00	06000	34.201791	-118.5360655	Los Angeles County
330208	Ordering, Referring, Prescribing	N/A	1366100232	0	0	DEGRAVE, JEANNETTE F LMFT	1/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52554	N/A	N/A	N/A	N/A	N/A	1010 NORTH MAIN STREET	None	SANTA ANA	CA	92701	3602	00	06000	33.754131	-117.867627	Orange County
330213	Ordering, Referring, Prescribing	N/A	1366131591	0	0	DE VERA, NATHALIE PA-C	11/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63686	N/A	N/A	N/A	N/A	N/A	1218 W OLIVE AVE	None	BURBANK	CA	91506	2216	00	06000	34.17057716	-118.3196429	Los Angeles County
330226	Ordering, Referring, Prescribing	N/A	1366182016	0	0	DIXON, ELIZABETH	7/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64782	N/A	N/A	N/A	N/A	N/A	2500 CALIFORNIA ST	A	MOUNTAIN VIEW	CA	94040	1302	00	06000	37.40337202	-122.1063817	Santa Clara County
330229	Ordering, Referring, Prescribing	N/A	1366191439	0	0	DESAI, PRIYA R DO	9/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21495	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
330236	Ordering, Referring, Prescribing	N/A	1366193963	0	0	DICKINSON, SARAH J LCSW	4/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122138	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
330248	Ordering, Referring, Prescribing	N/A	1366412165	0	0	DAR, SAIRA M MD	2/10/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C163926	N/A	N/A	N/A	N/A	N/A	401 PARADISE RD STE E	None	MODESTO	CA	95351	3163	00	06000	37.62692973	-121.0131742	Stanislaus County
330257	Ordering, Referring, Prescribing	N/A	1366508707	0	0	DIEP, CLAIRE T	12/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55900	N/A	N/A	N/A	N/A	N/A	33509 WESTERN AVENUE	None	UNION CITY	CA	94587	3203	00	06000	37.59233528	-122.0347014	Alameda County
330311	Ordering, Referring, Prescribing	N/A	1366623811	0	0	DOMINGUEZ, ROSALVA LCSW	2/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW91222	N/A	N/A	N/A	N/A	N/A	11731 TELEGRAPH	STE K	SANTA FE SPRINGS	CA	90670	6815	00	06000	33.94630253	-118.0832082	Los Angeles County
330331	Ordering, Referring, Prescribing	N/A	1366674236	0	0	DELANEY, KELLEY E	3/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22328	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
330334	Ordering, Referring, Prescribing	N/A	1366687162	0	0	DOMINGUEZ, FERMIN C LMFT	11/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129228	N/A	N/A	N/A	N/A	N/A	6957 N FIGUEROA ST	None	LOS ANGELES	CA	90042	1245	00	06000	34.12873587	-118.18774	Los Angeles County
330372	Ordering, Referring, Prescribing	N/A	1366764532	0	0	DURAN, JESUS A PA	9/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA20805	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
330378	Ordering, Referring, Prescribing	N/A	1366773061	0	0	DEMARCO, TRACIE M NP	11/13/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19440	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	STE 1100	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
330402	Ordering, Referring, Prescribing	N/A	1366815953	0	0	DRAKE, JENNIFER PHARMD	9/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70981	N/A	N/A	N/A	N/A	N/A	14840 HWY 4	None	DISCOVERY BAY	CA	94505	2236	00	06000	37.8894845	-121.621392	Contra Costa County
330419	Ordering, Referring, Prescribing	N/A	1366841306	0	0	DIAZ, JESSICA L LCSW	10/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97835	N/A	N/A	N/A	N/A	N/A	901 WEST VICTORIA STREET	F&G	COMPTON	CA	90220	1000	00	06000	33.86784006	-118.2368928	Los Angeles County
330455	Ordering, Referring, Prescribing	N/A	1366885188	0	0	DEBARAN, FRANCISCO B LMFT	6/14/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106990	N/A	N/A	N/A	N/A	N/A	41870 MCALBY CT	None	MURRIETA	CA	92562	7036	00	06000	33.53032632	-117.1852196	Riverside County
330473	Ordering, Referring, Prescribing	N/A	1366910796	0	0	DEWITT, DANA PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79180	N/A	N/A	N/A	N/A	N/A	6008 VENTURA CANYON AVE	None	VAN NUYS	CA	91401	0000	00	06000	34.17990949	-118.4288595	Los Angeles County
330494	Ordering, Referring, Prescribing	N/A	1366956211	0	0	DANG, THI PHARMD	2/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	56258	N/A	N/A	N/A	N/A	N/A	1250 S SUNSET AVE	207	WEST COVINA	CA	91790	3961	00	06000	34.0610671	-117.9463685	Los Angeles County
330580	Ordering, Referring, Prescribing	N/A	1376112250	0	0	DARAKDJIAN, SETA NANOR NP	9/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017265	N/A	N/A	N/A	N/A	N/A	235 S PALISADE DR	None	SANTA MARIA	CA	93454	5906	00	06000	34.9516506	-120.4121902	Santa Barbara County
330604	Ordering, Referring, Prescribing	N/A	1376156299	0	0	DUFFY, DANAE A LMFT	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106296	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BLDG A	NAP	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
330608	Ordering, Referring, Prescribing	N/A	1376165449	0	0	DAGOSTINO, JUSTIN DO	3/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20735	N/A	N/A	N/A	N/A	N/A	1555 SOUTH GAREY AVENUE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
330609	Ordering, Referring, Prescribing	N/A	1376163675	0	0	DALTON, ALEXANDRA L DO	5/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21761	N/A	N/A	N/A	N/A	N/A	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
330744	Ordering, Referring, Prescribing	N/A	1376735688	0	0	DEHYAR, MARIAM MD	7/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102480	N/A	N/A	N/A	N/A	N/A	29738 RANCHO CALIFORNIA	B	TEMECULA	CA	92591	5322	00	06000	33.50612116	-117.1438774	Riverside County
330774	Ordering, Referring, Prescribing	N/A	1376812545	0	0	DAHLIN, OLIVIA N LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48799	N/A	N/A	N/A	N/A	N/A	1812 W PARK AVE	None	REDLANDS	CA	92373	9999	00	06000	34.05931058	-117.216243	San Bernardino County
330816	Ordering, Referring, Prescribing	N/A	1376886879	0	0	DAO, LINH C T MD	7/19/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134609	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY 4TH FLOOR	STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
330820	Ordering, Referring, Prescribing	N/A	1376895987	0	0	DIGIORGIO, SABRINA A	2/4/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0700709	N/A	N/A	N/A	N/A	N/A	1014 1/2 N VERMONT AVE	None	LOS ANGELES	CA	90029	2620	00	06000	34.0900257	-118.2916693	Los Angeles County
330832	Ordering, Referring, Prescribing	N/A	1376913764	0	0	DUONG, LINDA PHARMD	3/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	72461	N/A	N/A	N/A	N/A	N/A	1301 N VICTORY PL	None	BURBANK	CA	91502	1649	00	06000	34.18876413	-118.3246411	Los Angeles County
330851	Ordering, Referring, Prescribing	N/A	1376945741	0	0	DONAHUE, JACQUELINE PSYD	3/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY31339	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS #54	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
330865	Ordering, Referring, Prescribing	N/A	1376943043	0	0	DAVIS, JANE C LCSW	2/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94015	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	None	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
330899	Ordering, Referring, Prescribing	N/A	1386011047	0	0	DELGADILLO, KAREN I LMFT	7/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	133711	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
330978	Ordering, Referring, Prescribing	N/A	1386128940	0	0	DEVINE, KRISTINA H NP	8/28/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009854	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	MEDICAL MALL #220	SAN DIEGO	CA	92126	2359	00	06000	32.91416051	-117.1437943	San Diego County
330979	Ordering, Referring, Prescribing	N/A	1386128643	0	0	DAVIS, ERIC A MD	4/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185850	N/A	N/A	N/A	N/A	N/A	513 PARNASSUS AVE	RM S257A	SAN FRANCISCO	CA	94143	0410	00	06000	37.76344756	-122.4581992	San Francisco County
330986	Ordering, Referring, Prescribing	N/A	1386147916	0	0	DUGAN, NECOLE CNP	8/15/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008482	N/A	N/A	N/A	N/A	N/A	130 LA CASA VIA	110	WALNUT CREEK	CA	94598	3045	00	06000	37.91175467	-122.0414101	Contra Costa County
330994	Ordering, Referring, Prescribing	N/A	1386153302	0	0	DIAZ, ESMERALDA LMFT	4/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123364	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
331011	Ordering, Referring, Prescribing	N/A	1386162543	0	0	DIAZ, KAREN S LCSW	3/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114204	N/A	N/A	N/A	N/A	N/A	20800 SHERMAN WAY	None	WINNETKA	CA	91306	2707	00	06000	34.20097455	-118.586502	Los Angeles County
331029	Ordering, Referring, Prescribing	N/A	1386186153	0	0	DEWYN, GAIL NP	8/9/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004971	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
331040	Ordering, Referring, Prescribing	N/A	1386205235	0	0	DIEP, JASON DDS	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	103830	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
331051	Ordering, Referring, Prescribing	N/A	1386228518	0	0	DINH, ANDY DDS	6/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108844	N/A	N/A	N/A	N/A	N/A	330-340 E 8TH ST	None	NATIONAL CITY	CA	91950	2312	00	06000	32.67687664	-117.1030716	San Diego County
331081	Ordering, Referring, Prescribing	N/A	1386299014	0	0	DONGRE, SHIVANI LPCC	5/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC12112	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
331134	Ordering, Referring, Prescribing	N/A	1386615995	0	0	DRAKES, THOMAS P MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G31160	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
331265	Ordering, Referring, Prescribing	N/A	1386919967	0	0	DAVIS, JEANNE LCSW	3/26/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18510	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
331288	Ordering, Referring, Prescribing	N/A	1386969194	0	0	DELLA RIPA, CYNTHIA A LMFT	4/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47975	N/A	N/A	N/A	N/A	N/A	20501 VENTURA BLVD.	SUITE 213	WOODLAND HILLS	CA	91364	0847	00	06000	34.16800818	-118.5797688	Los Angeles County
331340	Ordering, Referring, Prescribing	N/A	1396045399	0	0	DOWLING, JENNIFER PHARMD	5/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61549	N/A	N/A	N/A	N/A	N/A	2345 FENTON PKWY	None	SAN DIEGO	CA	92108	4743	00	06000	32.782482	-117.1285875	San Diego County
331345	Ordering, Referring, Prescribing	N/A	1396046983	0	0	DE VERA, DOMINGA M PHARMD	12/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59191	N/A	N/A	N/A	N/A	N/A	475 W MAIN ST	None	BRAWLEY	CA	92227	2244	00	06000	32.97865516	-115.5503473	Imperial County
331355	Ordering, Referring, Prescribing	N/A	1396085098	0	0	DRISCOLL, KARRIE ANNE W NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0816961	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
331358	Ordering, Referring, Prescribing	N/A	1396102745	0	0	DUNN, JOSEPH PHD	10/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	7693	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DR,	SUITE A	RANCHO MIRAGE	CA	92270	2001	00	06000	33.786126	-116.406086	Riverside County
331369	Ordering, Referring, Prescribing	N/A	1396115580	0	0	DE LA PENA, MONIQUE D	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95194	N/A	N/A	N/A	N/A	N/A	24050 MADISON STREET, SU	None	TORRANCE	CA	90505	6015	00	06000	33.80594851	-118.348558	Los Angeles County
331386	Ordering, Referring, Prescribing	N/A	1396142436	0	0	DAVID, GEORGE J PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70924	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
331403	Ordering, Referring, Prescribing	N/A	1396165056	0	0	DESHMUKH, POONAM MD	9/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158459	N/A	N/A	N/A	N/A	N/A	302 CHERRY LANE	208	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
331405	Ordering, Referring, Prescribing	N/A	1396165981	0	0	DE LA PENA, MARTHA C	12/8/2014	Taxonomy not applicable	NA	n/a	099	DENTIST	D63105	N/A	N/A	N/A	N/A	N/A	1525 SILVER AVE	None	SAN FRANCISCO	CA	94134	1229	00	06000	37.73224392	-122.4063707	San Francisco County
331483	Ordering, Referring, Prescribing	N/A	1396281994	0	0	DAVID, PAUL A LMFT	4/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132288	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	STE 210	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
331498	Ordering, Referring, Prescribing	N/A	1396303236	0	0	D'OTO, ALEXANDRA MD	3/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195091	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
331501	Ordering, Referring, Prescribing	N/A	1396321998	0	0	DIAZ, DIANA NP	2/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015657	N/A	N/A	N/A	N/A	N/A	2727 MACDONALD AVE	None	RICHMOND	CA	94804	3006	00	06000	37.93503193	-122.3422799	Contra Costa County
331532	Ordering, Referring, Prescribing	N/A	1396359709	0	0	DUNN, KADY OT	9/7/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	22783	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST.	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
331549	Ordering, Referring, Prescribing	N/A	1396384335	0	0	DAVODI-FAR, MARYAM LMFT	10/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108127	N/A	N/A	N/A	N/A	N/A	2304 DE LA VINA STREET	None	SANTA BARBARA	CA	93105	1900	00	06000	34.43182915	-119.7208149	Santa Barbara County
331581	Ordering, Referring, Prescribing	N/A	1396491585	0	0	DIEMERT, ANDREA N LMFT	12/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130217	N/A	N/A	N/A	N/A	N/A	510 E MAGNOLIA ST	STE 100	STOCKTON	CA	95202	1850	00	06000	37.96446348	-121.2872245	San Joaquin County
331606	Ordering, Referring, Prescribing	N/A	1396758900	0	0	DAGHER, MAY K MD	4/24/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73681	N/A	N/A	N/A	N/A	N/A	630 N. 13TH AVE	E	UPLAND	CA	91786	4978	00	06000	34.10137569	-117.6336729	San Bernardino County
331651	Ordering, Referring, Prescribing	N/A	1396863551	0	0	DU, AUDREY L	12/28/2004	Taxonomy not applicable	NA	n/a	099	DENTIST	D47614	N/A	N/A	N/A	N/A	N/A	8841 GARVEY AVE	None	ROSEMEAD	CA	91770	3358	00	06000	34.06276591	-118.07587	Los Angeles County
331659	Ordering, Referring, Prescribing	N/A	1396873121	0	0	DIAZ-AMBRIZ, ELIZABETH LMFT	2/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53125	N/A	N/A	N/A	N/A	N/A	6 CENTERPOINTE DR	700	LA PALMA	CA	90623	2503	00	06000	33.86052378	-118.0296232	Orange County
331679	Ordering, Referring, Prescribing	N/A	1396896213	0	0	DESAMPARO, NICOLE D LMFT	5/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48275	N/A	N/A	N/A	N/A	N/A	399 TAYLOR BLVD	210	PLEASANT HILL	CA	94523	0101	00	06000	37.96117359	-122.0721927	Contra Costa County
331714	Ordering, Referring, Prescribing	N/A	1396978037	0	0	DIEDRICH, JUSTIN MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114859	N/A	N/A	N/A	N/A	N/A	1873 COMMERCENTER W	None	SAN BERNARDINO	CA	92408	3303	00	06000	34.067781	-117.286122	San Bernardino County
331736	Ordering, Referring, Prescribing	N/A	1407027618	0	0	DEWART, ELIZABETH A NP	5/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22736	N/A	N/A	N/A	N/A	N/A	4930 NAPLES ST	None	SAN DIEGO	CA	92110	3820	00	06000	32.77013831	-117.2030986	San Diego County
331747	Ordering, Referring, Prescribing	N/A	1407050297	0	0	DI ENNO, LISA R MD	5/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C162286	N/A	N/A	N/A	N/A	N/A	11622 EL CAMINO REAL	None	SAN DIEGO	CA	92130	2049	00	06000	32.92850143	-117.2381467	San Diego County
331788	Ordering, Referring, Prescribing	N/A	1407159288	0	0	DAVIS, CAMILLA L	4/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	PA21338	N/A	N/A	N/A	N/A	N/A	46100 WASHINGTON ST	None	LA QUINTA	CA	92253	2000	00	06000	33.7160676	-116.2947656	Riverside County
331810	Ordering, Referring, Prescribing	N/A	1407203789	0	0	DURAN, ALEXANDRA T LMFT	4/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106663	N/A	N/A	N/A	N/A	N/A	40 E MINARETS AVE	None	PINEDALE	CA	93650	1239	00	06000	36.84269447	-119.7897525	Fresno County
331827	Ordering, Referring, Prescribing	N/A	1407234644	0	0	DUONG, TRANG M DPM	8/21/2023	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5164	N/A	N/A	N/A	N/A	N/A	8800 ALONDRA BVD	STE C	BELLFLOWER	CA	91724	2267	00	06000	33.88918249	-118.1446785	Los Angeles County
331835	Ordering, Referring, Prescribing	N/A	1407239148	0	0	DEVIREDDY, VIJAY MD	10/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171844	N/A	N/A	N/A	N/A	N/A	311 W I ST	None	LOS BANOS	CA	93635	3479	00	06000	37.06343055	-120.8570545	Merced County
331850	Ordering, Referring, Prescribing	N/A	1407282478	0	0	DEKIVADIA, DHARAGAURI G PHARMD	10/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	74285	N/A	N/A	N/A	N/A	N/A	2110 TRUXTUN AVE	SUITE 400	BAKERSFIELD	CA	93301	3703	00	06000	35.37344851	-119.0261655	Kern County
331882	Ordering, Referring, Prescribing	N/A	1407321557	0	0	DUONG, TRUC PHARMD	11/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	78333	N/A	N/A	N/A	N/A	N/A	22280 FOOTHILL BLVD	None	HAYWARD	CA	94541	2731	00	06000	37.67922752	-122.0844431	Alameda County
331886	Ordering, Referring, Prescribing	N/A	1407323025	0	0	DUNCAN, SHIRLEY CNP	9/14/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010030	N/A	N/A	N/A	N/A	N/A	58375 29 PALMS HWY	None	YUCCA VALLEY	CA	92284	5813	00	06000	34.13141256	-116.3904357	San Bernardino County
331929	Ordering, Referring, Prescribing	N/A	1407380462	0	0	DALE, MONAE D LCSW	12/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99225	N/A	N/A	N/A	N/A	N/A	6762 LEXINGTON AVE	None	LOS ANGELES	CA	90038	1217	00	06000	34.09253848	-118.3378635	Los Angeles County
331946	Ordering, Referring, Prescribing	N/A	1407405871	0	0	DETRIE, RACHEL PHD	4/19/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	34051	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	STE. 210	OXNARD	CA	93036	0617	00	06000	34.219566	-119.1539365	Ventura County
331953	Ordering, Referring, Prescribing	N/A	1407425010	0	0	DEGRAVE, KARA A PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84526	N/A	N/A	N/A	N/A	N/A	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	00	06000	37.246896	-121.8040865	Santa Clara County
331960	Ordering, Referring, Prescribing	N/A	1407463268	0	0	DEANDA, NICOLE	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83192	N/A	N/A	N/A	N/A	N/A	23893 CLINTON KEITH RD	None	WILDOMAR	CA	92595	7894	00	06000	33.595668	-117.241912	Riverside County
332068	Ordering, Referring, Prescribing	N/A	1407981541	0	0	DEESPINOSA, KELLINE M PSYD	3/12/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19312	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
332075	Ordering, Referring, Prescribing	N/A	1407989700	0	0	DUNBAUGH, CHRISTOPHER LMFT	6/3/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84796	N/A	N/A	N/A	N/A	N/A	360 NEVADA ST	None	AUBURN	CA	95603	3720	00	06000	38.9065593	-121.0824284	Placer County
332154	Ordering, Referring, Prescribing	N/A	1417108176	0	0	DE FIGUEIREDO, SOPHIE B PSYD	4/26/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	25349	N/A	N/A	N/A	N/A	N/A	1000 VETERAN AVE	None	LOS ANGELES	CA	90095	2704	00	06000	34.0605595	-118.4499527	Los Angeles County
332169	Ordering, Referring, Prescribing	N/A	1417168741	0	0	DOAN, TIGER K LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49747	N/A	N/A	N/A	N/A	N/A	15350 SHERMAN WAY	STE 200	VAN NUYS	CA	91406	4203	00	06000	34.20109649	-118.467432	Los Angeles County
332184	Ordering, Referring, Prescribing	N/A	1417192733	0	0	DASHEVSKY, DIMA	11/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82579	N/A	N/A	N/A	N/A	N/A	320 RIVER ST	None	SANTA CRUZ	CA	95060	3200	00	06000	36.98095917	-122.028884	Santa Cruz County
332199	Ordering, Referring, Prescribing	N/A	1417230046	0	0	DINH, THUY-TRANG T PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59815	N/A	N/A	N/A	N/A	N/A	1285 S MISSION RD	None	FALLBROOK	CA	92028	4005	00	06000	33.37002334	-117.251391	San Diego County
332261	Ordering, Referring, Prescribing	N/A	1417333006	0	0	DENBOW, RACHEL L PA-C	12/8/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA56393	N/A	N/A	N/A	N/A	N/A	5442 SYCUAN RD	None	EL CAJON	CA	92019	1816	00	06000	32.78885903	-116.8320996	San Diego County
332292	Ordering, Referring, Prescribing	N/A	1417381526	0	0	DE VITA, CASSANDRA L LCSW	5/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107775	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	M.S. 5-120	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
332302	Ordering, Referring, Prescribing	N/A	1417394974	0	0	DUNN, VALERIE L LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96013	N/A	N/A	N/A	N/A	N/A	1330 E. COOLEY DR.	None	COLTON	CA	92324	3905	00	06000	34.0544745	-117.305721	San Bernardino County
332306	Ordering, Referring, Prescribing	N/A	1417397555	0	0	DE NITTO, LAUREN N LCSW	7/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70792	N/A	N/A	N/A	N/A	N/A	100 W. WALNUT ST.	375	PASADENA	CA	91124	0001	00	06000	34.14963648	-118.1522925	Los Angeles County
332308	Ordering, Referring, Prescribing	N/A	1417395104	0	0	DILLARD, ROLAN LCSW	9/22/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79894	N/A	N/A	N/A	N/A	N/A	891 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9713	00	06000	38.19035603	-120.6679939	Calaveras County
332310	Ordering, Referring, Prescribing	N/A	1417403320	0	0	DE JONG, SASKIA C OT	12/13/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT8671	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST SUITE	A	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
332313	Ordering, Referring, Prescribing	N/A	1417410481	0	0	DECILVEO, ALEXANDER P MD	3/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194513	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
332325	Ordering, Referring, Prescribing	N/A	1417433665	0	0	DENNO, RICHARD F LMFT	6/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139908	N/A	N/A	N/A	N/A	N/A	480 E 13TH ST	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
332353	Ordering, Referring, Prescribing	N/A	1417483868	0	0	DHILLON, SAMEEP	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161019	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
332386	Ordering, Referring, Prescribing	N/A	1417529587	0	0	DADKHAH, ARMIN DPM	2/7/2024	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E6021	N/A	N/A	N/A	N/A	N/A	1919 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	1121	00	06000	34.02704017	-118.2578387	Los Angeles County
332388	Ordering, Referring, Prescribing	N/A	1417538745	0	0	DELZER, MOLLY C PA	3/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	59266	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	105	ANAHEIM	CA	92805	2936	00	06000	33.83508976	-117.9177981	Orange County
332419	Ordering, Referring, Prescribing	N/A	1417594508	0	0	DIMANH, PHOUTTHA APHAI PHARMD	9/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	81231	N/A	N/A	N/A	N/A	N/A	498 CASTRO ST	None	SAN FRANCISCO	CA	94114	2020	00	06000	37.76111969	-122.4350504	San Francisco County
332456	Ordering, Referring, Prescribing	N/A	1417720376	0	0	DURO, JESSE PA-C	1/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA63669	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
332489	Ordering, Referring, Prescribing	N/A	1427084839	0	0	DESAGANI, KISHORE K MD	1/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99666	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	A	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
332495	Ordering, Referring, Prescribing	N/A	1427104199	0	0	DAVIDSON, TODD J LMFT	8/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47087	N/A	N/A	N/A	N/A	N/A	5100 BULLION ST	None	MARIPOSA	CA	95338	2411	00	06000	37.48928959	-119.9679953	Mariposa County
332502	Ordering, Referring, Prescribing	N/A	1427112408	0	0	DE VASQUES, DANIELA M PSYD	9/27/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	26897	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
332506	Ordering, Referring, Prescribing	N/A	1427117142	0	0	DANG, NHU-DIEM T LCSW	6/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29778	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
332668	Ordering, Referring, Prescribing	N/A	1427437458	0	0	DINH, ANN	9/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	65123	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD.	MS SEC2-B	BOISE	ID	83706	0000	00	06000	43.59860438	-116.1806635	Ada County
332673	Ordering, Referring, Prescribing	N/A	1427451855	0	0	DUNN, AMANDA L NP	6/5/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	850698	N/A	N/A	N/A	N/A	N/A	3317 CHANATE RD	STE 2C	SANTA ROSA	CA	95404	1737	00	06000	38.470896	-122.708889	Sonoma County
332681	Ordering, Referring, Prescribing	N/A	1427465541	0	0	DAVIDSON, MICHELLE D LCSW	9/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103948	N/A	N/A	N/A	N/A	N/A	1119 E CUMBERLAND RD	None	ORANGE	CA	92865	3505	00	06000	33.82538372	-117.842042	Orange County
332735	Ordering, Referring, Prescribing	N/A	1427538347	0	0	DOIG, HUGO M LMFT	2/12/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124313	N/A	N/A	N/A	N/A	N/A	2062 JOHN JONES RD.	240	CITY IS NOT LISTE	CA	95616	9709	00	06000	38.5636139	-121.769196	Yolo County
332761	Ordering, Referring, Prescribing	N/A	1427582063	0	0	DI PIAZZA, GIULIANA DDS	5/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	103102	N/A	N/A	N/A	N/A	N/A	1110 N DUTTON AVENUE	None	SANTA ROSA	CA	95401	4606	00	06000	38.446731	-122.729859	Sonoma County
332823	Ordering, Referring, Prescribing	N/A	1427727718	0	0	DALTON, OLIVIA NP	11/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015042	N/A	N/A	N/A	N/A	N/A	1 BARNARD DR	None	OCEANSIDE	CA	92056	3820	00	06000	33.19116177	-117.3015485	San Diego County
332849	Ordering, Referring, Prescribing	N/A	1427810845	0	0	DAVIS, SALISH NP	8/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026977	N/A	N/A	N/A	N/A	N/A	3743 S LA BREA AVE	None	LOS ANGELES	CA	90016	5309	00	06000	34.01991	-118.355626	Los Angeles County
332887	Ordering, Referring, Prescribing	N/A	1437230638	0	0	DURAN, ELVIA C LCSW	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17161	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
332898	Ordering, Referring, Prescribing	N/A	1437260619	0	0	DESILVA, LEANNE CNP	12/26/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP11867	N/A	N/A	N/A	N/A	N/A	3730 HIGHWAY 45	None	COLUSA	CA	95932	0000	00	06000	39.2523858	-122.0314922	Colusa County
332949	Ordering, Referring, Prescribing	N/A	1437339637	0	0	DESAI, ANGELA NP	3/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9871	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
332966	Ordering, Referring, Prescribing	N/A	1437376464	0	0	DEKRUSE, JET L LMFT	7/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	22590	N/A	N/A	N/A	N/A	N/A	2440 6TH ST	None	EUREKA	CA	95501	0788	00	06000	40.80368802	-124.1456878	Humboldt County
332978	Ordering, Referring, Prescribing	N/A	1437402138	0	0	DUONG, LILY PHARMD	3/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68046	N/A	N/A	N/A	N/A	N/A	2449 W KETTLEMAN LANE	None	LODI	CA	95242	4124	00	06000	38.117124	-121.3058115	San Joaquin County
333008	Ordering, Referring, Prescribing	N/A	1437439908	0	0	DHALIWAL, SIMERJIT S	5/29/2017	Taxonomy not applicable	NA	n/a	000	Unknown	21761	N/A	N/A	N/A	N/A	N/A	2440 W TAHOE AVE	None	CARUTHERS	CA	93609	9476	00	06000	36.54046763	-119.83553	Fresno County
333010	Ordering, Referring, Prescribing	N/A	1437443470	0	0	DUNCAN, SANDRA J LCSW	4/26/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	16223	N/A	N/A	N/A	N/A	N/A	650 ZEDIKER AVE	None	PARLIER	CA	93648	2666	00	06000	36.60500164	-119.5210273	Fresno County
333033	Ordering, Referring, Prescribing	N/A	1437480746	0	0	DANIEL, ANSE LMFT	1/6/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138656	N/A	N/A	N/A	N/A	N/A	455 K ST	None	CRESCENT CITY	CA	95531	4107	00	06000	41.75468313	-124.1960818	Del Norte County
333057	Ordering, Referring, Prescribing	N/A	1437528676	0	0	DO, THERESA PHARMD	6/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57894	N/A	N/A	N/A	N/A	N/A	3116 E CHAPMAN AVE	None	ORANGE	CA	92869	3708	00	06000	33.78777454	-117.8202105	Orange County
333102	Ordering, Referring, Prescribing	N/A	1437588084	0	0	DREW, TERRI J NP	7/15/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN746615	N/A	N/A	N/A	N/A	N/A	5995 PLAZA DRIVE	PLAZA BUILDING	CYPRESS	CA	90630	5028	00	06000	33.8057046	-118.0290234	Orange County
333106	Ordering, Referring, Prescribing	N/A	1437591245	0	0	DI GIORDANO, JOSEPH P LMFT	12/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115306	N/A	N/A	N/A	N/A	N/A	11512 B AVE	None	AUBURN	CA	95603	2605	00	06000	38.93969517	-121.1046397	Placer County
333209	Ordering, Referring, Prescribing	N/A	1437746617	0	0	DOSH, KRISTIN D LP	11/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	4037	N/A	N/A	N/A	N/A	N/A	9401 PAINTER AVE	None	WHITTIER	CA	90605	2729	00	06000	33.953337	-118.046439	Los Angeles County
333225	Ordering, Referring, Prescribing	N/A	1437784352	0	0	DEVRIES, KAYLENE N PHARMD	1/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	82001	N/A	N/A	N/A	N/A	N/A	120 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3007	00	06000	32.74828048	-117.1634535	San Diego County
333255	Ordering, Referring, Prescribing	N/A	1437840352	0	0	DAVIS, MEGAN M NP	2/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95024314	N/A	N/A	N/A	N/A	N/A	11919 HESPERIA RD	None	HESPERIA	CA	92345	2158	00	06000	34.46759507	-117.2925837	San Bernardino County
333256	Ordering, Referring, Prescribing	N/A	1437845112	0	0	DURNALL, NATALIE PT	4/28/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	39241	N/A	N/A	N/A	N/A	N/A	1311 SANGUINETTI ROAD	SUITE C	SONORA	CA	95370	6210	00	06000	37.97447385	-120.3613052	Tuolumne County
333272	Ordering, Referring, Prescribing	N/A	1437891561	0	0	DE VERA, JOHN MENARD C NP	4/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020629	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
333327	Ordering, Referring, Prescribing	N/A	1447323985	0	0	DENT, JANELLE LMFT	11/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49596	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
333350	Ordering, Referring, Prescribing	N/A	1447375902	0	0	DAVILA, FLOR LMFT	12/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47438	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
333412	Ordering, Referring, Prescribing	N/A	1447520028	0	0	DARNELL, ANNAMARIE R LMFT	6/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95054	N/A	N/A	N/A	N/A	N/A	1125 E. CLARK AVE	SUITE A-3 #7	SANTA MARIA	CA	93455	5144	00	06000	34.8650853	-120.4175195	Santa Barbara County
333442	Ordering, Referring, Prescribing	N/A	1447566161	0	0	DAVRILL, HALLIE J LMFT	8/1/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97643	N/A	N/A	N/A	N/A	N/A	312 S LINCOLN ST	None	FORT BRAGG	CA	95437	4499	00	06000	39.43892314	-123.7955129	Mendocino County
333451	Ordering, Referring, Prescribing	N/A	1447601752	0	0	DINH, MAI-HAN PSYD	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120315	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	#155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
333531	Ordering, Referring, Prescribing	N/A	1447710819	0	0	DANIEL, RAEYE A MD	1/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181612	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
333571	Ordering, Referring, Prescribing	N/A	1447785217	0	0	DEGIORGIO, ANDREW C MD	9/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171545	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
333582	Ordering, Referring, Prescribing	N/A	1447799739	0	0	DE JESUS, TIFFANY S NP	8/23/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022332	N/A	N/A	N/A	N/A	N/A	1310 SAN BERNARDINO RD	105	UPLAND	CA	91786	4979	00	06000	34.10260261	-117.6332582	San Bernardino County
333598	Ordering, Referring, Prescribing	N/A	1447815220	0	0	DELANEY, ASHLEY D DO	5/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	20A21202	N/A	N/A	N/A	N/A	N/A	554-850 MEDICAL CENTER D	None	BIEBER	CA	96009	0277	00	06000	0	0	None
333614	Ordering, Referring, Prescribing	N/A	1447887880	0	0	DICKERSON, CAMILLE	2/14/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA57845	N/A	N/A	N/A	N/A	N/A	2500 CALIFORNIA STREET	A	MOUNTAIN VIEW	CA	94040	1359	00	06000	37.40337202	-122.1063817	Santa Clara County
333664	Ordering, Referring, Prescribing	N/A	1457068298	0	0	DOWLEY, PATRICIA NP	9/16/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022676	N/A	N/A	N/A	N/A	N/A	1685 E MAIN ST	301	EL CAJON	CA	92021	5225	00	06000	32.81132509	-116.9192044	San Diego County
333720	Ordering, Referring, Prescribing	N/A	1457449308	0	0	DELEON, ENRIQUE Q	5/3/2017	Taxonomy not applicable	NA	n/a	000	Unknown	13722	N/A	N/A	N/A	N/A	N/A	2701 CHESTER AVE	STE 101	BAKERSFIELD	CA	93301	2016	00	06000	35.384166	-119.0188765	Kern County
333790	Ordering, Referring, Prescribing	N/A	1457577207	0	0	DORVALLIER-WYATT, MONIQUE C	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0524069	N/A	N/A	N/A	N/A	N/A	1075 CAMINO DEL RIO S	None	SAN DIEGO	CA	92108	3538	00	06000	32.76444721	-117.1537188	San Diego County
333854	Ordering, Referring, Prescribing	N/A	1457724106	0	0	DEUJA, AJEETA OT	4/16/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	15619	N/A	N/A	N/A	N/A	N/A	1901 N. RICE AVENUE	SUITE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
333912	Ordering, Referring, Prescribing	N/A	1457803322	0	0	DAMASCO, CLARISSA DMD	5/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS100490	N/A	N/A	N/A	N/A	N/A	949 PALM AVE	None	IMPERIAL BEACH	CA	91932	1503	00	06000	32.58380109	-117.1133687	San Diego County
333917	Ordering, Referring, Prescribing	N/A	1457807281	0	0	DAMROTH, MONIQUE D	5/2/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY35032	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
333926	Ordering, Referring, Prescribing	N/A	1457821522	0	0	DAVIS, JORDAN M LMFT	4/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132516	N/A	N/A	N/A	N/A	N/A	323 E MATILIJA ST	215	OJAI	CA	93023	3277	00	06000	34.44881032	-119.243301	Ventura County
333982	Ordering, Referring, Prescribing	N/A	1457882789	0	0	DIEP, CHRISTINA DDS	9/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS102440	N/A	N/A	N/A	N/A	N/A	707 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2210	00	06000	37.76250114	-122.4611816	San Francisco County
333999	Ordering, Referring, Prescribing	N/A	1457911513	0	0	DASTRUP, SAMUEL E	11/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	104442	N/A	N/A	N/A	N/A	N/A	1920 MEMORIAL DR	None	CERES	CA	95307	1827	00	06000	37.600146	-120.961042	Stanislaus County
334055	Ordering, Referring, Prescribing	N/A	1467025809	0	0	DANIEL, LORA L LCSW	12/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119679	N/A	N/A	N/A	N/A	N/A	24275 JEFFERSON AVE	None	MURRIETA	CA	92562	7285	00	06000	33.5676365	-117.2174559	Riverside County
334067	Ordering, Referring, Prescribing	N/A	1467064766	0	0	DIEP, QUYNH TRANG OD	3/11/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34642	N/A	N/A	N/A	N/A	N/A	1024 MISSION STREET	SUITE B	SOUTH PASADENA	CA	91030	3198	00	06000	34.1158083	-118.1559893	Los Angeles County
334084	Ordering, Referring, Prescribing	N/A	1467085068	0	0	DE LA RIVA, OLIVIA LCSW	4/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114848	N/A	N/A	N/A	N/A	N/A	265 S ANITA DR	None	ORANGE	CA	92868	3355	00	06000	33.78499409	-117.8811837	Orange County
334118	Ordering, Referring, Prescribing	N/A	1467217703	0	0	DEBRUYN, JOHANNA L RN BS	6/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	802986	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DRIV	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
334133	Ordering, Referring, Prescribing	N/A	1467436113	0	0	DURAND, CURTISS MD	12/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G28314	N/A	N/A	N/A	N/A	N/A	1234 EMPIRE ST	2200	FAIRFIELD	CA	94533	5711	00	06000	38.25037548	-122.049045	Solano County
334137	Ordering, Referring, Prescribing	N/A	1467451245	0	0	DALAL, KARL N MD	5/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A95570	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DR	STE 204	SACRAMENTO	CA	95823	2628	00	06000	38.493576	-121.436559	Sacramento County
334154	Ordering, Referring, Prescribing	N/A	1467523712	0	0	DO, CLEMENTINE LMFT	3/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102141	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
334178	Ordering, Referring, Prescribing	N/A	1467584532	0	0	DEWRI, WAYNE T PA	10/29/2017	Taxonomy not applicable	NA	n/a	000	Unknown	18316	N/A	N/A	N/A	N/A	N/A	665 NORTH D ST	None	SAN BERNARDINO	CA	92401	1109	00	06000	34.111737	-117.2918735	San Bernardino County
334201	Ordering, Referring, Prescribing	N/A	1467640433	0	0	DOLKAR, YANGCHEN MD	3/29/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127458	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA STREET	SUITE 506	SAN FRANCISCO	CA	94110	4418	00	06000	37.74746923	-122.4202583	San Francisco County
334214	Ordering, Referring, Prescribing	N/A	1467664409	0	0	D'AMICO, GRETA H	1/11/2016	Taxonomy not applicable	NA	n/a	000	Unknown	21	N/A	N/A	N/A	N/A	N/A	1449 LINCOLN WAY	None	AUBURN	CA	95603	5008	00	06000	38.89611356	-121.0765541	Placer County
334222	Ordering, Referring, Prescribing	N/A	1467686014	0	0	DUVALL, DONNA S NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0600193	N/A	N/A	N/A	N/A	N/A	1820 MARRON ROAD	SUITE 110	CARLSBAD	CA	92008	1177	00	06000	33.17711559	-117.3396763	San Diego County
334296	Ordering, Referring, Prescribing	N/A	1467807560	0	0	DY, DIANE J MD	2/1/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153344	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
334345	Ordering, Referring, Prescribing	N/A	1467874214	0	0	DEAX-KEIRNS, SUSAN LMFT	11/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47262	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
334349	Ordering, Referring, Prescribing	N/A	1467881664	0	0	DOMINGUEZ, VICTORIA LMSW	2/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89255	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
334354	Ordering, Referring, Prescribing	N/A	1467887323	0	0	DIAZ, VELICIA N LCSW	3/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85639	N/A	N/A	N/A	N/A	N/A	2221 ENBORG LN	None	SAN JOSE	CA	95128	2608	00	06000	37.31105733	-121.937923	Santa Clara County
334382	Ordering, Referring, Prescribing	N/A	1467908889	0	0	DELONG, JACLYN LCSW	4/23/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88755	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
334384	Ordering, Referring, Prescribing	N/A	1467919753	0	0	DAMATIAN, ASYA PA-C	2/26/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57290	N/A	N/A	N/A	N/A	N/A	22001 MAYALL ST	None	CHATSWORTH	CA	91311	2822	00	06000	34.255368	-118.606419	Los Angeles County
334392	Ordering, Referring, Prescribing	N/A	1467942540	0	0	DE NIEAR, MATTHEW A MD	4/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166649	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
334398	Ordering, Referring, Prescribing	N/A	1467946020	0	0	DE GUZMAN, SONIA C NP	2/22/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008215	N/A	N/A	N/A	N/A	N/A	2200 DEL PASO BLVD	None	SACRAMENTO	CA	95815	3102	00	06000	38.609991	-121.4506125	Sacramento County
334419	Ordering, Referring, Prescribing	N/A	1467962746	0	0	DAVIS, SUCCURA M CNP	4/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008073	N/A	N/A	N/A	N/A	N/A	815 DR MARTIN LUTHER KIN	None	BAKERSFIELD	CA	93307	1365	00	06000	35.3655	-118.985202	Kern County
334424	Ordering, Referring, Prescribing	N/A	1467984120	0	0	DIGERONIMO, RYAN MD MPH	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158951	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2307	00	06000	38.555181	-121.4566785	Sacramento County
334443	Ordering, Referring, Prescribing	N/A	1477014611	0	0	DECAMPS, SCARLETT M MD	9/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181452	N/A	N/A	N/A	N/A	N/A	4725 MARKET STREET	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
334458	Ordering, Referring, Prescribing	N/A	1477044295	0	0	DENNIS, JESSICA	10/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118677	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
334470	Ordering, Referring, Prescribing	N/A	1477061232	0	0	DABALUS, EDEN B NP	12/12/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008189	N/A	N/A	N/A	N/A	N/A	2690 PACIFIC AVENUE	SUITE 370	LONG BEACH	CA	90806	2657	00	06000	33.805854	-118.1936805	Los Angeles County
334474	Ordering, Referring, Prescribing	N/A	1477071900	0	0	DE LA ROCHA, LILIANA LMFT	7/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116842	N/A	N/A	N/A	N/A	N/A	123 W GUTIERREZ ST	None	SANTA BARBARA	CA	93101	3424	00	06000	34.41387023	-119.6962788	Santa Barbara County
334512	Ordering, Referring, Prescribing	N/A	1477134906	0	0	DAVIS, CAMILLE I MD	10/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7658	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
334528	Ordering, Referring, Prescribing	N/A	1477149094	0	0	DOWNARD, JESSE L LMFT	4/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139273	N/A	N/A	N/A	N/A	N/A	208 PROVIDENCE MINE RD S	STE 122	NEVADA CITY	CA	95959	2955	00	06000	39.25021269	-121.0300958	Nevada County
334532	Ordering, Referring, Prescribing	N/A	1477187037	0	0	DRAGOVIC, MARINA LMFT	9/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149431	N/A	N/A	N/A	N/A	N/A	19050 MALAGUERRA AVE	BEHAVIORAL HEALTH	MORGAN HILL	CA	95037	9032	00	06000	37.166796	-121.644315	Santa Clara County
334571	Ordering, Referring, Prescribing	N/A	1477329381	0	0	DHRUV, SHUBH D PA-C	11/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63768	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1378	00	06000	34.29321532	-119.1597424	Ventura County
334624	Ordering, Referring, Prescribing	N/A	1477636504	0	0	DOW, ANDREW R MD	6/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G140359	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
334630	Ordering, Referring, Prescribing	N/A	1477638997	0	0	DENOMME, PHUONG T PHARMD	4/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51074	N/A	N/A	N/A	N/A	N/A	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	00	06000	32.82283469	-117.1248707	San Diego County
334659	Ordering, Referring, Prescribing	N/A	1477703650	0	0	DUGAN, CHERYL A	2/20/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88848	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	SANTA BARBARA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
334666	Ordering, Referring, Prescribing	N/A	1477725984	0	0	DIXON, NIKITA MD	8/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116123	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SANTA CLARA	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara
334669	Ordering, Referring, Prescribing	N/A	1477734614	0	0	DOVE, SAMUEL D	4/16/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D29258	N/A	N/A	N/A	N/A	N/A	10039 VINE ST	None	LAKESIDE	CA	92040	3120	00	06000	32.86110914	-116.9211687	San Diego County
334682	Ordering, Referring, Prescribing	N/A	1477756690	0	0	DIAZ, BRENDA M LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99479	N/A	N/A	N/A	N/A	N/A	2990 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4899	00	06000	34.069824	-117.5873175	San Bernardino County
334686	Ordering, Referring, Prescribing	N/A	1477782225	0	0	DOUDEN, SHERRY L LMFT	1/31/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42531	N/A	N/A	N/A	N/A	N/A	265 NEVADA ST	None	AUBURN	CA	95603	4617	00	06000	38.90388189	-121.0825738	Placer County
334713	Ordering, Referring, Prescribing	N/A	1477810968	0	0	DEBACKER, MARY E LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	24991	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
334739	Ordering, Referring, Prescribing	N/A	1477852150	0	0	DOMOTO, MAYA LCSW	11/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85188	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DR	None	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
334765	Ordering, Referring, Prescribing	N/A	1477908028	0	0	DUDLEY, ROBERT L LMFT	6/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90336	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4256	00	06000	38.39662494	-122.8201368	Sonoma County
334850	Ordering, Referring, Prescribing	N/A	1487029435	0	0	DE JESUS, ANA M LCSW	7/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71894	N/A	N/A	N/A	N/A	N/A	3478 BUSKIRK AVE STE 100	SUITE 1000	PLEASANT HILL	CA	94523	4378	00	06000	37.93963113	-122.0591644	Contra Costa County
334853	Ordering, Referring, Prescribing	N/A	1487034690	0	0	DE GA, KRISTOPHER MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159059	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2307	00	06000	38.555181	-121.4566785	Sacramento County
334857	Ordering, Referring, Prescribing	N/A	1487033577	0	0	DINH, LINDSEY PHARMD	8/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74545	N/A	N/A	N/A	N/A	N/A	3860 DECOTO RD	None	FREMONT	CA	94555	3112	00	06000	37.57147949	-122.031738	Alameda County
334865	Ordering, Referring, Prescribing	N/A	1487048112	0	0	DOSANJH, JAGDIP PHARMD	4/6/2020	Taxonomy not applicable	NA	n/a	000	Unknown	72076	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
334903	Ordering, Referring, Prescribing	N/A	1487088134	0	0	DELFINO, VANESA G LCSW	2/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128487	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	107	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
334922	Ordering, Referring, Prescribing	N/A	1487120721	0	0	DOGADKIN, SAMANTHA N LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102150	N/A	N/A	N/A	N/A	N/A	170 S SPRUCE AVE	None	SOUTH SAN FRANCIS	CA	94080	4557	00	06000	37.64883531	-122.4187311	San Mateo County
335014	Ordering, Referring, Prescribing	N/A	1487274106	0	0	DRICKMAN, DANIEL K	7/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LEP4039	N/A	N/A	N/A	N/A	N/A	511 S ORCHARD AVE	None	UKIAH	CA	95482	5022	00	06000	39.14729048	-123.1987868	Mendocino County
335145	Ordering, Referring, Prescribing	N/A	1487795738	0	0	DASTUR, VAN ANH T	7/6/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D41387	N/A	N/A	N/A	N/A	N/A	137 N VIRGIL AVE	None	LOS ANGELES	CA	90004	4811	00	06000	34.07457287	-118.2868414	Los Angeles County
335151	Ordering, Referring, Prescribing	N/A	1487798062	0	0	DESENNA, ELAINE V LCSW	2/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74713	N/A	N/A	N/A	N/A	N/A	734 SILVER SPUR ROAD	202	ROLLING HILLS EST	CA	90274	3805	00	06000	33.77108101	-118.3696012	Los Angeles County
335173	Ordering, Referring, Prescribing	N/A	1487852794	0	0	DO, HIEU V	1/20/2003	Taxonomy not applicable	NA	n/a	099	DENTIST	D50593	N/A	N/A	N/A	N/A	N/A	6901 S ATLANTIC BLVD	None	BELL	CA	90201	3646	00	06000	33.97291242	-118.1878808	Los Angeles County
335231	Ordering, Referring, Prescribing	N/A	1487975041	0	0	DHILLON, PRENEET K MD	12/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110967	N/A	N/A	N/A	N/A	N/A	900 FULTON AVE	SUITE 205	SACRAMENTO	CA	95825	4517	00	06000	38.581902	-121.4007615	Sacramento County
335234	Ordering, Referring, Prescribing	N/A	1487974374	0	0	DUNCAN, CORINNE N NP	5/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	829283	N/A	N/A	N/A	N/A	N/A	301 6TH ST	SUITE 214	SANTA ROSA	CA	95401	6270	00	06000	38.440269	-122.7188745	Sonoma County
335235	Ordering, Referring, Prescribing	N/A	1487990321	0	0	DANISH, ELISA K LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36468	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	200	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
335240	Ordering, Referring, Prescribing	N/A	1487997128	0	0	DIAMENT, TIFFANY M MD	11/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134062	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	SUITE 200	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
335260	Ordering, Referring, Prescribing	N/A	1497025225	0	0	DANG, VI T PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53001	N/A	N/A	N/A	N/A	N/A	310 SYCAMORE AVE	None	VISTA	CA	92083	7702	00	06000	33.16952438	-117.2127924	San Diego County
335272	Ordering, Referring, Prescribing	N/A	1497037162	0	0	DUGGAN, STEPHANIE R PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64475	N/A	N/A	N/A	N/A	N/A	14001 PALM DR	None	DESERT HOT SPRING	CA	92240	6845	00	06000	33.94673142	-116.5018116	Riverside County
335281	Ordering, Referring, Prescribing	N/A	1497056907	0	0	DAVIS, HILARY LPCC	6/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	1881	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	133	OAKLAND	CA	94605	2424	00	06000	37.768221	-122.17608	Alameda County
335282	Ordering, Referring, Prescribing	N/A	1497055057	0	0	DECKER, MELANIE PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62499	N/A	N/A	N/A	N/A	N/A	501 J ST	None	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
335288	Ordering, Referring, Prescribing	N/A	1497066617	0	0	DUONG, KRISTINE C	4/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63477	N/A	N/A	N/A	N/A	N/A	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	00	06000	34.072245	-117.4319685	San Bernardino County
335303	Ordering, Referring, Prescribing	N/A	1497099535	0	0	DASTRUP, KAREN L LMFT	4/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	37461	N/A	N/A	N/A	N/A	N/A	18411 CRENSHAW BLVD.	SUITE 400	TORRANCE	CA	90504	5076	00	06000	33.86333387	-118.3265193	Los Angeles County
335310	Ordering, Referring, Prescribing	N/A	1497106058	0	0	DELGADO, DENISE LMFT	3/20/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138700	N/A	N/A	N/A	N/A	N/A	13800 HEACOCK ST	C220	MORENO VALLEY	CA	92553	3332	00	06000	33.91968997	-117.2437139	Riverside County
335314	Ordering, Referring, Prescribing	N/A	1497108500	0	0	DEO, SHAYAL K PHARMD	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74354	N/A	N/A	N/A	N/A	N/A	1235 STRATFORD AVE	None	DIXON	CA	95620	2024	00	06000	38.45801447	-121.838922	Solano County
335375	Ordering, Referring, Prescribing	N/A	1497204226	0	0	DI GREGORIO, KARINA LMFT	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112648	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD.	SUITE A	IRWINDALE	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
335391	Ordering, Referring, Prescribing	N/A	1497225676	0	0	DAVIS, MARIYA RN	2/6/2018	Taxonomy not applicable	NA	n/a	000	Unknown	712045	N/A	N/A	N/A	N/A	N/A	1530 E 19TH STREET	None	BAKERSFIELD	CA	93305	5406	00	06000	35.37150365	-118.9798847	Kern County
335409	Ordering, Referring, Prescribing	N/A	1497257349	0	0	D'AVANZO, DEVON LMFT	11/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151638	N/A	N/A	N/A	N/A	N/A	2300 MLK JR WAY	None	BERKELEY	CA	94704	1412	00	06000	37.86671106	-122.2725212	Alameda County
335423	Ordering, Referring, Prescribing	N/A	1497288351	0	0	DURNS, TYLER MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170485	N/A	N/A	N/A	N/A	N/A	2315 E STOCKTON BLVD	None	GALT	CA	95817	2282	00	06000	38.555181	-121.4566785	Sacramento County
335448	Ordering, Referring, Prescribing	N/A	1497326029	0	0	DO, KATHERINE Q OD	5/2/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35111	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
335464	Ordering, Referring, Prescribing	N/A	1497378293	0	0	DAOUD, MELISSA S LMFT	11/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119476	N/A	N/A	N/A	N/A	N/A	650 CLARK WAY	None	PALO ALTO	CA	94304	2300	00	06000	37.43949537	-122.1784133	Santa Clara County
335477	Ordering, Referring, Prescribing	N/A	1497399265	0	0	DELGADO, JOANNA M LCSW	11/4/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111864	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD	STE I	BALDWIN PARK	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
335495	Ordering, Referring, Prescribing	N/A	1497422570	0	0	DITTMORE, ERIKA J LCSW	12/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127630	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
335518	Ordering, Referring, Prescribing	N/A	1497507164	0	0	DETH, CAROLYN PHARMD	6/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH75905	N/A	N/A	N/A	N/A	N/A	6336 PASSONS BLVD	ROOM 100	PICO RIVERA	CA	90660	3355	00	06000	33.98515856	-118.0862644	Los Angeles County
335519	Ordering, Referring, Prescribing	N/A	1497499909	0	0	DEVINENI, ADITYA MD	12/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189731	N/A	N/A	N/A	N/A	N/A	17259 JASMINE ST	SUITE B	VICTORVILLE	CA	92395	7787	00	06000	34.47490447	-117.2855835	San Bernardino County
335527	Ordering, Referring, Prescribing	N/A	1497727820	0	0	DESOCIO, KAREN A LCSW	4/10/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18451	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
335535	Ordering, Referring, Prescribing	N/A	1497800015	0	0	DAVIS, KATRECE R	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0462482	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
335555	Ordering, Referring, Prescribing	N/A	1497844914	0	0	DIAZ, SONIA E LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCW29269	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
335556	Ordering, Referring, Prescribing	N/A	1497845614	0	0	DUBLIN, JORGE N MD	10/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A24464	N/A	N/A	N/A	N/A	N/A	4010 WATSON PLAZA DR	STE 285	LAKEWOOD	CA	90712	4408	00	06000	33.83123565	-118.1550195	Los Angeles County
335557	Ordering, Referring, Prescribing	N/A	1497851489	0	0	DEWGARDE, LYNN	7/29/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G00079134	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
335648	Ordering, Referring, Prescribing	N/A	1508056508	0	0	DE LEON GONZALEZ, ANA LILIA LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20804	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
335692	Ordering, Referring, Prescribing	N/A	1508141953	0	0	DAC, JULIE PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63582	N/A	N/A	N/A	N/A	N/A	770 1ST ST	None	GILROY	CA	95020	0000	00	06000	37.01344257	-121.5843817	Santa Clara County
335694	Ordering, Referring, Prescribing	N/A	1508148610	0	0	DESMET, SARA LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90559	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	404	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
335767	Ordering, Referring, Prescribing	N/A	1508258559	0	0	DESAI, RAJ MD	6/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163057	N/A	N/A	N/A	N/A	N/A	11160 WARNER AVE, SUITE	417	FOUNTAIN VALLEY	CA	92708	8703	00	06000	33.71630854	-117.934317	Orange County
335768	Ordering, Referring, Prescribing	N/A	1508267824	0	0	DOSSI, DOLORA A PSY	3/13/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29332	N/A	N/A	N/A	N/A	N/A	18144 SECO ST	None	JAMESTOWN	CA	95327	9737	00	06000	37.95208073	-120.4216785	Tuolumne County
335771	Ordering, Referring, Prescribing	N/A	1508275025	0	0	DINH, ANDREW D	4/24/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D63813	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
335796	Ordering, Referring, Prescribing	N/A	1508316464	0	0	DELGADO, BRITTANY D LMFT	2/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113116	N/A	N/A	N/A	N/A	N/A	1231 E DYER RD	135	SANTA ANA	CA	92705	5606	00	06000	33.710643	-117.856773	Orange County
335854	Ordering, Referring, Prescribing	N/A	1508412214	0	0	DEBARRY, DENA M NP	3/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013847	N/A	N/A	N/A	N/A	N/A	1436 GOODRICH BLVD	None	COMMERCE	CA	90022	5111	00	06000	34.01117577	-118.1585527	Los Angeles County
335859	Ordering, Referring, Prescribing	N/A	1508417544	0	0	DYTAN, MICHELLE ERIKA V OT	9/23/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT25336	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
335882	Ordering, Referring, Prescribing	N/A	1508475138	0	0	DUONG, ALYSSA PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79136	N/A	N/A	N/A	N/A	N/A	4306 MING AVE	None	BAKERSFIELD	CA	93309	4802	00	06000	35.33968648	-119.0507265	Kern County
335892	Ordering, Referring, Prescribing	N/A	1508498148	0	0	DIAZ SORTO, JOSELYN PA	10/31/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58303	N/A	N/A	N/A	N/A	N/A	808 W 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
335943	Ordering, Referring, Prescribing	N/A	1508802828	0	0	DANGREMOND, ADRIANNA MD	3/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G138260	N/A	N/A	N/A	N/A	N/A	628 W MICHELTORENA ST	None	SANTA BARBARA	CA	93101	4131	00	06000	34.41910081	-119.7158618	Santa Barbara County
335947	Ordering, Referring, Prescribing	N/A	1508818543	0	0	DRAKE, CATHY L MD	9/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	8753	N/A	N/A	N/A	N/A	N/A	1100 CENTRAL AVE SE	None	ALBUQUERQUE	NM	87106	4930	00	06000	35.08239279	-106.6353509	Bernalillo County
335949	Ordering, Referring, Prescribing	N/A	1508837980	0	0	DOMINGUEZ, JAIME S	3/17/1999	Taxonomy not applicable	NA	n/a	099	DENTIST	D37097	N/A	N/A	N/A	N/A	N/A	672 E ROMIE LN	None	SALINAS	CA	93901	4206	00	06000	36.65937073	-121.6437601	Monterey County
335967	Ordering, Referring, Prescribing	N/A	1508887761	0	0	DE ARTOLA, IGNACIO MD	8/11/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G51149	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
336098	Ordering, Referring, Prescribing	N/A	1518153659	0	0	DE BRER, VANESSA C LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60940	N/A	N/A	N/A	N/A	N/A	1500 FRANKLIN STREET	1500 FRANKLIN STREET	SAN FRANCISCO	CA	94109	4523	00	06000	37.78847503	-122.4235955	San Francisco County
336150	Ordering, Referring, Prescribing	N/A	1518237122	0	0	DIROLL, YVETTE T PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61709	N/A	N/A	N/A	N/A	N/A	19001 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92704	0000	00	06000	33.70974625	-117.954522	Orange County
336151	Ordering, Referring, Prescribing	N/A	1518261288	0	0	DE LA TORRE, BRENDA LMFT	12/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108961	N/A	N/A	N/A	N/A	N/A	530 W BADILLO ST	None	COVINA	CA	91722	3787	00	06000	34.08625283	-117.8999625	Los Angeles County
336192	Ordering, Referring, Prescribing	N/A	1518345099	0	0	DI MARTINO, LINDSEY LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108564	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	STE 210	EL CAJON	CA	92021	7417	00	06000	32.80772549	-116.94771	San Diego County
336195	Ordering, Referring, Prescribing	N/A	1518345859	0	0	DOHRMANN, ELIZABETH MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156684	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
336205	Ordering, Referring, Prescribing	N/A	1518360643	0	0	DANG, HOANG PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71708	N/A	N/A	N/A	N/A	N/A	4041 N SIERRA WAY	None	SAN BERNARDINO	CA	92407	3816	00	06000	34.16544	-117.2850005	San Bernardino County
336213	Ordering, Referring, Prescribing	N/A	1518368331	0	0	DELGADO, ANDREW M LCSW	12/28/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87293	N/A	N/A	N/A	N/A	N/A	3750 ROHNERVILLE RD	None	FORTUNA	CA	95540	3750	00	06000	40.58219346	-124.1308513	Humboldt County
336259	Ordering, Referring, Prescribing	N/A	1518435379	0	0	DYTHAVON, NOOR RN MA	1/29/2020	Taxonomy not applicable	NA	n/a	000	Unknown	488218	N/A	N/A	N/A	N/A	N/A	1620 35TH AVE SUITE D	None	SACRAMENTO	CA	95822	0606	00	06000	38.520315	-121.499604	Sacramento County
336260	Ordering, Referring, Prescribing	N/A	1518429844	0	0	DESAI, PAYAL P MD MPH	5/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178437	N/A	N/A	N/A	N/A	N/A	747 52ND ST, OAKLAND CA	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
336263	Ordering, Referring, Prescribing	N/A	1518433473	0	0	DIAZ, BRENDA M LPCC	1/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC15650	N/A	N/A	N/A	N/A	N/A	555 TECHNOLOGY CT	300	RIVERSIDE	CA	92507	2155	00	06000	34.00024862	-117.32403	Riverside County
336276	Ordering, Referring, Prescribing	N/A	1518481407	0	0	DORADO, SUE DC	6/26/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33927	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
336297	Ordering, Referring, Prescribing	N/A	1518505387	0	0	DOAN, CHRISTINA L PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH81008	N/A	N/A	N/A	N/A	N/A	253200 MUIR RD	None	MARTINEZ	CA	94553	0002	00	06000	37.99043671	-122.0984069	Contra Costa County
336323	Ordering, Referring, Prescribing	N/A	1518581586	0	0	DIWAKER, GUNJEETA B	8/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	104906	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
336338	Ordering, Referring, Prescribing	N/A	1518642305	0	0	DIAZ AVALOS, ESMERALDA	10/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025529	N/A	N/A	N/A	N/A	N/A	650 NORTH FULTON STREE	None	FRESNO	CA	93728	3404	00	06000	36.75213	-119.800333	Fresno County
336341	Ordering, Referring, Prescribing	N/A	1518664960	0	0	DEWITT, HOLLIE A NP	2/15/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024293	N/A	N/A	N/A	N/A	N/A	301 BRUNDAGE LANE	None	BAKERSFIELD	CA	93304	3248	00	06000	35.35386839	-119.0055269	Kern County
336378	Ordering, Referring, Prescribing	N/A	1528021516	0	0	DOAN, BONG MD	2/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45613	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	223	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
336383	Ordering, Referring, Prescribing	N/A	1528045838	0	0	DURAN, MARTHA PA-C	4/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	14451	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
336398	Ordering, Referring, Prescribing	N/A	1528105368	0	0	DOIG, MARIANA LMFT	9/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48279	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
336399	Ordering, Referring, Prescribing	N/A	1528106622	0	0	DEROSE, MICHAEL LMFT	7/9/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43058	N/A	N/A	N/A	N/A	N/A	440 E CANAL DR	None	TURLOCK	CA	95380	3936	00	06000	37.50031048	-120.843576	Stanislaus County
336433	Ordering, Referring, Prescribing	N/A	1528191020	0	0	DOUGHERTY, JENNIFER I LCSW	5/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW18078	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	SUITE 200	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
336464	Ordering, Referring, Prescribing	N/A	1528247681	0	0	DAVILA, ANNA S LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76044	N/A	N/A	N/A	N/A	N/A	777 NORTH FIRST ST	STE 220	SAN JOSE	CA	95112	6352	00	06000	37.35064564	-121.9015633	Santa Clara County
336488	Ordering, Referring, Prescribing	N/A	1528300514	0	0	DANIEL, EDESSA K PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69448	N/A	N/A	N/A	N/A	N/A	1050 NORTH HIGHLAND AVE	None	LOS ANGELES	CA	90038	2407	00	06000	34.090398	-118.338573	Los Angeles County
336492	Ordering, Referring, Prescribing	N/A	1528316114	0	0	DIMAPAWI, MARK P PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67634	N/A	N/A	N/A	N/A	N/A	20623 W CHESTNUT CIR	None	PORTER RANCH	CA	91326	4949	00	06000	34.29319915	-118.5836334	Los Angeles County
336500	Ordering, Referring, Prescribing	N/A	1528333275	0	0	DENLEY, ERICA M	5/16/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D60791	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
336523	Ordering, Referring, Prescribing	N/A	1528357266	0	0	DIEP, DAT Q PHARMD	7/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50117	N/A	N/A	N/A	N/A	N/A	860 EAST AVE	None	CHICO	CA	95926	0000	00	06000	39.76088587	-121.8450071	Butte County
336564	Ordering, Referring, Prescribing	N/A	1528433208	0	0	DE LA PAZ, LIZETTE PHARMD	10/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73874	N/A	N/A	N/A	N/A	N/A	30901 RIVERSIDE DR	None	LAKE ELSINORE	CA	92530	9253	00	06000	33.68550069	-117.3658249	Riverside County
336572	Ordering, Referring, Prescribing	N/A	1528437043	0	0	DAVIS, KELLSIE MSW LCSW	2/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121225	N/A	N/A	N/A	N/A	N/A	401 S TUSTIN STREET	BUILDING D	ORANGE	CA	92866	2550	00	06000	33.782094	-117.8357215	Orange County
336573	Ordering, Referring, Prescribing	N/A	1528440765	0	0	DANSIE, MAYA S LCSW	4/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100648	N/A	N/A	N/A	N/A	N/A	339 MELODY LN	None	SALINAS	CA	93901	2735	00	06000	36.67280761	-121.6552475	Monterey County
336578	Ordering, Referring, Prescribing	N/A	1528445210	0	0	DOAN, JOSEPH MD	5/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147313	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
336642	Ordering, Referring, Prescribing	N/A	1528557576	0	0	DOAN, DUC N	1/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78153	N/A	N/A	N/A	N/A	N/A	2700 PARK AVE	None	TUSTIN	CA	92782	2708	00	06000	33.69923603	-117.821646	Orange County
336682	Ordering, Referring, Prescribing	N/A	1528613981	0	0	DE LEON, NOEL ED	6/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS104173	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	315	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
336724	Ordering, Referring, Prescribing	N/A	1528715943	0	0	DANG, CATHERINE	10/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019431	N/A	N/A	N/A	N/A	N/A	765 THIRD AVE	100	CHULA VISTA	CA	91910	5842	00	06000	32.62545436	-117.0736724	San Diego County
336758	Ordering, Referring, Prescribing	N/A	1528899622	0	0	DAHLIN, ILSOOK NP	8/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031582	N/A	N/A	N/A	N/A	N/A	35324 HIGHWAY 41	None	COARSEGOLD	CA	93614	8302	00	06000	37.26242065	-119.6987402	Madera County
336766	Ordering, Referring, Prescribing	N/A	1538148697	0	0	DENSERT, RUCHIRA S MD	9/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C133474	N/A	N/A	N/A	N/A	N/A	8770 CUYAMACA ST	SUITE 4	SANTEE	CA	92071	4373	00	06000	32.83525722	-116.9839255	San Diego County
336774	Ordering, Referring, Prescribing	N/A	1538187208	0	0	DAVIS, MARIANNE LMFT	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC25421	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE.	None	BERKELEY	CA	94703	1287	00	06000	37.87060038	-122.2812128	Alameda County
336837	Ordering, Referring, Prescribing	N/A	1538299938	0	0	DOVICK, SACHA M PSYD	11/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19633	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
336870	Ordering, Referring, Prescribing	N/A	1538379649	0	0	DIAZ, NOEL J PSYD	6/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23569	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
336883	Ordering, Referring, Prescribing	N/A	1538395884	0	0	DE AVILA, MARIBEL LCSW	3/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94273	N/A	N/A	N/A	N/A	N/A	1120 W LA VETA AVE	660	ORANGE	CA	92868	4231	00	06000	33.78029455	-117.864369	Orange County
336982	Ordering, Referring, Prescribing	N/A	1538560008	0	0	DEAGON, JENNIFER LCSW	9/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107884	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
336996	Ordering, Referring, Prescribing	N/A	1538575188	0	0	DUNEHEW, THOMAS J	9/1/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64933	N/A	N/A	N/A	N/A	N/A	4305 UNIVERSITY AVE	STE 150	SAN DIEGO	CA	92105	1690	00	06000	32.74957853	-117.101439	San Diego County
337028	Ordering, Referring, Prescribing	N/A	1538618020	0	0	DELGADO-ESCALERA, LESLIE M LMFT	12/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136697	N/A	N/A	N/A	N/A	N/A	555 N PERRIS BLVD	None	PERRIS	CA	92571	2811	00	06000	33.79131	-117.226053	Riverside County
337034	Ordering, Referring, Prescribing	N/A	1538624630	0	0	DO, VIVIAN LMFT	8/26/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149151	N/A	N/A	N/A	N/A	N/A	3631 SOUTH HARBOR BLVD	200	SANTA ANA	CA	92704	7936	00	06000	33.6988425	-117.919374	Orange County
337051	Ordering, Referring, Prescribing	N/A	1538665799	0	0	DUONG, JULIA T	1/31/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104561	N/A	N/A	N/A	N/A	N/A	1600 WEEOT WAY	None	ARCATA	CA	95521	0000	00	06000	40.89808837	-124.0923819	Humboldt County
337077	Ordering, Referring, Prescribing	N/A	1538707765	0	0	DHARKAR-SURBER, SAPNA NP	12/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013257	N/A	N/A	N/A	N/A	N/A	217 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	1518	00	06000	32.68298968	-117.1005464	San Diego County
337085	Ordering, Referring, Prescribing	N/A	1538723622	0	0	DAO, PATRICK H NP	6/19/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011665	N/A	N/A	N/A	N/A	N/A	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8511	00	06000	32.773176	-115.5270465	Imperial County
337087	Ordering, Referring, Prescribing	N/A	1538726765	0	0	DIAZ, CLAUDIA LCSW	8/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117114	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
337125	Ordering, Referring, Prescribing	N/A	1538865134	0	0	DI YORIO, EMILY M LMFT	9/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149944	N/A	N/A	N/A	N/A	N/A	555 N PERRIS BLVD	None	PERRIS	CA	92571	2811	00	06000	33.79131	-117.226053	Riverside County
337144	Ordering, Referring, Prescribing	N/A	1538898903	0	0	DAVIS, RYAN DDS	9/4/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110723	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
337146	Ordering, Referring, Prescribing	N/A	1538927793	0	0	DURUTOVIC, CARLY PA	3/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64289	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK ST	C	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
337155	Ordering, Referring, Prescribing	N/A	1548019763	0	0	DECOOL, TAYLOR A NP	5/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030295	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
337171	Ordering, Referring, Prescribing	N/A	1548208242	0	0	DE VENTE, JEROME MD	9/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71061	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	302	LONG BEACH	CA	90813	3271	00	06000	33.779655	-118.1880065	Los Angeles County
337202	Ordering, Referring, Prescribing	N/A	1548318348	0	0	DOBOS, DAVID M MD	6/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G57276	N/A	N/A	N/A	N/A	N/A	31764 CASINO DR	SUITE 300	LAKE ELSINORE	CA	92530	2312	00	06000	33.65724839	-117.29582	Riverside County
337220	Ordering, Referring, Prescribing	N/A	1548363468	0	0	DAWSON, TODD A MD	4/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68915	N/A	N/A	N/A	N/A	N/A	47923 OASIS STREET	None	INDIO	CA	92201	9203	00	06000	33.70080223	-116.2209518	Riverside County
337227	Ordering, Referring, Prescribing	N/A	1548388242	0	0	DILLON, PAULA L LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42355	N/A	N/A	N/A	N/A	N/A	1539 MCHENRY AVE	None	MODESTO	CA	95350	4528	00	06000	37.666836	-120.994007	Stanislaus County
337249	Ordering, Referring, Prescribing	N/A	1548423585	0	0	DIAZ, MONIQUE MD	10/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C162717	N/A	N/A	N/A	N/A	N/A	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3929	00	06000	35.11274104	-120.588873	San Luis Obispo County
337264	Ordering, Referring, Prescribing	N/A	1548461981	0	0	DACOSTA BASS, JULIE A LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17287	N/A	N/A	N/A	N/A	N/A	2045 FAIRMONT DR.	None	SAN LEANDRO	CA	94578	1088	00	06000	37.709892	-122.118966	Alameda County
337289	Ordering, Referring, Prescribing	N/A	1548532344	0	0	DAMBRUOSO, SARAH F	1/6/2014	Taxonomy not applicable	NA	n/a	000	Unknown	RN0747029	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLVD	SUITE 550	SANTA MONICA	CA	90404	2125	00	06000	34.02901811	-118.4795396	Los Angeles County
337333	Ordering, Referring, Prescribing	N/A	1548615230	0	0	DEOL, MANDEEP PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69149	N/A	N/A	N/A	N/A	N/A	10360 BRIDGEVIEW LN	None	STOCKTON	CA	95219	7280	00	06000	38.05014126	-121.3894039	San Joaquin County
337348	Ordering, Referring, Prescribing	N/A	1548636491	0	0	DIAZ, JOSUE LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89766	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	A	SANTA FE SPRINGS	CA	90670	2010	00	06000	33.9462235	-118.0830161	Los Angeles County
337350	Ordering, Referring, Prescribing	N/A	1548638414	0	0	DARWISH MOUSTAFA, NASHWA NP	3/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017015	N/A	N/A	N/A	N/A	N/A	16192 SISKIYOU RD	STE 3	APPLE VALLEY	CA	92307	1316	00	06000	34.54544253	-117.2671778	San Bernardino County
337384	Ordering, Referring, Prescribing	N/A	1548697733	0	0	DELANEY, SARA NP	9/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011694	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
337412	Ordering, Referring, Prescribing	N/A	1548745094	0	0	DEAN, DEANNE M LPCC	11/4/2019	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC7225	N/A	N/A	N/A	N/A	N/A	2045 S SAN JACINTO AVE	None	SAN JACINTO	CA	92583	5626	00	06000	33.76536396	-116.9587092	Riverside County
337423	Ordering, Referring, Prescribing	N/A	1548757271	0	0	DAO, NANCY N PHARMD	9/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77399	N/A	N/A	N/A	N/A	N/A	20151 SW BIRCH ST STE 10	SUITE	NEWPORT BEACH	CA	92660	0775	00	06000	33.6589924	-117.8755279	Orange County
337441	Ordering, Referring, Prescribing	N/A	1548787559	0	0	DURAN, ELISA G LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119405	N/A	N/A	N/A	N/A	N/A	3800 WATT AVE	110	SACRAMENTO	CA	95821	2670	00	06000	38.634417	-121.3818435	Sacramento County
337481	Ordering, Referring, Prescribing	N/A	1548897119	0	0	DASILVA, AUDREY J MD	10/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182796	N/A	N/A	N/A	N/A	N/A	2201 SOUTH AVENUE	None	SOUTH LAKE TAHOE	CA	96150	7025	00	06000	38.91235444	-119.996422	El Dorado County
337482	Ordering, Referring, Prescribing	N/A	1548885445	0	0	DANG, CATHERINE T DMD	6/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107468	N/A	N/A	N/A	N/A	N/A	4212 MISSOURI FLAT ROAD	None	PLACERVILLE	CA	95682	7432	00	06000	38.706228	-120.834891	El Dorado County
337495	Ordering, Referring, Prescribing	N/A	1548934789	0	0	DIAZ, CRYSTAL LMFT	8/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84792	N/A	N/A	N/A	N/A	N/A	6061 EAST AVE.	None	ETIWANDA	CA	91739	2218	00	06000	34.14421719	-117.514554	San Bernardino County
337500	Ordering, Referring, Prescribing	N/A	1548982952	0	0	DE DIOS, ELIZABETH	9/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	4874	N/A	N/A	N/A	N/A	N/A	4515 ENCINITA AVE	None	ROSEMEAD	CA	91770	1433	00	06000	34.08715264	-118.0677261	Los Angeles County
337509	Ordering, Referring, Prescribing	N/A	1558015180	0	0	DICKELMAN, SHANNON M NP	9/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032229	N/A	N/A	N/A	N/A	N/A	400 WEST PUEBLO STREET	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
337525	Ordering, Referring, Prescribing	N/A	1558062398	0	0	DHILLON, NAPINDER K NP	5/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023269	N/A	N/A	N/A	N/A	N/A	1945 N. FINE	SUITE 100	FRESNO	CA	93727	1528	00	06000	36.76832721	-119.7290143	Fresno County
337544	Ordering, Referring, Prescribing	N/A	1558143776	0	0	DUMBUYA, JAINABA	6/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64585	N/A	N/A	N/A	N/A	N/A	2907 EL CAMINO REAL	None	REDWOOD CITY	CA	94061	4003	00	06000	37.46906354	-122.2114417	San Mateo County
337568	Ordering, Referring, Prescribing	N/A	1558392449	0	0	DEMONTEIRO, CHINNAVUTH P MD	2/12/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73896	N/A	N/A	N/A	N/A	N/A	2415 HIGH SCHOOL AVE	STE 800	CONCORD	CA	94520	1858	00	06000	37.98481374	-122.0347555	Contra Costa County
337573	Ordering, Referring, Prescribing	N/A	1558434100	0	0	DREDAR, SANAA PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51324	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	0058	00	06000	37.33636857	-121.9958111	Santa Clara County
337575	Ordering, Referring, Prescribing	N/A	1558435297	0	0	DONNELLY, EILEEN M	9/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	11304	N/A	N/A	N/A	N/A	N/A	21507 E CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
337580	Ordering, Referring, Prescribing	N/A	1558438697	0	0	DEL CASTILLO, LYSETTE LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25873	N/A	N/A	N/A	N/A	N/A	1679 E MAIN ST	102	EL CAJON	CA	92021	5212	00	06000	32.81117533	-116.9193178	San Diego County
337597	Ordering, Referring, Prescribing	N/A	1558485185	0	0	DEFAZIO, DONNA M LCSW	4/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26885	N/A	N/A	N/A	N/A	N/A	1520 N RAYMOND AVE	BLDG 2 - 7	PASADENA	CA	91103	1819	00	06000	34.171812	-118.1490725	Los Angeles County
337613	Ordering, Referring, Prescribing	N/A	1558511030	0	0	DELACRUZ, NICHOLAS P	12/1/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D57180	N/A	N/A	N/A	N/A	N/A	106 E MAIN ST	None	FOWLER	CA	93625	2433	00	06000	36.62899034	-119.6785493	Fresno County
337643	Ordering, Referring, Prescribing	N/A	1558597484	0	0	DANG, KHOI D LCSW	8/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75158	N/A	N/A	N/A	N/A	N/A	1360 MISSION ST	None	SAN FRANCISCO	CA	94103	2626	00	06000	37.77570758	-122.4154141	San Francisco County
337658	Ordering, Referring, Prescribing	N/A	1558615385	0	0	DEVRIES, EMILY R LCSW	8/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103114	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92301	1223	00	06000	34.54007429	-117.2744761	San Bernardino County
337723	Ordering, Referring, Prescribing	N/A	1558730473	0	0	DUNKIN, CHARLIE O LCSW	12/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99307	N/A	N/A	N/A	N/A	N/A	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
337735	Ordering, Referring, Prescribing	N/A	1558757807	0	0	DOVAS, CHRISTINA P NP	7/6/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	750036	N/A	N/A	N/A	N/A	N/A	6 WOODLAND RD	STE 304	ST HELENA	CA	94574	9562	00	06000	38.54297115	-122.4754501	Napa County
337752	Ordering, Referring, Prescribing	N/A	1558787911	0	0	DIAZ, JACQUELINE A LCSW	7/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124197	N/A	N/A	N/A	N/A	N/A	2620 INDUSTRY WAY	None	LYNWOOD	CA	90262	4024	00	06000	33.92360701	-118.2254995	Los Angeles County
337777	Ordering, Referring, Prescribing	N/A	1558826123	0	0	DUONG, JULIE LCSW	8/1/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117015	N/A	N/A	N/A	N/A	N/A	1940 E DEERE AVE	SUITE 100	SANTA ANA	CA	92705	5718	00	06000	33.70430421	-117.8482556	Orange County
337789	Ordering, Referring, Prescribing	N/A	1558849661	0	0	DEROSE, SONJA D MD	11/15/2017	Taxonomy not applicable	NA	n/a	000	Unknown	G151475	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LN	None	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
337857	Ordering, Referring, Prescribing	N/A	1558981738	0	0	DURAN HERNANDEZ, REYNA LMFT	8/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134173	N/A	N/A	N/A	N/A	N/A	505 N. EUCLID STREET	SUITE 300	ANAHEIM	CA	92801	5514	00	06000	33.8379454	-117.9416147	Orange County
337881	Ordering, Referring, Prescribing	N/A	1568025856	0	0	DOOLEN, CHRISTIN D LMFT	7/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120121	N/A	N/A	N/A	N/A	N/A	1908 BUSINESS CENTER DR	109	SAN BERNARDINO	CA	92408	3469	00	06000	34.06732096	-117.2801085	San Bernardino County
337886	Ordering, Referring, Prescribing	N/A	1568038412	0	0	DEL MORAL, LETICIA L PSYD	1/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3680	N/A	N/A	N/A	N/A	N/A	31350 RANCHO VISTA RD	None	TEMECULA	CA	92592	6200	00	06000	33.50406869	-117.1134793	Riverside County
337916	Ordering, Referring, Prescribing	N/A	1568099927	0	0	DOLAN, ESTELLE MD	7/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177657	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	140	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
337917	Ordering, Referring, Prescribing	N/A	1568130557	0	0	DILLARD, CHRISTINA	11/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3529	N/A	N/A	N/A	N/A	N/A	2335 PLAZA DEL AMO	None	TORRANCE	CA	90501	3420	00	06000	33.82819611	-118.3213536	Los Angeles County
337939	Ordering, Referring, Prescribing	N/A	1568188324	0	0	DURAN, SONIA M LCSW	10/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110894	N/A	N/A	N/A	N/A	N/A	250 LOCUST ST	None	SANTA CRUZ	CA	95060	3813	00	06000	36.97493323	-122.028799	Santa Cruz County
337944	Ordering, Referring, Prescribing	N/A	1568197143	0	0	DATNER, WAVERLY PA	11/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63706	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
337958	Ordering, Referring, Prescribing	N/A	1568414712	0	0	DANSEREAU, JEAN J MD	3/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44031	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	250	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
337959	Ordering, Referring, Prescribing	N/A	1568428704	0	0	DEGUZMAN, JAIME M LAC	11/27/2018	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	10241	N/A	N/A	N/A	N/A	N/A	7275 E SOUTHGATE DR	204	SACRAMENTO	CA	95823	2629	00	06000	38.493576	-121.436559	Sacramento County
337979	Ordering, Referring, Prescribing	N/A	1568515310	0	0	DIEP, CHIN K MSW LCSW	6/28/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26829	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
337992	Ordering, Referring, Prescribing	N/A	1568534915	0	0	DEAN, JOEL MD	3/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C195160	N/A	N/A	N/A	N/A	N/A	1325 E CHURCH ST	STE 202	SANTA MARIA	CA	93454	0001	00	06000	34.95209265	-120.4147348	Santa Barbara County
338011	Ordering, Referring, Prescribing	N/A	1568582229	0	0	DENNY, SUSAN LMFT	5/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39304	N/A	N/A	N/A	N/A	N/A	207 37TH ST	None	RICHMOND	CA	94805	2105	00	06000	37.93329292	-122.3343935	Contra Costa County
338087	Ordering, Referring, Prescribing	N/A	1568740975	0	0	DUENAS, NORMA M LMFT	11/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86218	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
338100	Ordering, Referring, Prescribing	N/A	1568756260	0	0	DELORME, BRIAN PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	61668	N/A	N/A	N/A	N/A	N/A	189 NIBLICK RD	None	PASO ROBLES	CA	93446	4845	00	06000	35.61505753	-120.6811935	San Luis Obispo County
338106	Ordering, Referring, Prescribing	N/A	1568761518	0	0	DUNCAN, RONNI L LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94304	N/A	N/A	N/A	N/A	N/A	7000-B SO. CENTER DR.	None	CLEARLAKE	CA	95422	0318	00	06000	38.933529	-122.6196511	Lake County
338132	Ordering, Referring, Prescribing	N/A	1568808822	0	0	DORSEY, ALEXANDER T LPCC	11/30/2019	Taxonomy not applicable	NA	n/a	000	Unknown	5160	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
338155	Ordering, Referring, Prescribing	N/A	1568831394	0	0	DE LA CRUZ, ELLE M LCSW	6/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101875	N/A	N/A	N/A	N/A	N/A	5275 CLAREMONT AVE.	None	OAKLAND	CA	94618	1032	00	06000	37.8391822	-122.260841	Alameda County
338180	Ordering, Referring, Prescribing	N/A	1568863538	0	0	DITTA, CAITLIN LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88610	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
338206	Ordering, Referring, Prescribing	N/A	1568894624	0	0	DUCCINI, STEPHANIE R LMFT	1/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102787	N/A	N/A	N/A	N/A	N/A	1908 BUSINESS CENTER DR	None	SAN BERNARDINO	CA	92408	3436	00	06000	34.06732096	-117.2801085	San Bernardino County
338278	Ordering, Referring, Prescribing	N/A	1578012753	0	0	DESHMUKH, NEHA LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101327	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
338287	Ordering, Referring, Prescribing	N/A	1578031423	0	0	DESAI, SONAM NP	7/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95009447	N/A	N/A	N/A	N/A	N/A	8540 ALONDRA BLVD	SUITE B-2	PARAMOUNT	CA	90723	5200	00	06000	33.88915049	-118.1500515	Los Angeles County
338305	Ordering, Referring, Prescribing	N/A	1578058681	0	0	DELTORO, JOSE L LMFT	10/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120167	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	2ND FLOOR	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
338331	Ordering, Referring, Prescribing	N/A	1578095113	0	0	DESAI, ANYA S MD	7/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160200	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE BLDG 83	None	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
338339	Ordering, Referring, Prescribing	N/A	1578107025	0	0	DOSHI, ANISHA A PHARMD	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80802	N/A	N/A	N/A	N/A	N/A	668 MOWRY AVE	None	FREMONT	CA	94536	4113	00	06000	37.56683221	-121.9739694	Alameda County
338343	Ordering, Referring, Prescribing	N/A	1578114831	0	0	DANIEL, DANIEL G	2/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80750	N/A	N/A	N/A	N/A	N/A	1291 SANGUINETTI RD	None	SONORA	CA	95370	6215	00	06000	37.97421219	-120.3621248	Tuolumne County
338362	Ordering, Referring, Prescribing	N/A	1578156881	0	0	DUARTE, KATRINA A PA	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59337	N/A	N/A	N/A	N/A	N/A	918 W FOOTHILL BLVD	STE. A	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
338363	Ordering, Referring, Prescribing	N/A	1578165122	0	0	DO, ALLAN T PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83598	N/A	N/A	N/A	N/A	N/A	4900 PANAMA LANE	None	BAKERSFIELD	CA	93313	6235	00	06000	35.297802	-119.058516	Kern County
338365	Ordering, Referring, Prescribing	N/A	1578165031	0	0	DEAL, CHRISTINA NP	1/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013519	N/A	N/A	N/A	N/A	N/A	3533 W PICO BLVD	None	LOS ANGELES	CA	90019	4534	00	06000	34.04721925	-118.3197384	Los Angeles County
338388	Ordering, Referring, Prescribing	N/A	1578232732	0	0	DEL TORO, VIRGINIA	3/8/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	4223	N/A	N/A	N/A	N/A	N/A	1401 BROADWAY AVE	None	ATWATER	CA	95301	3546	00	06000	37.34777935	-120.6114041	Merced County
338392	Ordering, Referring, Prescribing	N/A	1578239711	0	0	DEOL, ELIZABETH LCSW	5/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122855	N/A	N/A	N/A	N/A	N/A	480 CHADBOURNE RD	None	FAIRFIELD	CA	94534	9639	00	06000	38.23538389	-122.0821428	Solano County
338414	Ordering, Referring, Prescribing	N/A	1578331369	0	0	DAQUILLA, REGINA F	11/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028138	N/A	N/A	N/A	N/A	N/A	252 FRASER LN	None	VENTURA	CA	93001	1108	00	06000	34.32846181	-119.2872828	Ventura County
338481	Ordering, Referring, Prescribing	N/A	1578694014	0	0	DYER, LANITA LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	82475	N/A	N/A	N/A	N/A	N/A	3881 S WESTERN AVE	None	LOS ANGELES	CA	90062	1105	00	06000	34.015032	-118.308937	Los Angeles County
338502	Ordering, Referring, Prescribing	N/A	1578717302	0	0	DEIMLING, KIMBERLY S CNM	1/23/2020	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	1809	N/A	N/A	N/A	N/A	N/A	18077 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	00	06000	34.54021616	-117.2696677	San Bernardino County
338512	Ordering, Referring, Prescribing	N/A	1578743894	0	0	DOBALIAN, DANIEL D MD	5/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G41926	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
338518	Ordering, Referring, Prescribing	N/A	1578751046	0	0	DELOS REYES, IMELDA F	7/19/2004	Taxonomy not applicable	NA	n/a	099	DENTIST	D52370	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
338551	Ordering, Referring, Prescribing	N/A	1578792800	0	0	DUFOUR, MARTIN MD	1/30/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C141556	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
338571	Ordering, Referring, Prescribing	N/A	1578842548	0	0	DOAN, JIMMY MD	1/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122521	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
338579	Ordering, Referring, Prescribing	N/A	1578846127	0	0	DEVAUGHN, ALEXANDRIA R NP	9/3/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95032003	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVENUE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
338584	Ordering, Referring, Prescribing	N/A	1578845384	0	0	DUONG, KIM PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60418	N/A	N/A	N/A	N/A	N/A	26531 ALISO CREEK RD	None	ALISO VIEJO	CA	92656	2882	00	06000	33.57711083	-117.7232234	Orange County
338589	Ordering, Referring, Prescribing	N/A	1578862553	0	0	DUONG, NHAN	1/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	52252	N/A	N/A	N/A	N/A	N/A	3250 W GRANT LINE RD	None	TRACY	CA	95304	8427	00	06000	37.750995	-121.4752365	San Joaquin County
338600	Ordering, Referring, Prescribing	N/A	1578876199	0	0	DENG, JIE MD	4/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	A128020	N/A	N/A	N/A	N/A	N/A	845 JACKSON ST	B1	SAN FRANCISCO	CA	94133	4851	00	06000	37.79571919	-122.4089166	San Francisco County
338634	Ordering, Referring, Prescribing	N/A	1578918421	0	0	DAYRIT, JEREMY KAY MD	9/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166787	N/A	N/A	N/A	N/A	N/A	265 POSADA LN	STE B	TEMPLETON	CA	93465	4065	00	06000	35.55354235	-120.7214149	San Luis Obispo County
338643	Ordering, Referring, Prescribing	N/A	1578925087	0	0	DELISSER, MONIQUE A MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154102	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
338660	Ordering, Referring, Prescribing	N/A	1578944161	0	0	DESJARDINS, MARK P LCSW	5/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101485	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	SUITE 107	LAKE ELSINORE	CA	92530	4419	00	06000	33.66201142	-117.3001906	Riverside County
338681	Ordering, Referring, Prescribing	N/A	1578980652	0	0	DOWRAY, SUNAINA R MD	7/15/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137966	N/A	N/A	N/A	N/A	N/A	2525 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78246242	-122.4448129	San Francisco County
338700	Ordering, Referring, Prescribing	N/A	1578990925	0	0	DANG, RICHARD H	5/17/2017	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	69784	N/A	N/A	N/A	N/A	N/A	1510 SAN PABLO	STE 144	LOS ANGELES	CA	90033	5320	00	06000	34.06287152	-118.2029433	Los Angeles County
338702	Ordering, Referring, Prescribing	N/A	1588005110	0	0	DEGUZMAN, MYLENE PHARMD	3/4/2023	Taxonomy not applicable	NA	n/a	000	Unknown	APH11120	N/A	N/A	N/A	N/A	N/A	8510 BALBOA BLVD	150	NORTHRIDGE	CA	91325	3583	00	06000	34.224507	-118.5026015	Los Angeles County
338706	Ordering, Referring, Prescribing	N/A	1588004840	0	0	DELFOSSE, ERIN M NP	1/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95000683	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
338750	Ordering, Referring, Prescribing	N/A	1588059661	0	0	DACUYCUY, LEONIEROSE N MD	11/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144075	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
338766	Ordering, Referring, Prescribing	N/A	1588072920	0	0	DUNKELBERGER, ARLENE LMFT	10/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142309	N/A	N/A	N/A	N/A	N/A	1272 HAYES ST	None	NAPA	CA	94559	1711	00	06000	38.30442969	-122.2936442	Napa County
338804	Ordering, Referring, Prescribing	N/A	1588129183	0	0	DE JESUS, JULIE R NP	9/9/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009965	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
338839	Ordering, Referring, Prescribing	N/A	1588193213	0	0	DAVILA, GABRIELA LAC	6/5/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17236	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
338861	Ordering, Referring, Prescribing	N/A	1588227383	0	0	DIAS, REBECCA L LMFT	5/24/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132908	N/A	N/A	N/A	N/A	N/A	516 N KAWEAH AVE	None	EXETER	CA	93221	1200	00	06000	36.30416949	-119.1357315	Tulare County
338866	Ordering, Referring, Prescribing	N/A	1588243729	0	0	DIVAGARAN, ADHIRA MD	9/7/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL7123	N/A	N/A	N/A	N/A	N/A	455 OCONNOR DR	None	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
338897	Ordering, Referring, Prescribing	N/A	1588368815	0	0	DUERKS, MABEL PSYD	10/31/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	4000	N/A	N/A	N/A	N/A	N/A	1791 W ACACIA AVE	None	HEMET	CA	92545	3797	00	06000	33.74376019	-116.9903284	Riverside County
338901	Ordering, Referring, Prescribing	N/A	1588364756	0	0	DAY, NICOLE A LCSW	4/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93705	N/A	N/A	N/A	N/A	N/A	28751 COLE GRADE RD	None	VALLEY CENTER	CA	92082	6575	00	06000	33.236019	-117.021447	San Diego County
338916	Ordering, Referring, Prescribing	N/A	1588438220	0	0	DANG, TIMOTHY TIN DINH DDS	10/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109626	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
338952	Ordering, Referring, Prescribing	N/A	1588725832	0	0	DESAI, PRATIBHA R MD	5/13/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A31924	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVENUE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
338978	Ordering, Referring, Prescribing	N/A	1588775043	0	0	DALWADI, KAMINI OD	12/9/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT13205	N/A	N/A	N/A	N/A	N/A	330 INLAND CTR	None	SAN BERNARDINO	CA	92408	1956	00	06000	34.08959257	-117.2965002	San Bernardino County
339016	Ordering, Referring, Prescribing	N/A	1588858062	0	0	DEANER-HARRINGTON, SHERRY D OD	3/1/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	10628	N/A	N/A	N/A	N/A	N/A	303 E. MAIN ST.	None	EL CAJON	CA	92020	0000	00	06000	32.79492548	-116.9584785	San Diego County
339023	Ordering, Referring, Prescribing	N/A	1588862528	0	0	DANG, KRISTEL L	10/28/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0676160	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
339028	Ordering, Referring, Prescribing	N/A	1588897003	0	0	DUTTON, JERILYN N AU	3/26/2020	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	2690	N/A	N/A	N/A	N/A	N/A	7759 HERSCHEL AVENUE	SUITE B	LA JOLLA	CA	92037	4478	00	06000	32.84493624	-117.2726009	San Diego County
339038	Ordering, Referring, Prescribing	N/A	1588913776	0	0	DICKERSON, DEANNA R LCSW	5/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92414	N/A	N/A	N/A	N/A	N/A	23228 MADERO	None	MISSION VIEJO	CA	92691	2706	00	06000	33.62548354	-117.6804077	Orange County
339052	Ordering, Referring, Prescribing	N/A	1588937361	0	0	DUONG, LIN	3/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60018	N/A	N/A	N/A	N/A	N/A	975 SERENO DR	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
339060	Ordering, Referring, Prescribing	N/A	1588939466	0	0	DIAZ, CARMEN G PA-C	1/2/2024	Taxonomy not applicable	NA	n/a	000	Unknown	22144	N/A	N/A	N/A	N/A	N/A	3410 S CENTRAL AVE	None	LOS ANGELES	CA	90011	2161	00	06000	34.0123647	-118.2564389	Los Angeles County
339063	Ordering, Referring, Prescribing	N/A	1588946388	0	0	DUONG, MACLAN N PHARMD	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62014	N/A	N/A	N/A	N/A	N/A	26531 ALISO CREEK RD	None	ALISO VIEJO	CA	92656	2882	00	06000	33.57711083	-117.7232234	Orange County
339095	Ordering, Referring, Prescribing	N/A	1588971808	0	0	DELGADO, CARISSA E MSW LCSW	12/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	67045	N/A	N/A	N/A	N/A	N/A	8019 S COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
339145	Ordering, Referring, Prescribing	N/A	1598047565	0	0	DANG, MICHAEL S LMFT	7/30/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99064	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY STREET	None	RED BLUFF	CA	96080	4605	00	06000	40.157883	-122.2250685	Tehama County
339192	Ordering, Referring, Prescribing	N/A	1598129223	0	0	DASGUPTA, DEBORSHI DPM	4/15/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	5542	N/A	N/A	N/A	N/A	N/A	2240 W MONTE VISTA AVE	None	TURLOCK	CA	95382	9667	00	06000	37.52173653	-120.8741705	Stanislaus County
339207	Ordering, Referring, Prescribing	N/A	1598150666	0	0	DAVIS, MAISHA A	7/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156908	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
339226	Ordering, Referring, Prescribing	N/A	1598168361	0	0	DE LEON-FIGUEROA, NENIA LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101255	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD.	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
339234	Ordering, Referring, Prescribing	N/A	1598193963	0	0	DING, ZUOHONG	9/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	AC15591	N/A	N/A	N/A	N/A	N/A	2308 TARAVAL ST	None	SAN FRANCISCO	CA	94116	2252	00	06000	37.74240656	-122.4910367	San Francisco County
339244	Ordering, Referring, Prescribing	N/A	1598199275	0	0	DANA, ALISON C PA	8/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59818	N/A	N/A	N/A	N/A	N/A	4305 UNIVERSITY AVE	SUITE 350	SAN DIEGO	CA	92105	8602	00	06000	32.74957853	-117.101439	San Diego County
339265	Ordering, Referring, Prescribing	N/A	1598246639	0	0	DURBIN, CARA LMFT	4/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	136397	N/A	N/A	N/A	N/A	N/A	2545 SAN PABLO AVE	None	OAKLAND	CA	94612	1121	00	06000	37.81631446	-122.2752306	Alameda County
339279	Ordering, Referring, Prescribing	N/A	1598276149	0	0	DAO, QUYEN PHARMD	7/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77607	N/A	N/A	N/A	N/A	N/A	1351 W CAPITOL AVE	None	WEST SACRAMENTO	CA	95691	3213	00	06000	38.58078833	-121.5255797	Yolo County
339294	Ordering, Referring, Prescribing	N/A	1598295024	0	0	DOVER, SARAH S LMFT	11/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123090	N/A	N/A	N/A	N/A	N/A	2218 N 1ST ST	None	SAN JOSE	CA	95131	2007	00	06000	37.37769052	-121.9213491	Santa Clara County
339453	Ordering, Referring, Prescribing	N/A	1598921686	0	0	DICKENS, LATISHA LCSW	1/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79261	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
339455	Ordering, Referring, Prescribing	N/A	1598929887	0	0	DUBNER, SARAH E MD	9/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116689	N/A	N/A	N/A	N/A	N/A	21507 EAST CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
339465	Ordering, Referring, Prescribing	N/A	1598943235	0	0	DOI, KATHERINE LMFT	10/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT128982	N/A	N/A	N/A	N/A	N/A	4001 LONG BEACH BLVD.	None	LONG BEACH	CA	90807	2616	00	06000	33.83091	-118.189377	Los Angeles County
339529	Ordering, Referring, Prescribing	N/A	1609097385	0	0	DANG, ALEXANDER LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51923	N/A	N/A	N/A	N/A	N/A	10 NORTH SAN PEDRO RD.	SUITE 1020	SAN RAFAEL	CA	94903	4178	00	06000	37.99529182	-122.5300426	Marin County
339536	Ordering, Referring, Prescribing	N/A	1609122795	0	0	DIAZ DE TUESTA, YVETTE K LCSW	7/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75365	N/A	N/A	N/A	N/A	N/A	27201 TOURNEY RD	201K	VALENCIA	CA	91355	1854	00	06000	34.41741018	-118.5770409	Los Angeles County
339559	Ordering, Referring, Prescribing	N/A	1609151943	0	0	DENG, KIMBERLY PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66224	N/A	N/A	N/A	N/A	N/A	216 WESTLAKE CTR	None	DALY CITY	CA	94015	1430	00	06000	37.70123591	-122.4833751	San Mateo County
339591	Ordering, Referring, Prescribing	N/A	1609201086	0	0	DIAZ, ALICIA LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106083	N/A	N/A	N/A	N/A	N/A	1950 MARKET STREET	None	RIVERSIDE	CA	92501	9992	00	06000	34.00316496	-117.3767967	Riverside County
339612	Ordering, Referring, Prescribing	N/A	1609234244	0	0	DUONG, CHRISTIE T	11/3/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101602	N/A	N/A	N/A	N/A	N/A	1830 COMMERCIAL WAY	None	SANTA CRUZ	CA	95065	1819	00	06000	36.98837145	-121.9802206	Santa Cruz County
339638	Ordering, Referring, Prescribing	N/A	1609291491	0	0	DEWAN, LAURA B LMFT	5/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34062	N/A	N/A	N/A	N/A	N/A	5650 MOUNT ACKERLY DR	None	SAN DIEGO	CA	92111	4016	00	06000	32.80910151	-117.1793115	San Diego County
339648	Ordering, Referring, Prescribing	N/A	1609297118	0	0	DIAZ, MARYANNE LMFT	10/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112317	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD	100	CONCORD	CA	94520	7928	00	06000	37.97055112	-122.0492933	Contra Costa County
339703	Ordering, Referring, Prescribing	N/A	1609385616	0	0	DUNCAN, TIFFANY M LCSW	3/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114560	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
339716	Ordering, Referring, Prescribing	N/A	1609401132	0	0	DO, BRYAN M	8/30/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106572	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	None	LONG BEACH	CA	90813	3271	00	06000	33.779655	-118.1880065	Los Angeles County
339725	Ordering, Referring, Prescribing	N/A	1609416205	0	0	DE YNCHAUSTI, MICHELLE NP	12/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013588	N/A	N/A	N/A	N/A	N/A	42135 10TH STREET WEST	SUITE 201	LANCASTER	CA	93534	7099	00	06000	34.648533	-118.1477975	Los Angeles County
339735	Ordering, Referring, Prescribing	N/A	1609434711	0	0	DELAYO, VANESSA PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78975	N/A	N/A	N/A	N/A	N/A	7462 N. FRESNO STREET	None	93720	CA	93720	2404	00	06000	36.845919	-119.7836615	Fresno County
339740	Ordering, Referring, Prescribing	N/A	1609449289	0	0	DORTCH, AMBER	10/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95032590	N/A	N/A	N/A	N/A	N/A	1907 BORDER AVE	None	TORRANCE	CA	90501	3606	00	06000	33.828615	-118.3130985	Los Angeles County
339798	Ordering, Referring, Prescribing	N/A	1609656610	0	0	DHILLON, KARAMPREET NP	8/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025898	N/A	N/A	N/A	N/A	N/A	4131 MING AVE	None	BAKERSFIELD	CA	93309	4994	00	06000	35.33945463	-119.0506798	Kern County
339837	Ordering, Referring, Prescribing	N/A	1609933274	0	0	DONCHEVA, DIANA M MD	3/25/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C55408	N/A	N/A	N/A	N/A	N/A	2400 GLENDALE LN	None	SACRAMENTO	CA	95825	2431	00	06000	38.597355	-121.405212	Sacramento County
339869	Ordering, Referring, Prescribing	N/A	1609995711	0	0	DORDULIAN, MARINE LCSW	8/29/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25186	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
339878	Ordering, Referring, Prescribing	N/A	1619016904	0	0	DUECK, MELVIN J NP	5/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	424587	N/A	N/A	N/A	N/A	N/A	1433 N ACACIA AVE	None	REEDLEY	CA	93654	2102	00	06000	36.60898603	-119.4510614	Fresno County
339921	Ordering, Referring, Prescribing	N/A	1619107174	0	0	DING, XIAO XI LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89605	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVE.	None	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
339957	Ordering, Referring, Prescribing	N/A	1619176559	0	0	DO, THAI V MD	3/5/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53614	N/A	N/A	N/A	N/A	N/A	1220 HEMLOCK WAY	STE 102	SANTA ANA	CA	92707	3651	00	06000	33.70975375	-117.8842792	Orange County
339977	Ordering, Referring, Prescribing	N/A	1619205457	0	0	DOAN, MYA D PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76766	N/A	N/A	N/A	N/A	N/A	4130 LA JOLLA VILLAGE DR	None	LA JOLLA	CA	92037	9121	00	06000	32.87194345	-117.2173414	San Diego County
339994	Ordering, Referring, Prescribing	N/A	1619244019	0	0	DANG, TRAM H PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	46873	N/A	N/A	N/A	N/A	N/A	70 W HEDDING ST	None	SAN JOSE	CA	95110	1705	00	06000	37.35249294	-121.9050815	Santa Clara County
340001	Ordering, Referring, Prescribing	N/A	1619254760	0	0	DOI, ANNIE L PHARMD	8/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57822	N/A	N/A	N/A	N/A	N/A	26022 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	3262	00	06000	33.585984	-117.6576165	Orange County
340007	Ordering, Referring, Prescribing	N/A	1619258266	0	0	DIAZ, ROSA M LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79889	N/A	N/A	N/A	N/A	N/A	9101 WHITTIER BLVD.	None	PICO RIVERA	CA	90660	2405	00	06000	34.00074139	-118.0822944	Los Angeles County
340010	Ordering, Referring, Prescribing	N/A	1619260015	0	0	DAVIS, IRENE J	3/19/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0571393	N/A	N/A	N/A	N/A	N/A	1260 16TH ST	STE A454	SANTA MONICA	CA	90404	0000	00	06000	34.0273959	-118.4860069	Los Angeles County
340044	Ordering, Referring, Prescribing	N/A	1619334745	0	0	DU, RANDAL	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72889	N/A	N/A	N/A	N/A	N/A	200 MUIR RD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
340060	Ordering, Referring, Prescribing	N/A	1619356706	0	0	DENG, JING MD	12/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152687	N/A	N/A	N/A	N/A	N/A	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	00	06000	34.07140294	-118.0516061	Los Angeles County
340066	Ordering, Referring, Prescribing	N/A	1619359973	0	0	DUXBURYSMITH, CAROLINE	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	43276	N/A	N/A	N/A	N/A	N/A	1018 CASITAS PASS RD	None	CARPINTERIA	CA	93013	2109	00	06000	34.395972	-119.5130879	Santa Barbara County
340068	Ordering, Referring, Prescribing	N/A	1619362407	0	0	DAVIS, VALERIE A LCSW	9/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110295	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
340092	Ordering, Referring, Prescribing	N/A	1619383619	0	0	DU, MONICA X MD	3/18/2023	Taxonomy not applicable	NA	n/a	000	Unknown	A147285	N/A	N/A	N/A	N/A	N/A	1122 S ST	102	FRESNO	CA	93721	1430	00	06000	36.74185388	-119.7823667	Fresno County
340123	Ordering, Referring, Prescribing	N/A	1619435914	0	0	DHILLON, MUNDIP K PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	74451	N/A	N/A	N/A	N/A	N/A	7301 GREENBACK LN.	None	CITRUS HEIGHTS	CA	95621	5587	00	06000	38.679966	-121.2938775	Sacramento County
340127	Ordering, Referring, Prescribing	N/A	1619447562	0	0	DEATS, LAUREN P CNP	2/8/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95152528	N/A	N/A	N/A	N/A	N/A	5500 IRVINE CENTER DR	SSC 150	IRVINE	CA	92618	0301	00	06000	33.6776395	-117.7761988	Orange County
340132	Ordering, Referring, Prescribing	N/A	1619452869	0	0	DONGALLO, KRISTEL NP	7/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010107	N/A	N/A	N/A	N/A	N/A	1028 E VERNON AVE	None	LOS ANGELES	CA	90011	3717	00	06000	34.00389853	-118.257615	Los Angeles County
340170	Ordering, Referring, Prescribing	N/A	1619526969	0	0	DURAN, SILVIA NP	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95012578	N/A	N/A	N/A	N/A	N/A	4575 COLLEGE AVE	None	SAN DIEGO	CA	92115	4011	00	06000	32.76023438	-117.0667611	San Diego County
340207	Ordering, Referring, Prescribing	N/A	1619629649	0	0	DAVIS, TYLER S NP	1/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019681	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	STE 210	SACRAMENTO	CA	95815	3317	00	06000	38.60568	-121.4345385	Sacramento County
340235	Ordering, Referring, Prescribing	N/A	1619930260	0	0	DO, TRI M MD	10/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55472	N/A	N/A	N/A	N/A	N/A	5091 MITTY WAY	None	SAN JOSE	CA	95129	1849	00	06000	37.3158495	-121.993236	Santa Clara County
340258	Ordering, Referring, Prescribing	N/A	1629044045	0	0	DIETERKAPPHAHN, KAREN L LCSW	7/5/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21751	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
340269	Ordering, Referring, Prescribing	N/A	1629063136	0	0	DUMONT, FRANK D MD	1/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C165599	N/A	N/A	N/A	N/A	N/A	201 CALIFORNIA AVENUE	SUITE 1300	SAN FRANCISCO	CA	94111	5015	00	06000	37.7933184	-122.3990768	San Francisco County
340275	Ordering, Referring, Prescribing	N/A	1629106778	0	0	DIMIDJIAN, NATALIE LCSW	4/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60573	N/A	N/A	N/A	N/A	N/A	1350 ARNOLD DR	102	MARTINEZ	CA	94553	4190	00	06000	37.99217145	-122.0982508	Contra Costa County
340284	Ordering, Referring, Prescribing	N/A	1629122122	0	0	DUNN, ALANA L LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	46090	N/A	N/A	N/A	N/A	N/A	1105 E FLORIDA AVE	None	HEMET	CA	92543	4512	00	06000	33.74750951	-116.960463	Riverside County
340300	Ordering, Referring, Prescribing	N/A	1629146188	0	0	DANNER, MICHAEL A LCSW	9/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26405	N/A	N/A	N/A	N/A	N/A	160 E. VIRGINIA STREET	None	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
340301	Ordering, Referring, Prescribing	N/A	1629150628	0	0	DACOSTA, LYNNE M LCSW	4/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21205	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
340372	Ordering, Referring, Prescribing	N/A	1629309935	0	0	DESILVA, JASON LMFT	5/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53202	N/A	N/A	N/A	N/A	N/A	3801 3RD ST	STE. 400	SAN FRANCISCO	CA	94124	1409	00	06000	37.74208019	-122.3880422	San Francisco County
340470	Ordering, Referring, Prescribing	N/A	1629478284	0	0	DOMINGUEZ, EULA NOELLE D PHARMD	7/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71034	N/A	N/A	N/A	N/A	N/A	111 S MAIN ST	None	ORANGE	CA	92868	0000	00	06000	33.787512	-117.867272	Orange County
340535	Ordering, Referring, Prescribing	N/A	1629588017	0	0	DIAZ, THALIA LMFT	9/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122000	N/A	N/A	N/A	N/A	N/A	855 N EUCLID AVE	None	ONTARIO	CA	91762	2729	00	06000	34.074063	-117.6514785	San Bernardino County
340538	Ordering, Referring, Prescribing	N/A	1629592084	0	0	DELGADO, ROCIO A LMFT	3/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125259	N/A	N/A	N/A	N/A	N/A	1339 20TH ST	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
340547	Ordering, Referring, Prescribing	N/A	1629578836	0	0	DIZON, JONATHAN B OD	2/11/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	33887	N/A	N/A	N/A	N/A	N/A	955 SOUTH CARILLO AVE	STE 105	LOS ANGELES	CA	90048	5400	00	06000	33.73540787	-118.2946295	Los Angeles County
340588	Ordering, Referring, Prescribing	N/A	1629653076	0	0	DEBRITO, ANDREA LMFT	7/31/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	148506	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
340589	Ordering, Referring, Prescribing	N/A	1629653944	0	0	DONATO, MARK VINCENT DMD	12/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108453	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
340601	Ordering, Referring, Prescribing	N/A	1629689088	0	0	DEL VILLAR, MIGUEL A RN	6/3/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95138125	N/A	N/A	N/A	N/A	N/A	304 N ACACIA AVE	None	RIPON	CA	95366	2404	00	06000	37.7421049	-121.1284661	San Joaquin County
340637	Ordering, Referring, Prescribing	N/A	1629828827	0	0	DENARO, ALEXA NP	3/14/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029462	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
340651	Ordering, Referring, Prescribing	N/A	1639193659	0	0	DUNHAM, CHRISTOPHER B MD	12/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83339	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
340669	Ordering, Referring, Prescribing	N/A	1639224637	0	0	DIMIDJIAN, CONSTANCE	5/1/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0566414	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
340748	Ordering, Referring, Prescribing	N/A	1639412042	0	0	DOAN, FORREST DO	6/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16145	N/A	N/A	N/A	N/A	N/A	1600 E BELLE TER	None	BAKERSFIELD	CA	93307	3871	00	06000	35.34672702	-118.9837495	Kern County
340767	Ordering, Referring, Prescribing	N/A	1639446230	0	0	DU, MICHAEL	8/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH60730	N/A	N/A	N/A	N/A	N/A	2551 W MAIN ST	None	ALHAMBRA	CA	91801	1652	00	06000	34.09530369	-118.1513792	Los Angeles County
340780	Ordering, Referring, Prescribing	N/A	1639456593	0	0	DRYE, ROCIO G LCSW	9/7/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100494	N/A	N/A	N/A	N/A	N/A	161 W WILLIAMS ST	None	BANNING	CA	92220	4746	00	06000	33.9272313	-116.878477	Riverside County
340787	Ordering, Referring, Prescribing	N/A	1639459340	0	0	DANKER, MARINA M PHARMD	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH55000	N/A	N/A	N/A	N/A	N/A	440 BLOSSOM HILL	None	SAN JOSE	CA	95132	1608	00	06000	37.25120454	-121.829967	Santa Clara County
340796	Ordering, Referring, Prescribing	N/A	1639486566	0	0	DWUMFUOH, TAKYI LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103566	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
340813	Ordering, Referring, Prescribing	N/A	1639512684	0	0	DIAZ, ELIZABETH C LCSW	6/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93243	N/A	N/A	N/A	N/A	N/A	7200 BANCROFT AVE	125C	OAKLAND	CA	94605	2403	00	06000	37.768221	-122.17608	Alameda County
340819	Ordering, Referring, Prescribing	N/A	1639514441	0	0	DELGADO, ISAMAR E LMFT	1/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111868	N/A	N/A	N/A	N/A	N/A	811 GRAND AVE	SUITE D	SACRAMENTO	CA	95838	3466	00	06000	38.637621	-121.4470125	Sacramento County
340822	Ordering, Referring, Prescribing	N/A	1639517790	0	0	DAVIS, HADLEY A LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97532	N/A	N/A	N/A	N/A	N/A	1 SANTA BARBARA RD	None	PLEASANT HILL	CA	94523	4215	00	06000	37.937538	-122.0669775	Contra Costa County
340827	Ordering, Referring, Prescribing	N/A	1639522972	0	0	DANG, CRISTINA PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72776	N/A	N/A	N/A	N/A	N/A	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	00	06000	38.576079	-121.2938325	Sacramento County
340835	Ordering, Referring, Prescribing	N/A	1639541535	0	0	DO, MAI DUNG T PHARMD	6/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	63068	N/A	N/A	N/A	N/A	N/A	6790 BERNAL AVE	None	PLEASANTON	CA	94566	0001	00	06000	37.65713003	-121.9002405	Alameda County
340840	Ordering, Referring, Prescribing	N/A	1639552086	0	0	DEVANEY, ANA S PA-C	5/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	52608	N/A	N/A	N/A	N/A	N/A	970 EMBARCADERO DEL MAR	None	GOLETA	CA	93117	4869	00	06000	34.411707	-119.857011	Santa Barbara County
340858	Ordering, Referring, Prescribing	N/A	1639571789	0	0	DE CORO, MICHAEL B	8/24/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D63766	N/A	N/A	N/A	N/A	N/A	401 E SCHOOL AVE	None	VISALIA	CA	93291	5032	00	06000	36.332757	-119.288682	Tulare County
340908	Ordering, Referring, Prescribing	N/A	1639638968	0	0	DOAN, ANGELA CNP	7/24/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009568	N/A	N/A	N/A	N/A	N/A	23336 SANTA MONICA BLVD	304	SANTA MONICA	CA	90404	2067	00	06000	34.03058284	-118.4776549	Los Angeles County
340916	Ordering, Referring, Prescribing	N/A	1639651888	0	0	DE DIOS-MANALOTO, CATHERINE LCSW	11/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127412	N/A	N/A	N/A	N/A	N/A	10549 JEFFERSON BLVD	None	CULVER CITY	CA	90232	3513	00	06000	34.00659325	-118.3923586	Los Angeles County
340948	Ordering, Referring, Prescribing	N/A	1639703259	0	0	DELGADO, URIAHN LCSW	7/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115751	N/A	N/A	N/A	N/A	N/A	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
340963	Ordering, Referring, Prescribing	N/A	1639734742	0	0	DE ALMEIDA, JULIA C LCSW	9/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110472	N/A	N/A	N/A	N/A	N/A	1940 E DEERE AVE	100	SANTA ANA	CA	92705	5718	00	06000	33.70430421	-117.8482556	Orange County
340980	Ordering, Referring, Prescribing	N/A	1639791452	0	0	DOAN, PETER MD	3/25/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181106	N/A	N/A	N/A	N/A	N/A	12442 LIMONITE AVE SUITE	None	EASTVALE	CA	91752	2467	00	06000	33.97511454	-117.5531895	Riverside County
341000	Ordering, Referring, Prescribing	N/A	1639841521	0	0	DIEHL, KATRINA NP	4/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018546	N/A	N/A	N/A	N/A	N/A	23772 NEWHALL AVE	None	NEWHALL	CA	91321	3125	00	06000	34.37160007	-118.5160227	Los Angeles County
341125	Ordering, Referring, Prescribing	N/A	1649423088	0	0	DREXLER, JEAN C	4/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	43762	N/A	N/A	N/A	N/A	N/A	940 N TUSTIN ST	None	ORANGE	CA	92867	5956	00	06000	33.803298	-117.837702	Orange County
341171	Ordering, Referring, Prescribing	N/A	1649521733	0	0	DOMINGO, KAREN LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71232	N/A	N/A	N/A	N/A	N/A	921 E COMPTON BLVD	FIRST FLOOR	COMPTON	CA	90221	3303	00	06000	33.89604551	-118.213137	Los Angeles County
341186	Ordering, Referring, Prescribing	N/A	1649562760	0	0	DIAZ, CARLOS M LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45760	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
341196	Ordering, Referring, Prescribing	N/A	1649576851	0	0	DE GAST, ILKA	11/1/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24409	N/A	N/A	N/A	N/A	N/A	241 LIBERTY STREET	None	PETALUMA	CA	94952	2809	00	06000	38.23620839	-122.6448229	Sonoma County
341232	Ordering, Referring, Prescribing	N/A	1649619792	0	0	DAVILA, BELEN MD	4/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A148569	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
341242	Ordering, Referring, Prescribing	N/A	1649635665	0	0	DAVID, TATUM LYNNIE FRANCISCO NP	10/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016367	N/A	N/A	N/A	N/A	N/A	1751 S VICTORIA AVE	SUITE 250	VENTURA	CA	93003	6152	00	06000	34.25829287	-119.2110876	Ventura County
341276	Ordering, Referring, Prescribing	N/A	1649681628	0	0	DREXLER, NAOMI LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88334	N/A	N/A	N/A	N/A	N/A	1930 MARKET ST	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
341304	Ordering, Referring, Prescribing	N/A	1649750407	0	0	DANG, TRAM ANH PHARMD	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	78463	N/A	N/A	N/A	N/A	N/A	7251 CAMINO ARROYO	None	GILROY	CA	95020	7340	00	06000	37.00917535	-121.5548666	Santa Clara County
341306	Ordering, Referring, Prescribing	N/A	1649751652	0	0	DERKOUCH, ADAM H PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74579	N/A	N/A	N/A	N/A	N/A	2420 N BLACKSTONE AVE	None	FRESNO	CA	93703	1747	00	06000	36.772776	-119.790442	Fresno County
341310	Ordering, Referring, Prescribing	N/A	1649754961	0	0	DE GREEF, LUCIANE LMFT	5/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122332	N/A	N/A	N/A	N/A	N/A	2021 SPERRY AVE	SUITE 41	VENTURA	CA	93003	7408	00	06000	34.25452652	-119.2178238	Ventura County
341317	Ordering, Referring, Prescribing	N/A	1649754367	0	0	DECENA, VINAI P NP	2/24/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009808	N/A	N/A	N/A	N/A	N/A	401 PARADISE ROAD	BUILDING E	MODESTO	CA	95351	3163	00	06000	37.62692973	-121.0131742	Stanislaus County
341357	Ordering, Referring, Prescribing	N/A	1649837006	0	0	DE MATEI, LYNDSAY PA	8/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56792	N/A	N/A	N/A	N/A	N/A	317 W. EL MONTE WAY	None	DINUBA	CA	93618	1557	00	06000	36.54595565	-119.397867	Tulare County
341362	Ordering, Referring, Prescribing	N/A	1649837733	0	0	DEATON, OLGA LMFT	10/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150818	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO STRE	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
341379	Ordering, Referring, Prescribing	N/A	1649877747	0	0	DABBAGH, ZIAD N PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83412	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
341388	Ordering, Referring, Prescribing	N/A	1649897869	0	0	DOAN, QUYEN DDS	8/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS104940	N/A	N/A	N/A	N/A	N/A	11750 CHOLLA DR	None	DESERT HOT SPRING	CA	92240	3065	00	06000	33.96386115	-116.5144878	Riverside County
341389	Ordering, Referring, Prescribing	N/A	1649896408	0	0	DOVER, MELISSA A NP	9/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015180	N/A	N/A	N/A	N/A	N/A	306 E PACIFIC COAST HWY	2	LONG BEACH	CA	90806	6259	00	06000	33.78984347	-118.1885985	Los Angeles County
341390	Ordering, Referring, Prescribing	N/A	1649903717	0	0	DEOCAMPO, DANIELLE J PA-C	7/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64838	N/A	N/A	N/A	N/A	N/A	1403 W LOMITA BLVD	STE 101	HARBOR CITY	CA	90710	2067	00	06000	33.79785936	-118.3016552	Los Angeles County
341404	Ordering, Referring, Prescribing	N/A	1649947284	0	0	DUQUE, TARA	9/13/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149750	N/A	N/A	N/A	N/A	N/A	3109 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.777285	-119.7635385	Fresno County
341429	Ordering, Referring, Prescribing	N/A	1659016657	0	0	DE LA VEGA, JESUS E PHARMD	4/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86113	N/A	N/A	N/A	N/A	N/A	13255 BLACK MOUNTAIN RD	None	SAN DIEGO	CA	92129	2658	00	06000	32.95881607	-117.1266381	San Diego County
341432	Ordering, Referring, Prescribing	N/A	1659026581	0	0	DANG, LILY T PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	85811	N/A	N/A	N/A	N/A	N/A	3560 W CENTURY BLVD	None	INGLEWOOD	CA	90303	1201	00	06000	33.942825	-118.333431	Los Angeles County
341466	Ordering, Referring, Prescribing	N/A	1659302198	0	0	DAWE, AMANDA OD	11/12/2023	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT12015	N/A	N/A	N/A	N/A	N/A	1031 W CHAPMAN AVE	203	ORANGE	CA	92868	2872	00	06000	33.78791049	-117.8632755	Orange County
341477	Ordering, Referring, Prescribing	N/A	1659354504	0	0	DAVIS, JANE L MD	5/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G45584	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
341506	Ordering, Referring, Prescribing	N/A	1659452688	0	0	DAVIS, CHERYL L PHD	11/10/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY11149	N/A	N/A	N/A	N/A	N/A	19231VICTORY BLVD	SUITE 110	RESEDA	CA	91335	6300	00	06000	34.18659852	-118.552221	Los Angeles County
341507	Ordering, Referring, Prescribing	N/A	1659460616	0	0	DEGUIA, RAY D PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57411	N/A	N/A	N/A	N/A	N/A	300 PULLMAN ST	BUILDING B	LIVERMORE	CA	94551	9756	00	06000	37.70755227	-121.7149933	Alameda County
341541	Ordering, Referring, Prescribing	N/A	1659525699	0	0	DOSTA, KATHERINE M LMFT	5/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97717	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
341554	Ordering, Referring, Prescribing	N/A	1659548675	0	0	DELGADO, XIOMARA A LCSW	4/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	15100	N/A	N/A	N/A	N/A	N/A	2801 BRISTOL ST	None	COSTA MESA	CA	92626	5996	00	06000	33.67474907	-117.889122	Orange County
341599	Ordering, Referring, Prescribing	N/A	1659645984	0	0	DEESE, CANDACE L	12/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116627	N/A	N/A	N/A	N/A	N/A	1025 CALIMESA BLVD	5A	CALIMESA	CA	92320	1146	00	06000	33.99998425	-117.0603297	Riverside County
341623	Ordering, Referring, Prescribing	N/A	1659667319	0	0	DAUGHERTY, DENNIS A LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48676	N/A	N/A	N/A	N/A	N/A	1209 W TOKAY ST	SUITE 5	LODI	CA	95240	3845	00	06000	38.12635934	-121.2874011	San Joaquin County
341655	Ordering, Referring, Prescribing	N/A	1659725968	0	0	DARDEN, JOLYNN M LCSW	1/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99387	N/A	N/A	N/A	N/A	N/A	555 DANA AVE	None	SAN JOSE	CA	95126	1000	00	06000	37.325556	-121.9262355	Santa Clara County
341659	Ordering, Referring, Prescribing	N/A	1659728798	0	0	DEGRO VALLADARES, KEISHLA J MD	9/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170251	N/A	N/A	N/A	N/A	N/A	1919 W 7TH STREET	SECOND FLOOR	LOS ANGELES	CA	90057	0001	00	06000	34.05575686	-118.2751751	Los Angeles County
341696	Ordering, Referring, Prescribing	N/A	1659778439	0	0	DANG, ALLISON H PHARMD	5/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	72046	N/A	N/A	N/A	N/A	N/A	46848 MISSION BLVD	None	FREMONT	CA	94539	7943	00	06000	37.49001935	-121.9292205	Alameda County
341703	Ordering, Referring, Prescribing	N/A	1659793016	0	0	DEICHLER, MARIANNE PHARMD	2/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	41518	N/A	N/A	N/A	N/A	N/A	122 ROBLES WAY	None	VALLEJO	CA	94591	8039	00	06000	38.08348053	-122.2102102	Solano County
341708	Ordering, Referring, Prescribing	N/A	1659795342	0	0	DATILES, ROBERTO	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH66710	N/A	N/A	N/A	N/A	N/A	215 N 2ND ST	None	EL CAJON	CA	92021	7243	00	06000	32.796792	-116.935631	San Diego County
341711	Ordering, Referring, Prescribing	N/A	1659803849	0	0	DE GUIA, DANIELLE R LCSW	7/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124291	N/A	N/A	N/A	N/A	N/A	5730 PACKARD AVE	SUITE 500	MARYSVILLE	CA	95901	7118	00	06000	39.12014523	-121.5659991	Yuba County
341730	Ordering, Referring, Prescribing	N/A	1659827293	0	0	DRDA, ANNABELLE LMFT	8/6/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104340	N/A	N/A	N/A	N/A	N/A	550 WATER ST.	BLDG. F2	SANTA CRUZ	CA	95060	4131	00	06000	36.98046158	-122.018718	Santa Cruz County
341772	Ordering, Referring, Prescribing	N/A	1659903839	0	0	DEHN, MICHELLE PA-C	1/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57542	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	115	SAN CLEMENTE	CA	92673	6226	00	06000	33.44951265	-117.6075825	Orange County
341833	Ordering, Referring, Prescribing	N/A	1669048872	0	0	DHALIWAL, HARJEET K	11/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017421	N/A	N/A	N/A	N/A	N/A	17720 FULLERFARM ST	None	NORTHRIDGE	CA	91325	1313	00	06000	34.25396314	-118.5206348	Los Angeles County
341841	Ordering, Referring, Prescribing	N/A	1669077855	0	0	DONTH, ELIZABETH A LCSW	5/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85511	N/A	N/A	N/A	N/A	N/A	31946 MISSION TRAIL	#B	LAKE ELSINORE	CA	92530	4539	00	06000	33.65640803	-117.2979656	Riverside County
341842	Ordering, Referring, Prescribing	N/A	1669081337	0	0	DHATT, JAGJIWAN K RN CPNP	12/16/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95119888	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
341911	Ordering, Referring, Prescribing	N/A	1669500013	0	0	DELGADO, JOHN A	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24724	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVENUE #100	None	GILROY	CA	95020	3657	00	06000	37.03080985	-121.5741639	Santa Clara County
341917	Ordering, Referring, Prescribing	N/A	1669506242	0	0	DRINCIC, MARKO V	12/16/1998	Taxonomy not applicable	NA	n/a	099	DENTIST	D44866	N/A	N/A	N/A	N/A	N/A	650 S ZEDIKER AVE	BLDG 3	PARLIER	CA	93648	2667	00	06000	36.60500164	-119.5210273	Fresno County
341927	Ordering, Referring, Prescribing	N/A	1669526752	0	0	D'SOUZA, GILBERT NP	3/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16458	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	None	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
341959	Ordering, Referring, Prescribing	N/A	1669615530	0	0	DUNNAVANT, JAMES W	10/3/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	NV2855	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
341980	Ordering, Referring, Prescribing	N/A	1669667267	0	0	DOONAN, RONDA L PSYD	5/1/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY20944	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
341996	Ordering, Referring, Prescribing	N/A	1669715512	0	0	DEMARTINI, JEREMY M MD	3/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133611	N/A	N/A	N/A	N/A	N/A	2150 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	00	06000	38.557287	-121.461444	Sacramento County
342007	Ordering, Referring, Prescribing	N/A	1669741328	0	0	DANG, CAROLYN H PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63143	N/A	N/A	N/A	N/A	N/A	1538 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	00	06000	33.78779155	-117.8367795	Orange County
342017	Ordering, Referring, Prescribing	N/A	1669753679	0	0	DEVOST-VARRIALE, MARYSE PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48587	N/A	N/A	N/A	N/A	N/A	7800 REDWOOD HIGHWAY	None	COTATI	CA	94931	0000	00	06000	38.3368045	-122.713282	Sonoma County
342034	Ordering, Referring, Prescribing	N/A	1669794863	0	0	DELGADO, JENNIFER M LMFT	1/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85034	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
342042	Ordering, Referring, Prescribing	N/A	1669804373	0	0	DRAGOMAN, MARTHA M LMFT	5/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88878	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	STE 207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
342043	Ordering, Referring, Prescribing	N/A	1669805412	0	0	DEVLIN, CARLY	4/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106938	N/A	N/A	N/A	N/A	N/A	401 ROLAND WAY	None	OAKLAND	CA	94621	2034	00	06000	37.74106765	-122.2051051	Alameda County
342067	Ordering, Referring, Prescribing	N/A	1669846093	0	0	DECKER, ALYSON D NP	3/31/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003244	N/A	N/A	N/A	N/A	N/A	356 7TH STREET.	None	SAN FRANCISCO	CA	94103	4030	00	06000	37.77603792	-122.4069716	San Francisco County
342111	Ordering, Referring, Prescribing	N/A	1669930350	0	0	DEO, NISHANT PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75822	N/A	N/A	N/A	N/A	N/A	7880 ALTA VALLEY DR	None	SACRAMENTO	CA	95823	4900	00	06000	38.471553	-121.4250525	Sacramento County
342121	Ordering, Referring, Prescribing	N/A	1669948709	0	0	DUNCAN, KELLY L RN	5/21/2018	Taxonomy not applicable	NA	n/a	000	Unknown	685045	N/A	N/A	N/A	N/A	N/A	331 N SHAFTER AVE	None	SHAFTER	CA	93263	1967	00	06000	35.50408126	-119.2783014	Kern County
342141	Ordering, Referring, Prescribing	N/A	1669982393	0	0	DIAZ, STEPHANIE PHARMD	7/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH77336	N/A	N/A	N/A	N/A	N/A	500 PARNASSUS, J LEVEL R	None	SAN FRANCISCO	CA	94143	2203	00	06000	37.76351054	-122.4579681	San Francisco County
342164	Ordering, Referring, Prescribing	N/A	1679024244	0	0	DOAN, CALLASANDRA L PHARMD	3/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	75401	N/A	N/A	N/A	N/A	N/A	22633 SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4647	00	06000	33.87492883	-117.7432851	Orange County
342197	Ordering, Referring, Prescribing	N/A	1679064091	0	0	DUNCAN, CARRISSA J LMFT	10/25/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134847	N/A	N/A	N/A	N/A	N/A	520 COTTONWOOD ST	None	WOODLAND	CA	95695	3603	00	06000	38.675016	-121.7933365	Yolo County
342207	Ordering, Referring, Prescribing	N/A	1679073555	0	0	DAVIS, TERESA A LCSW	4/12/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80913	N/A	N/A	N/A	N/A	N/A	210 N CHESTER AVE	None	BAKERSFIELD	CA	93308	4841	00	06000	35.407179	-119.0208925	Kern County
342223	Ordering, Referring, Prescribing	N/A	1679092571	0	0	DURIGAN, SHAWNA MSW LCSW	2/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107053	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
342232	Ordering, Referring, Prescribing	N/A	1679123806	0	0	DOS SANTOS, PAULO H NP	3/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021552	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	6B18	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
342255	Ordering, Referring, Prescribing	N/A	1679154702	0	0	DEHAVEN, MICHELLE R RN BS	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	424206	N/A	N/A	N/A	N/A	N/A	1302 E ORANGETHORPE AVE	None	PLACENTIA	CA	92870	5302	00	06000	33.86808812	-117.8395736	Orange County
342260	Ordering, Referring, Prescribing	N/A	1679190862	0	0	DE ROBLES, DANIEL PHARMD	1/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	82224	N/A	N/A	N/A	N/A	N/A	30251 MURRIETA RD	None	MENIFEE	CA	92584	8385	00	06000	33.684399	-117.2060495	Riverside County
342276	Ordering, Referring, Prescribing	N/A	1679224547	0	0	DABBAS, NOUR M PHARMD	12/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85679	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	3999	00	06000	43.59860438	-116.1806635	Ada County
342305	Ordering, Referring, Prescribing	N/A	1679399042	0	0	DUTCHER, JENYCE R PHARMD	7/29/2024	Taxonomy not applicable	NA	n/a	000	Unknown	RPH89733	N/A	N/A	N/A	N/A	N/A	3365 DEER VALLEY RD	None	ANTIOCH	CA	94531	6664	00	06000	37.98789856	-121.7855921	Contra Costa County
342306	Ordering, Referring, Prescribing	N/A	1679514798	0	0	DEL ROSARIO, SUSAN A	8/27/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D43933	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
342313	Ordering, Referring, Prescribing	N/A	1679575674	0	0	DOLGOS, ELIZABETH T MD	6/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C54494	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG. 400 SUITE 202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
342343	Ordering, Referring, Prescribing	N/A	1679652770	0	0	DEL CID, WENDY LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45335	N/A	N/A	N/A	N/A	N/A	303 SOUTH C STREET	None	LOMPOC	CA	93436	7305	00	06000	34.63525845	-120.451628	Santa Barbara County
342362	Ordering, Referring, Prescribing	N/A	1679694608	0	0	DIXON, MICHAEL V PA	9/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	11320	N/A	N/A	N/A	N/A	N/A	1209 WOODROW AVE SUITE B	None	MODESTO	CA	95350	1273	00	06000	37.68575206	-121.0112235	Stanislaus County
342366	Ordering, Referring, Prescribing	N/A	1679705693	0	0	DANIEL, WILLIAM E NP	12/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019429	N/A	N/A	N/A	N/A	N/A	69175 RAMON ROAD	BUILDING A	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
342377	Ordering, Referring, Prescribing	N/A	1679720189	0	0	DE LEON, JORGE DC	2/24/2020	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	26706	N/A	N/A	N/A	N/A	N/A	22675 ALESSANDRO BLVD	None	MORENO VALLEY	CA	92553	8551	00	06000	33.91695337	-117.2672536	Riverside County
342380	Ordering, Referring, Prescribing	N/A	1679733760	0	0	DO, HULBERT N MD	4/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C162072	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
342437	Ordering, Referring, Prescribing	N/A	1679827059	0	0	DELANO, CHRISTINA LCSW	2/19/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117373	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
342441	Ordering, Referring, Prescribing	N/A	1679841571	0	0	DUNHAM, DANA S LMFT	4/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95760	N/A	N/A	N/A	N/A	N/A	58967 BUSINESS CENTER DR	C, D	YUCCA VALLEY	CA	92284	7308	00	06000	34.1218252	-116.3771277	San Bernardino County
342445	Ordering, Referring, Prescribing	N/A	1679854889	0	0	DE VERA, ROWENA P PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62979	N/A	N/A	N/A	N/A	N/A	8400 ELK GROVE FLORIN RD	None	ELK GROVE	CA	95624	9450	00	06000	38.452203	-121.3727805	Sacramento County
342472	Ordering, Referring, Prescribing	N/A	1679905590	0	0	DEAN, GWENDOLYN A LCSW	2/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81196	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	None	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
342481	Ordering, Referring, Prescribing	N/A	1679936850	0	0	DALAL, SUNIT MD	11/14/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159459	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
342507	Ordering, Referring, Prescribing	N/A	1679974240	0	0	DELUCCHI, CARI LCSW	4/8/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121921	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
342606	Ordering, Referring, Prescribing	N/A	1689138539	0	0	DINH, HUY OT	5/24/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	10437	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	3145	00	06000	32.55831005	-117.0475102	San Diego County
342668	Ordering, Referring, Prescribing	N/A	1689216475	0	0	DINH, JIMMY	1/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57688	N/A	N/A	N/A	N/A	N/A	29 BAYWOOD AVE	None	SAN MATEO	CA	94402	0000	00	06000	37.56478204	-122.3289243	San Mateo County
342678	Ordering, Referring, Prescribing	N/A	1689244477	0	0	DIAZ, PORSCHA LMFT	10/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124699	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS ROAD	None	SAN DIEGO	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego
342688	Ordering, Referring, Prescribing	N/A	1689266157	0	0	DO, TIMOTHY D PHARMD	5/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83791	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
342711	Ordering, Referring, Prescribing	N/A	1689328775	0	0	DELISLE, ABIGAIL PA-C	3/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60905	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
342715	Ordering, Referring, Prescribing	N/A	1689337776	0	0	DIORES, JOY S NP	1/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019494	N/A	N/A	N/A	N/A	N/A	2015 W 1ST ST	SUITE L	SANTA ANA	CA	92703	3536	00	06000	33.74538578	-117.8965217	Orange County
342720	Ordering, Referring, Prescribing	N/A	1689353633	0	0	DAHIR, ASMA	6/23/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64562	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY ST	None	GILROY	CA	95020	5826	00	06000	37.00852861	-121.5694352	Santa Clara County
342721	Ordering, Referring, Prescribing	N/A	1689375040	0	0	DIETZ, KATELYN A NP	2/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024227	N/A	N/A	N/A	N/A	N/A	415 E CHAPEL ST	None	SANTA MARIA	CA	93454	4517	00	06000	34.95431543	-120.4307344	Santa Barbara County
342762	Ordering, Referring, Prescribing	N/A	1689708182	0	0	DE RUBIRA, CECILIA M LMFT	4/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53150	N/A	N/A	N/A	N/A	N/A	200 24TH STREET	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
342850	Ordering, Referring, Prescribing	N/A	1689917221	0	0	DAVIS, DANIELA S MD	2/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154928	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
342851	Ordering, Referring, Prescribing	N/A	1689919037	0	0	DE LA RIVA MORENO, ANDREA LCSW	5/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74794	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD.	E 100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
342875	Ordering, Referring, Prescribing	N/A	1689953911	0	0	DAVIDSON, JOSHUA DMD	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	104838	N/A	N/A	N/A	N/A	N/A	781 N SEQUOIA AVE	STE 4	LINDSAY	CA	93247	1448	00	06000	36.21240571	-119.0961081	Tulare County
342881	Ordering, Referring, Prescribing	N/A	1689957649	0	0	DHATT, KULBIR K PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45544	N/A	N/A	N/A	N/A	N/A	2040 E MARIPOSA RD	None	STOCKTON	CA	95205	7736	00	06000	37.93881784	-121.2438684	San Joaquin County
342894	Ordering, Referring, Prescribing	N/A	1689982811	0	0	DASGUPTA-TSINIKAS, ELENA D LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69299	N/A	N/A	N/A	N/A	N/A	10929 SOUTH STREET	SUITE 208B	CERRITOS	CA	90703	5368	00	06000	33.85836353	-118.101204	Los Angeles County
342898	Ordering, Referring, Prescribing	N/A	1689990434	0	0	DO, LINDA DO	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12084	N/A	N/A	N/A	N/A	N/A	485 N. FIRST STREET	None	SAN JOSE	CA	95112	4067	00	06000	37.34444033	-121.8968517	Santa Clara County
342900	Ordering, Referring, Prescribing	N/A	1689997967	0	0	DICKERMAN, LAURA J LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79191	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	300	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
343006	Ordering, Referring, Prescribing	N/A	1699181933	0	0	DE RAMOS, LIZETTE VIDA OD	9/20/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15045	N/A	N/A	N/A	N/A	N/A	19733 RINALDI ST	None	NORTHRIDGE	CA	91326	4143	00	06000	34.27487747	-118.5634395	Los Angeles County
343020	Ordering, Referring, Prescribing	N/A	1699209767	0	0	DAVIDSON, ALYSON J MD	10/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159027	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
343036	Ordering, Referring, Prescribing	N/A	1699227819	0	0	DUBEY, LAUREN B NP	8/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	847372	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
343038	Ordering, Referring, Prescribing	N/A	1699226134	0	0	DELVECCHIO, CARA A NP	10/2/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018653	N/A	N/A	N/A	N/A	N/A	1200 W HILLCREST	None	THOUSAND OAKS	CA	91320	0000	00	06000	34.18505362	-118.9068862	Ventura County
343045	Ordering, Referring, Prescribing	N/A	1699254060	0	0	DIEPLINGER, ALESSANDRA A	10/8/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	103034	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
343061	Ordering, Referring, Prescribing	N/A	1699279067	0	0	DAHODWALA, AMMAR	2/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166109	N/A	N/A	N/A	N/A	N/A	2051 MARENGO STREET	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
343074	Ordering, Referring, Prescribing	N/A	1699298976	0	0	DE VORE, DIANA PHARMD	4/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79190	N/A	N/A	N/A	N/A	N/A	1931 MAIN ST	None	WATSONVILLE	CA	95076	3027	00	06000	36.91820233	-121.7818664	Santa Cruz County
343106	Ordering, Referring, Prescribing	N/A	1699377093	0	0	DUONG, KEVIN T PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83644	N/A	N/A	N/A	N/A	N/A	2100 WEBSTER STREET	STE 105	SAN FRANCISCO	CA	94115	2373	00	06000	37.7904826	-122.4324477	San Francisco County
343109	Ordering, Referring, Prescribing	N/A	1699385476	0	0	DOSANJH, HARINDER K NP	8/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95015212	N/A	N/A	N/A	N/A	N/A	121 BARBOZA ST	None	MENDOTA	CA	93640	1901	00	06000	36.76619136	-120.3839072	Fresno County
343147	Ordering, Referring, Prescribing	N/A	1699446252	0	0	DO, WILLIAM T PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74057	N/A	N/A	N/A	N/A	N/A	3772 HOWE ST	GROUND FLOOR G30	OAKLAND	CA	94611	5300	00	06000	37.8243542	-122.2566075	Alameda County
343148	Ordering, Referring, Prescribing	N/A	1699459032	0	0	DENLINGER, TAMARA NP	1/6/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026082	N/A	N/A	N/A	N/A	N/A	426 N DATE ST	None	ESCONDIDO	CA	92025	3409	00	06000	33.12911363	-117.0715093	San Diego County
343162	Ordering, Referring, Prescribing	N/A	1699544726	0	0	DORSEY, LASHON L	3/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024450	N/A	N/A	N/A	N/A	N/A	1275 THARP RD	None	YUBA CITY	CA	95993	2645	00	06000	39.14572609	-121.6484225	Sutter County
343186	Ordering, Referring, Prescribing	N/A	1699786681	0	0	DEJARNETTE-HOLLY, TRACIE M MD	1/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G150142	N/A	N/A	N/A	N/A	N/A	331 N SANBORN RD	None	SALINAS	CA	93905	2220	00	06000	36.67873598	-121.6255027	Monterey County
343188	Ordering, Referring, Prescribing	N/A	1699789628	0	0	DIAZ, SILVIA MSW LCSW	3/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98336	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
343196	Ordering, Referring, Prescribing	N/A	1699806059	0	0	DELL, PETER A MD	11/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100801	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
343211	Ordering, Referring, Prescribing	N/A	1699831065	0	0	DERBOGHOSIAN ITUTMAZIAN, RUPEN DDS	9/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55226	N/A	N/A	N/A	N/A	N/A	1919 W 7TH STREET	SECOND FLOOR	LOS ANGELES	CA	90057	0121	00	06000	34.05575686	-118.2751751	Los Angeles County
343266	Ordering, Referring, Prescribing	N/A	1699951830	0	0	DESAI, MANISH DO	5/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9850	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
343364	Ordering, Referring, Prescribing	N/A	1700163862	0	0	DHALIWAL, RAMANDEEP	9/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56785	N/A	N/A	N/A	N/A	N/A	4771 W ASHLAN AVE	None	FRESNO	CA	93722	4307	00	06000	36.79349651	-119.8796918	Fresno County
343401	Ordering, Referring, Prescribing	N/A	1700209780	0	0	DE LA TORRE, ADRIANA LCSW	7/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95800	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
343411	Ordering, Referring, Prescribing	N/A	1700214806	0	0	DURANT, REBECCA	1/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92972	N/A	N/A	N/A	N/A	N/A	905 E. 8TH STREET	None	LOS ANGELES	CA	90021	1805	00	06000	34.03639545	-118.2465917	Los Angeles County
343413	Ordering, Referring, Prescribing	N/A	1700224037	0	0	DAN, WENDY L LCSW	1/30/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26015	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
343483	Ordering, Referring, Prescribing	N/A	1700336161	0	0	DIAZ, GINA A LCSW	4/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101337	N/A	N/A	N/A	N/A	N/A	370 WEST CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
343544	Ordering, Referring, Prescribing	N/A	1700427648	0	0	DWIGHT-FROST, JENNIFER LCSW	10/2/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60064	N/A	N/A	N/A	N/A	N/A	6540 WENTWORTH SPRINGS R	None	GEORGETOWN	CA	95634	9701	00	06000	38.911985	-120.8311335	El Dorado County
343572	Ordering, Referring, Prescribing	N/A	1700478484	0	0	DING, NING LAC	9/15/2021	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19017	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
343590	Ordering, Referring, Prescribing	N/A	1700539509	0	0	DANG, TIFFANY LY P PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84637	N/A	N/A	N/A	N/A	N/A	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	00	06000	34.21980849	-118.4301135	Los Angeles County
343604	Ordering, Referring, Prescribing	N/A	1700594728	0	0	DAIF, ZOUHAIR NP	12/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023746	N/A	N/A	N/A	N/A	N/A	45 NIELSON ST	None	WATSONVILLE	CA	95076	2468	00	06000	36.9282117	-121.7925859	Santa Cruz County
343610	Ordering, Referring, Prescribing	N/A	1700633120	0	0	DATTA, SASHA NP	5/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029992	N/A	N/A	N/A	N/A	N/A	10423 OLD PLACERVILLE RD	STE A	SACRAMENTO	CA	95827	2540	00	06000	38.570382	-121.3075395	Sacramento County
343708	Ordering, Referring, Prescribing	N/A	1710048319	0	0	DEVILLA, JUAN CARLOS PA-C	1/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	13664	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
343731	Ordering, Referring, Prescribing	N/A	1710094107	0	0	DYDELL, KARIN MD	5/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73350	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA ST	SUITE 506	SAN FRANCISCO	CA	94110	4423	00	06000	37.74746923	-122.4202583	San Francisco County
343775	Ordering, Referring, Prescribing	N/A	1710186564	0	0	DA SILVA, CARLOS	6/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS43434	N/A	N/A	N/A	N/A	N/A	610 W 3RD ST	None	DORRIS	CA	96023	9100	00	06000	41.9642673	-121.9241778	Siskiyou County
343805	Ordering, Referring, Prescribing	N/A	1710261680	0	0	DAVIS, KYLE PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH58388	N/A	N/A	N/A	N/A	N/A	4900 PANAMA LN	None	BAKERSFIELD	CA	93313	3479	00	06000	35.297802	-119.058516	Kern County
343855	Ordering, Referring, Prescribing	N/A	1710342167	0	0	DIAZ, HANNA LPCC	11/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	12724	N/A	N/A	N/A	N/A	N/A	212 CARMEN LN, STE 201	None	SANTA MARIA	CA	93458	7769	00	06000	34.92481416	-120.4383025	Santa Barbara County
343860	Ordering, Referring, Prescribing	N/A	1710351077	0	0	DELMAN, CONNOR MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158523	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
343901	Ordering, Referring, Prescribing	N/A	1710399811	0	0	DESANTIS, KRISTIN M MD	10/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138196	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVE	SUITE 100	SAN DIEGO	CA	92101	0000	00	06000	32.72646147	-117.1638767	San Diego County
343919	Ordering, Referring, Prescribing	N/A	1710431333	0	0	DIN, ANGELA C LCSW	7/30/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23197	N/A	N/A	N/A	N/A	N/A	949 UNIVERSITY AVENUE	SUITE 200	SACRAMENTO	CA	95825	6728	00	06000	38.563128	-121.4181855	Sacramento County
343927	Ordering, Referring, Prescribing	N/A	1710442470	0	0	DWYER, ALEXIS L LCSW	1/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127997	N/A	N/A	N/A	N/A	N/A	51 MARINA BLVD.	None	PITTSBURG	CA	94565	0001	00	06000	38.0354387	-121.8837345	Contra Costa County
343932	Ordering, Referring, Prescribing	N/A	1710451711	0	0	DANG, JONATHAN LMFT	7/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120325	N/A	N/A	N/A	N/A	N/A	4929 WILSHIRE BLVD	SUITE 245	LOS ANGELES	CA	90010	3808	00	06000	34.0621435	-118.3380975	Los Angeles County
343958	Ordering, Referring, Prescribing	N/A	1710495460	0	0	DELGADO, MELODY C NP	3/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007805	N/A	N/A	N/A	N/A	N/A	1550 N GAREY AVE	None	POMONA	CA	91767	3826	00	06000	34.07356342	-117.7522392	Los Angeles County
343972	Ordering, Referring, Prescribing	N/A	1710518808	0	0	DATE-CHONG, LAUREN CNP	2/13/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013441	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
343984	Ordering, Referring, Prescribing	N/A	1710533401	0	0	DEHDAR NASAB, NEGIN DDS	5/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	103839	N/A	N/A	N/A	N/A	N/A	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	00	06000	34.04452444	-118.2114844	Los Angeles County
343990	Ordering, Referring, Prescribing	N/A	1710554738	0	0	DARIN, MEGAN LCSW	8/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124848	N/A	N/A	N/A	N/A	N/A	3001 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2203	00	06000	37.77859396	-122.2279493	Alameda County
344002	Ordering, Referring, Prescribing	N/A	1710623442	0	0	DE LA CRUZ CARDENAS, CINTHYA PA-C	11/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65377	N/A	N/A	N/A	N/A	N/A	918 W FOOTHILL BLVD	None	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
344013	Ordering, Referring, Prescribing	N/A	1710648753	0	0	DULAY, MEGAN	9/28/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	33187	N/A	N/A	N/A	N/A	N/A	180 MONTGOMERY ST	SUITE 1850	SAN FRANCISCO	CA	94104	4205	00	06000	37.79072884	-122.4022871	San Francisco County
344023	Ordering, Referring, Prescribing	N/A	1710691282	0	0	DE LA CRUZ SANTAMARIA, RODRIGO J MD	7/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	P18	N/A	N/A	N/A	N/A	N/A	1500 W TULARE DR	None	TULARE	CA	93274	3424	00	06000	36.20637928	-119.3688387	Tulare County
344027	Ordering, Referring, Prescribing	N/A	1710731666	0	0	DHERI, PARMINDER	5/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030235	N/A	N/A	N/A	N/A	N/A	965 E YOSEMITE AVE	None	MANTECA	CA	95336	5938	00	06000	37.79749432	-121.2033865	San Joaquin County
344034	Ordering, Referring, Prescribing	N/A	1710799564	0	0	DENG, YILAN PT	3/6/2025	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	307599	N/A	N/A	N/A	N/A	N/A	728 PACIFIC AVE STE 301	STE 301	SAN FRANCISCO	CA	94133	4488	00	06000	37.79687859	-122.4074282	San Francisco County
344039	Ordering, Referring, Prescribing	N/A	1710925623	0	0	DEMITRI, MICHELLE F NP	2/7/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14546	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
344055	Ordering, Referring, Prescribing	N/A	1720018419	0	0	DURST, DEBRA R MD	9/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	37682	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
344056	Ordering, Referring, Prescribing	N/A	1720017148	0	0	DOAN, VIEN D DO	11/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A5276	N/A	N/A	N/A	N/A	N/A	4343 MARKET ST.	SUITE D	RIVERSIDE	CA	92501	0000	00	06000	33.97734857	-117.3791849	Riverside County
344129	Ordering, Referring, Prescribing	N/A	1720212053	0	0	DOMINGUEZ, IRENE LPCC	6/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	5300	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
344176	Ordering, Referring, Prescribing	N/A	1720312879	0	0	DELGADILLO, HERLINDA LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91602	N/A	N/A	N/A	N/A	N/A	325 W CHANNEL ISLANDS BL	None	OXNARD	CA	93033	4501	00	06000	34.17372846	-119.180817	Ventura County
344272	Ordering, Referring, Prescribing	N/A	1720432149	0	0	DO, VAN C PHARMD	3/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	65074	N/A	N/A	N/A	N/A	N/A	650 GATEWAY CENTER DR	None	SAN DIEGO	CA	92102	4530	00	06000	32.71403658	-117.1158307	San Diego County
344283	Ordering, Referring, Prescribing	N/A	1720452998	0	0	DEACON, CASSIE C LCSW	7/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW94105	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
344390	Ordering, Referring, Prescribing	N/A	1720592520	0	0	DORAIRAJ, SUSAN NP	1/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006080	N/A	N/A	N/A	N/A	N/A	3920 EAGLE ROCK BLVD	A	LOS ANGELES	CA	90065	3668	00	06000	34.11936223	-118.230111	Los Angeles County
344409	Ordering, Referring, Prescribing	N/A	1720625577	0	0	DAS, SANCHITA NP	10/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018755	N/A	N/A	N/A	N/A	N/A	1080 N. WESTERN AVE	None	LOS ANGELES	CA	90029	2310	00	06000	34.090281	-118.3091425	Los Angeles County
344450	Ordering, Referring, Prescribing	N/A	1720731011	0	0	DINH, HUONG K PHARMD	3/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57828	N/A	N/A	N/A	N/A	N/A	1280 EAST COOLEY DRIVE	STE 23	COLTON	CA	92324	3932	00	06000	34.05447547	-117.3069855	San Bernardino County
344474	Ordering, Referring, Prescribing	N/A	1720782477	0	0	DAVIS, JACQUELINE K LPCC	12/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	18167	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
344480	Ordering, Referring, Prescribing	N/A	1720791262	0	0	DANG, HENRY GIA N PHARMD	12/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87564	N/A	N/A	N/A	N/A	N/A	3250 W GRANT LINE RD	None	TRACY	CA	95304	8427	00	06000	37.750995	-121.4752365	San Joaquin County
344508	Ordering, Referring, Prescribing	N/A	1730206210	0	0	DRAPER, ORETA D LMFT	3/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42099	N/A	N/A	N/A	N/A	N/A	1301 PINE AVENUE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
344509	Ordering, Referring, Prescribing	N/A	1730206285	0	0	DOMINGO, JOANA P LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51074	N/A	N/A	N/A	N/A	N/A	506 W JACKMAN ST	None	LANCASTER	CA	93534	2531	00	06000	34.70193469	-118.1377582	Los Angeles County
344571	Ordering, Referring, Prescribing	N/A	1730326786	0	0	DA SILVA-MONTEMAYOR, GUILLERMO LMFT	7/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77730	N/A	N/A	N/A	N/A	N/A	12966 EUCLID ST	280	GARDEN GROVE	CA	92840	5200	00	06000	33.77455935	-117.9378298	Orange County
344584	Ordering, Referring, Prescribing	N/A	1730372152	0	0	DURAN, LARA LCSW	5/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60642	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY	207	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
344594	Ordering, Referring, Prescribing	N/A	1730382698	0	0	DECKARD, HILARY E LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	101252	N/A	N/A	N/A	N/A	N/A	409 S ATLANTIC BLVD	None	ALHAMBRA	CA	91801	3643	00	06000	34.086168	-118.134617	Los Angeles County
344598	Ordering, Referring, Prescribing	N/A	1730409624	0	0	DAVIS, RACHELLE PHARMD	11/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	56873	N/A	N/A	N/A	N/A	N/A	4050 PHELAN RD	STE 8	PHELAN	CA	92371	4454	00	06000	34.42633349	-117.573624	San Bernardino County
344643	Ordering, Referring, Prescribing	N/A	1730472143	0	0	DANG, KAREN PHARMD	8/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57079	N/A	N/A	N/A	N/A	N/A	3880 COACH LN	None	CAMERON PARK	CA	95682	3880	00	06000	38.658123	-120.9698464	El Dorado County
344680	Ordering, Referring, Prescribing	N/A	1730533191	0	0	DHAH, MANDIP PHARMD	9/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	50169	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS-SEC2-B	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
344683	Ordering, Referring, Prescribing	N/A	1730541707	0	0	DU, LINGYUN MD	3/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167622	N/A	N/A	N/A	N/A	N/A	1700 N ROSE AVE	450	OXNARD	CA	93030	7628	00	06000	34.21746	-119.155545	Ventura County
344689	Ordering, Referring, Prescribing	N/A	1730550500	0	0	DOUGLASS, ROBYN LCSW	2/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95169	N/A	N/A	N/A	N/A	N/A	2299 MOWRY AVE	3B	FREMONT	CA	94538	1621	00	06000	37.55671415	-121.9817758	Alameda County
344699	Ordering, Referring, Prescribing	N/A	1730570144	0	0	DOAN STEPHENS, CRYSTAL T MD	6/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152267	N/A	N/A	N/A	N/A	N/A	4305 UNIVERSITY AVENUE	STE 150	SAN DIEGO	CA	92105	9998	00	06000	32.74957853	-117.101439	San Diego County
344701	Ordering, Referring, Prescribing	N/A	1730573023	0	0	DIMAANO, LIEZEL R MD	1/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146941	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
344717	Ordering, Referring, Prescribing	N/A	1730601642	0	0	DANG, DIANA H PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76544	N/A	N/A	N/A	N/A	N/A	1760 STORY RD	None	SAN JOSE	CA	95122	1921	00	06000	37.34121313	-121.8410221	Santa Clara County
344730	Ordering, Referring, Prescribing	N/A	1730614652	0	0	DEBNATH, SHAPAN MD	9/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169995	N/A	N/A	N/A	N/A	N/A	950 S GRAND AVE	FL 2	LOS ANGELES	CA	90015	3999	00	06000	34.04362303	-118.2600164	Los Angeles County
344748	Ordering, Referring, Prescribing	N/A	1730662180	0	0	DUVALL, ALAN M	11/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	83806	N/A	N/A	N/A	N/A	N/A	1111 COLUMBUS ST	None	BAKERSFIELD	CA	93305	1936	00	06000	35.39744148	-118.9822815	Kern County
344758	Ordering, Referring, Prescribing	N/A	1730679978	0	0	DE JESUS, EDMOND S PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77939	N/A	N/A	N/A	N/A	N/A	2238 WESTBOROUGH BLVD	None	SOUTH SAN FRANCIS	CA	94080	5405	00	06000	37.64408241	-122.4516996	San Mateo County
344789	Ordering, Referring, Prescribing	N/A	1730727462	0	0	DYRENG, ANN B PHARMD	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	43453	N/A	N/A	N/A	N/A	N/A	1601 COLEMAN AVE	None	SANTA CLARA	CA	95050	3122	00	06000	37.35814451	-121.93908	Santa Clara County
344827	Ordering, Referring, Prescribing	N/A	1730802570	0	0	DANYELL, KRYSTYNE NP	9/5/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022462	N/A	N/A	N/A	N/A	N/A	1577 E CHEVY CHASE DR	SUITE 300	GLENDALE	CA	91206	4107	00	06000	34.15313959	-118.2299467	Los Angeles County
344855	Ordering, Referring, Prescribing	N/A	1730926858	0	0	DAQIQ, SANNA	10/28/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65308	N/A	N/A	N/A	N/A	N/A	2299 MOWRY AVE	3B	FREMONT	CA	94538	2211	00	06000	37.55671415	-121.9817758	Alameda County
344880	Ordering, Referring, Prescribing	N/A	1740220433	0	0	DAVDA, RAJESH	11/19/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C144439	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	4390	00	06000	37.54845774	-121.9773463	Alameda County
344929	Ordering, Referring, Prescribing	N/A	1740357599	0	0	DEDEN-CASTILLO, JETTIE NP	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	157	N/A	N/A	N/A	N/A	N/A	12900 FREDERICK ST	None	MORENO VALLEY	CA	92553	5266	00	06000	33.932655	-117.261383	Riverside County
344938	Ordering, Referring, Prescribing	N/A	1740378967	0	0	DUONG, QUYNH T OD	10/28/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12702	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
344984	Ordering, Referring, Prescribing	N/A	1740522408	0	0	DANG, CHUONG D	7/15/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133239	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL, STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
345004	Ordering, Referring, Prescribing	N/A	1740559434	0	0	DONG, HELEN C PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51403	N/A	N/A	N/A	N/A	N/A	9305 MISSION GORGE RD	None	SANTEE	CA	92071	3815	00	06000	32.83856247	-116.995401	San Diego County
345007	Ordering, Referring, Prescribing	N/A	1740562792	0	0	DENSTAEDT, CHRISTINE L LMFT	2/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84464	N/A	N/A	N/A	N/A	N/A	1515 S. BON VIEW AVE.	None	ONTARIO	CA	91761	4408	00	06000	34.045335	-117.636444	San Bernardino County
345034	Ordering, Referring, Prescribing	N/A	1740596360	0	0	DOPCHIZ DE MARTIN, DIANA LMFT	4/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90722	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
345046	Ordering, Referring, Prescribing	N/A	1740619063	0	0	DANIELS, CANDICE CNP	3/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015731	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
345056	Ordering, Referring, Prescribing	N/A	1740634062	0	0	DE LA ROSA, KRYSTAL MD	7/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179212	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
345082	Ordering, Referring, Prescribing	N/A	1740675404	0	0	DIQUATTRO, WESLEY T CRNA	3/24/2022	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	95000567	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
345106	Ordering, Referring, Prescribing	N/A	1740711175	0	0	DO, NHAN DO	5/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18216	N/A	N/A	N/A	N/A	N/A	6810 N MILBURN AVE	None	FRESNO	CA	93722	2102	00	06000	36.83655963	-119.8788638	Fresno County
345113	Ordering, Referring, Prescribing	N/A	1740720580	0	0	DANIELS, MELISSA PSYD	6/16/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32680	N/A	N/A	N/A	N/A	N/A	1330 E COOLEY DR	None	COLTON	CA	92324	3905	00	06000	34.0544745	-117.305721	San Bernardino County
345118	Ordering, Referring, Prescribing	N/A	1740706670	0	0	DAVISON, TIANA PA	3/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA54993	N/A	N/A	N/A	N/A	N/A	264 N HIGHLAND SPRINGS A	3D	BANNING	CA	92220	3082	00	06000	33.93063	-116.946864	Riverside County
345128	Ordering, Referring, Prescribing	N/A	1740745462	0	0	DOYLE, SUSAN J LCSW	9/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110610	N/A	N/A	N/A	N/A	N/A	66 HURLBUT STREET	None	PASADENA	CA	91105	1001	00	06000	34.12993251	-118.1516625	Los Angeles County
345160	Ordering, Referring, Prescribing	N/A	1740786862	0	0	DAON, LINDSEY D MD	6/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164839	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
345242	Ordering, Referring, Prescribing	N/A	1750011813	0	0	DESKINS, ASHIKA	8/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	ND1303	N/A	N/A	N/A	N/A	N/A	1375 GRAND AVE	202	PIEDMONT	CA	94610	1075	00	06000	37.8212997	-122.243983	Alameda County
345243	Ordering, Referring, Prescribing	N/A	1750013165	0	0	DINH, ANTHONY H PHARMD	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86005	N/A	N/A	N/A	N/A	N/A	8201 GREENLEAF AVE	None	WHITTIER	CA	90602	2910	00	06000	33.96517117	-118.0376617	Los Angeles County
345247	Ordering, Referring, Prescribing	N/A	1750019824	0	0	DE CASTRO, SHARLENE JOYCE S NP	7/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021762	N/A	N/A	N/A	N/A	N/A	2743 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	7410	00	06000	32.66109542	-117.0920417	San Diego County
345368	Ordering, Referring, Prescribing	N/A	1750540670	0	0	DYSON, LAURA S RN	5/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	852593	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DRIV	None	PALM SPRINGS	CA	92264	5123	00	06000	33.82485354	-116.4955129	Riverside County
345375	Ordering, Referring, Prescribing	N/A	1750550828	0	0	DEBENEDETTO, YELENA LMFT	3/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50437	N/A	N/A	N/A	N/A	N/A	209 E 7TH ST	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
345391	Ordering, Referring, Prescribing	N/A	1750610671	0	0	DEL AGUILA, SHIRLEY M LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99326	N/A	N/A	N/A	N/A	N/A	10526 DUBNOFF WAY	None	NORTH HOLLYWOOD	CA	91606	3921	00	06000	34.18666509	-118.3608552	Los Angeles County
345406	Ordering, Referring, Prescribing	N/A	1750657912	0	0	DETERMAN, MARA K MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128732	N/A	N/A	N/A	N/A	N/A	280 W MACARTHUR BLVD	11TH FLOOR	OAKLAND	CA	94611	5642	00	06000	37.8242017	-122.2578306	Alameda County
345442	Ordering, Referring, Prescribing	N/A	1750708772	0	0	DUHE, JESSICA M MD	7/15/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138678	N/A	N/A	N/A	N/A	N/A	2525 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78246242	-122.4448129	San Francisco County
345485	Ordering, Referring, Prescribing	N/A	1750759932	0	0	DOANE DIXON, REBECCA	1/21/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117711	N/A	N/A	N/A	N/A	N/A	901 MYRTLE AVE	None	EUREKA	CA	95501	1219	00	06000	40.80088276	-124.1502005	Humboldt County
345531	Ordering, Referring, Prescribing	N/A	1750832317	0	0	DAVID, MARVIC T PA-C	12/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	53748	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
345542	Ordering, Referring, Prescribing	N/A	1750840922	0	0	DIAZ-ARVIZU, MARIA NP	2/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011422	N/A	N/A	N/A	N/A	N/A	3529 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3031	00	06000	33.95422949	-118.2050894	Los Angeles County
345554	Ordering, Referring, Prescribing	N/A	1750872503	0	0	DANFORD-JOHN, KENDRA NP	4/12/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008232	N/A	N/A	N/A	N/A	N/A	308 N LA CADENA DR	None	COLTON	CA	92324	2946	00	06000	34.06815282	-117.3240225	San Bernardino County
345560	Ordering, Referring, Prescribing	N/A	1750889374	0	0	DELEON, DEANNA	10/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	8360	N/A	N/A	N/A	N/A	N/A	1005 REAM AVENUE	None	MOUNT SHASTA	CA	96067	2539	00	06000	41.30487104	-122.3111242	Siskiyou County
345571	Ordering, Referring, Prescribing	N/A	1750906061	0	0	DAVIS, CALEB A NP	10/7/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015643	N/A	N/A	N/A	N/A	N/A	630 BERCUT DR	C	SACRAMENTO	CA	95811	0110	00	06000	38.600856	-121.497543	Sacramento County
345575	Ordering, Referring, Prescribing	N/A	1750916441	0	0	DICKSON, KAITLYN R LMFT	8/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT141150	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
345608	Ordering, Referring, Prescribing	N/A	1750993978	0	0	DANIELS, PAMELA O	3/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014175	N/A	N/A	N/A	N/A	N/A	1030 W GARDENA BLVD	None	GARDENA	CA	90247	9005	00	06000	33.88154027	-118.2925662	Los Angeles County
345662	Ordering, Referring, Prescribing	N/A	1760106140	0	0	DEA, HANNAH F LCSW	8/12/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125047	N/A	N/A	N/A	N/A	N/A	25910 ACERO	SUITE 160	MISSION VIEJO	CA	92691	6468	00	06000	33.61712389	-117.6780482	Orange County
345669	Ordering, Referring, Prescribing	N/A	1760133953	0	0	DARAM, DYVAKRUPAKAR R PA-C	2/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	60800	N/A	N/A	N/A	N/A	N/A	400 E OAK AVE	None	VISALIA	CA	93291	5034	00	06000	36.332253	-119.288691	Tulare County
345677	Ordering, Referring, Prescribing	N/A	1760160337	0	0	DAVIS DEL PICCOLO, LARA N OT	7/12/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT21614	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
345686	Ordering, Referring, Prescribing	N/A	1760184006	0	0	DEIS, FAITH MD	5/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL14165	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
345689	Ordering, Referring, Prescribing	N/A	1760192793	0	0	DOUGLAS, REBECCA LCSW	9/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126112	N/A	N/A	N/A	N/A	N/A	900 FULTON AVE	SUITE 205	SACRAMENTO	CA	95825	4500	00	06000	38.581902	-121.4007615	Sacramento County
345692	Ordering, Referring, Prescribing	N/A	1760201008	0	0	DAO, VICTORIA H NP	10/3/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95032453	N/A	N/A	N/A	N/A	N/A	525 E MAIN STREET	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
345728	Ordering, Referring, Prescribing	N/A	1760516496	0	0	DAWSON, TIFFANY A PSYD	11/25/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26763	N/A	N/A	N/A	N/A	N/A	901 W VICTORIA ST	SUITE F & G	COMPTON	CA	90220	5807	00	06000	33.86784006	-118.2368928	Los Angeles County
345731	Ordering, Referring, Prescribing	N/A	1760516553	0	0	DANON, STEVEN S LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45506	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
345749	Ordering, Referring, Prescribing	N/A	1760551907	0	0	DOKKO, ANNE PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47342	N/A	N/A	N/A	N/A	N/A	23621 S. MAIN ST	None	CARSON	CA	90745	0000	00	06000	33.810615	-118.2757055	Los Angeles County
345778	Ordering, Referring, Prescribing	N/A	1760653588	0	0	DABIRI-FAR, SHAUNA S	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77396	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
345789	Ordering, Referring, Prescribing	N/A	1760661748	0	0	DECEW, CAROL D LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT79778	N/A	N/A	N/A	N/A	N/A	104 W 4TH ST	None	SAN BERNARDINO	CA	92415	0035	00	06000	34.1064933	-117.285246	San Bernardino County
345810	Ordering, Referring, Prescribing	N/A	1760672802	0	0	DASILVA, ANTONIO LAC	9/10/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	12089	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
345817	Ordering, Referring, Prescribing	N/A	1760722342	0	0	DURAN-OJEDA, REBECCA NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN602500	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	SUITE 201	CHULA VISTA	CA	91911	2976	00	06000	32.60364599	-117.0786521	San Diego County
345900	Ordering, Referring, Prescribing	N/A	1760849319	0	0	DRZEMALA, THOMAS DC	10/28/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	33108	N/A	N/A	N/A	N/A	N/A	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
345945	Ordering, Referring, Prescribing	N/A	1760917157	0	0	DENNIS, STEVEN K MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157348	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
345974	Ordering, Referring, Prescribing	N/A	1760943237	0	0	DUCKGEISCHEL, ASHLEY LMFT	5/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112109	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
345985	Ordering, Referring, Prescribing	N/A	1760966089	0	0	DAVIE, TYREE MD	8/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189072	N/A	N/A	N/A	N/A	N/A	3946 NORWOOD AVE	None	SACRAMENTO	CA	95838	3300	00	06000	38.639952	-121.456359	Sacramento County
346005	Ordering, Referring, Prescribing	N/A	1770009045	0	0	DIESTO, JEAN T NP	3/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95006875	N/A	N/A	N/A	N/A	N/A	1711 W TEMPLE ST	3695	LOS ANGELES	CA	90026	5421	00	06000	34.06891181	-118.2638033	Los Angeles County
346122	Ordering, Referring, Prescribing	N/A	1770333445	0	0	DUARTE LOPEZ, JESSIE E MD	8/28/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL16096	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
346136	Ordering, Referring, Prescribing	N/A	1770510489	0	0	DODGE, JOHN M MD	1/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G67831	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
346137	Ordering, Referring, Prescribing	N/A	1770523052	0	0	DUKE, HENRY H	10/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97274	N/A	N/A	N/A	N/A	N/A	3750 ARLINGTON AVE	None	RIVERSIDE	CA	92506	2607	00	06000	33.94621715	-117.399167	Riverside County
346139	Ordering, Referring, Prescribing	N/A	1770510521	0	0	DE TORRES, CHARLES F MD	6/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A62474	N/A	N/A	N/A	N/A	N/A	181 ANDRIEUX ST	208	SONOMA	CA	95476	6932	00	06000	38.28809911	-122.4613026	Sonoma County
346148	Ordering, Referring, Prescribing	N/A	1770607186	0	0	DYER, ELIZABETH MD	7/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A70406	N/A	N/A	N/A	N/A	N/A	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	7710	00	06000	33.61235015	-117.8704573	Orange County
346217	Ordering, Referring, Prescribing	N/A	1770759243	0	0	DIGAUDIO, ZULMA L PSYD	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52862	N/A	N/A	N/A	N/A	N/A	625 CITRACADO PKWY	102	ESCONDIDO	CA	92025	6428	00	06000	33.09177699	-117.078913	San Diego County
346233	Ordering, Referring, Prescribing	N/A	1770800534	0	0	DEBONO, HEATHER LCSW	12/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29273	N/A	N/A	N/A	N/A	N/A	2615 SIERRA MEADOWS DR	None	ROCKLIN	CA	95677	2126	00	06000	38.79183891	-121.2225706	Placer County
346239	Ordering, Referring, Prescribing	N/A	1770807000	0	0	DEUTSCH, ELIANA J NP	12/5/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0764518	N/A	N/A	N/A	N/A	N/A	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	00	06000	33.12861918	-117.0906689	San Diego County
346249	Ordering, Referring, Prescribing	N/A	1770817991	0	0	DESAI, SACHIN MD	3/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C194925	N/A	N/A	N/A	N/A	N/A	7301 STATE ST.	None	HUNTINGTON PARK	CA	90255	5823	00	06000	33.97149395	-118.2097278	Los Angeles County
346290	Ordering, Referring, Prescribing	N/A	1770903965	0	0	DIAZ SANCHEZ, DORA ALICIA LMFT	10/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129001	N/A	N/A	N/A	N/A	N/A	700 N JOHNSON AVE	SUITE P	EL CAJON	CA	92020	2592	00	06000	32.804316	-116.971049	San Diego County
346294	Ordering, Referring, Prescribing	N/A	1770910739	0	0	DU, NANCY PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	69862	N/A	N/A	N/A	N/A	N/A	840 E. DUNNE AVE	None	MORGAN HILL	CA	95037	4609	00	06000	37.13004895	-121.6372272	Santa Clara County
346295	Ordering, Referring, Prescribing	N/A	1770906992	0	0	DE FAZIO, JESSICA F	10/27/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D64173	N/A	N/A	N/A	N/A	N/A	678 3RD AVE	None	CHULA VISTA	CA	91910	5736	00	06000	32.62870793	-117.0750108	San Diego County
346316	Ordering, Referring, Prescribing	N/A	1770937187	0	0	DAVIS, ANGELA M LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99815	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
346323	Ordering, Referring, Prescribing	N/A	1770947210	0	0	DUQUE, RACHEL LMFT	8/14/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132379	N/A	N/A	N/A	N/A	N/A	17800 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
346335	Ordering, Referring, Prescribing	N/A	1770964686	0	0	DIBENEDETTO, LORI	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49700	N/A	N/A	N/A	N/A	N/A	481 S VENTURA RD	None	OXNARD	CA	93030	6550	00	06000	34.19848342	-119.1948902	Ventura County
346347	Ordering, Referring, Prescribing	N/A	1770986390	0	0	DIGIACOMO, KINDRA LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93361	N/A	N/A	N/A	N/A	N/A	775 SUNRISE AVE	110	ROSEVILLE	CA	95661	4523	00	06000	38.732436	-121.2720345	Placer County
346353	Ordering, Referring, Prescribing	N/A	1770990491	0	0	DEHESA ROSILLO, CAROLINA NP	5/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000851	N/A	N/A	N/A	N/A	N/A	751 LOMBARDI CT	SUITE B	SANTA ROSA	CA	95407	6798	00	06000	38.427804	-122.7493035	Sonoma County
346354	Ordering, Referring, Prescribing	N/A	1770998569	0	0	DROZDZ, RAFAL M	12/27/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D64971	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
346372	Ordering, Referring, Prescribing	N/A	1780023630	0	0	DAVAULT, HEATHER	8/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114636	N/A	N/A	N/A	N/A	N/A	15455 SAN FERNANDO MISSI	#300	MISSION HILLS	CA	91345	1300	00	06000	34.27194157	-118.469079	Los Angeles County
346393	Ordering, Referring, Prescribing	N/A	1780054650	0	0	DO, JUSTIN LMFT	8/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127690	N/A	N/A	N/A	N/A	N/A	15444 BROOKHURST ST	None	WESTMINSTER	CA	92683	7057	00	06000	33.7382955	-117.9547231	Orange County
346397	Ordering, Referring, Prescribing	N/A	1780074591	0	0	DRAKE, KENNETH J LAC	10/5/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	16400	N/A	N/A	N/A	N/A	N/A	2426 BUHNE ST	None	EUREKA	CA	95501	3207	00	06000	40.78592355	-124.1405936	Humboldt County
346411	Ordering, Referring, Prescribing	N/A	1780090571	0	0	DETIERRA, CAROLYN LMFT	12/31/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45053	N/A	N/A	N/A	N/A	N/A	2300 NORTHPOINT PKWY	None	SANTA ROSA	CA	95407	5004	00	06000	38.415258	-122.7536325	Sonoma County
346443	Ordering, Referring, Prescribing	N/A	1780125161	0	0	DRISLANE, CHRISTINA N LMFT	12/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47651	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO	None	OAKLAND	CA	94606	5334	00	06000	37.78179304	-122.2428136	Alameda County
346479	Ordering, Referring, Prescribing	N/A	1780194233	0	0	DEMERY, KARENEE M MD	9/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A182192	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
346487	Ordering, Referring, Prescribing	N/A	1780225250	0	0	DAVIS, MARK N	5/29/2019	Taxonomy not applicable	NA	n/a	000	Unknown	3468	N/A	N/A	N/A	N/A	N/A	1755 AIRPORT BLVD.	None	RED BLUFF	CA	96080	4514	00	06000	40.15638592	-122.2505326	Tehama County
346488	Ordering, Referring, Prescribing	N/A	1780216754	0	0	DENNIS, CYNTHIA L LCSW	9/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82946	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
346496	Ordering, Referring, Prescribing	N/A	1780233916	0	0	DAVIS, BENJAMIN NP	11/8/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95012731	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
346563	Ordering, Referring, Prescribing	N/A	1780616201	0	0	DO VALLE, MONIKA F DO	3/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11322	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
346624	Ordering, Referring, Prescribing	N/A	1780756346	0	0	DRACHENBERG, ROLANDO G	12/1/2014	Taxonomy not applicable	NA	n/a	099	DENTIST	D40578	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	CHULA VISTA	CA	91915	1200	00	06000	32.63248278	-116.9412076	San Diego County
346633	Ordering, Referring, Prescribing	N/A	1780812578	0	0	DAVIDSON, LESLIE LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52343	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
346651	Ordering, Referring, Prescribing	N/A	1780842146	0	0	DUONG, CHUONG DO	5/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9557	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
346652	Ordering, Referring, Prescribing	N/A	1780847004	0	0	DUARTE, SANDRA LMFT	4/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104541	N/A	N/A	N/A	N/A	N/A	909 N MAIN ST	SUITE 1	SANTA ANA	CA	92701	3503	00	06000	33.75288	-117.867582	Orange County
346686	Ordering, Referring, Prescribing	N/A	1780932236	0	0	DALE, ALEXANDRIA P LMFT	4/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100643	N/A	N/A	N/A	N/A	N/A	47825 OASIS STREET	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
346729	Ordering, Referring, Prescribing	N/A	1780996165	0	0	DHARNI, JAGJIT K NP	5/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	18690	N/A	N/A	N/A	N/A	N/A	6180 BROCKTON AVENUE	SUITE 204	RIVERSIDE	CA	92506	2233	00	06000	33.958692	-117.3967415	Riverside County
346730	Ordering, Referring, Prescribing	N/A	1780993147	0	0	DE LA CRUZ, JANET LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74064	N/A	N/A	N/A	N/A	N/A	3075 MYERS ST	None	RIVERSIDE	CA	92503	5525	00	06000	33.90872869	-117.4423238	Riverside County
346739	Ordering, Referring, Prescribing	N/A	1790018505	0	0	DUERR, MELISSA J PA-C	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA20388	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
346781	Ordering, Referring, Prescribing	N/A	1790070019	0	0	DOYLE, ANDREA M LMFT	5/19/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT86789	N/A	N/A	N/A	N/A	N/A	734 SILVER SPUR ROAD	202	ROLLING HILLS EST	CA	90274	1458	00	06000	33.77108101	-118.3696012	Los Angeles County
346787	Ordering, Referring, Prescribing	N/A	1790070373	0	0	DIAZ, STEFANY LCSW	12/21/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80088	N/A	N/A	N/A	N/A	N/A	24077 STATE HIGHWAY 49	None	NEVADA CITY	CA	95959	8519	00	06000	39.321882	-121.0992075	Nevada County
346843	Ordering, Referring, Prescribing	N/A	1790161339	0	0	DOWNEY, RUTH C LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100524	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
346845	Ordering, Referring, Prescribing	N/A	1790161180	0	0	DEAN, MICHELLE B LMFT	11/1/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109575	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
346856	Ordering, Referring, Prescribing	N/A	1790176543	0	0	DE VOS SCHMIDT, DIANE NP	10/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001895	N/A	N/A	N/A	N/A	N/A	350 POSADA LN	STE 202	TEMPLETON	CA	93465	4060	00	06000	35.55239522	-120.7215238	San Luis Obispo County
346862	Ordering, Referring, Prescribing	N/A	1790172716	0	0	DAVAR, KUSHA MD	1/31/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A161000	N/A	N/A	N/A	N/A	N/A	1200 N STATE ST	None	LOS ANGELES	CA	90089	1001	00	06000	34.05855992	-118.209755	Los Angeles County
346898	Ordering, Referring, Prescribing	N/A	1790239234	0	0	DEGUZMAN, MARIA REBECCA M	8/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH48610	N/A	N/A	N/A	N/A	N/A	2950 S ARCHIBALD AVE	None	ONTARIO	CA	91761	7303	00	06000	34.019559	-117.5936625	San Bernardino County
346957	Ordering, Referring, Prescribing	N/A	1790329555	0	0	DAURIA, DAMIAN DDS	8/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	104432	N/A	N/A	N/A	N/A	N/A	9521 FOLSOM BLVD	None	SACRAMENTO	CA	95827	1203	00	06000	38.570373	-121.341762	Sacramento County
346988	Ordering, Referring, Prescribing	N/A	1790419315	0	0	DOOLAN, JANINE LMFT	10/19/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT142230	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE	STE. 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
347021	Ordering, Referring, Prescribing	N/A	1790532513	0	0	DRAGON, AMANDA LCSW	8/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108532	N/A	N/A	N/A	N/A	N/A	1400 W STANFORD RANCH RD	None	ROCKLIN	CA	95765	3750	00	06000	38.81536853	-121.2856121	Placer County
347077	Ordering, Referring, Prescribing	N/A	1790851244	0	0	DOYLE, KRISTIN M LCSW	7/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74688	N/A	N/A	N/A	N/A	N/A	242 N.VILLA AVE	None	WILLOWS	CA	95988	2641	00	06000	39.52243848	-122.208844	Glenn County
347113	Ordering, Referring, Prescribing	N/A	1790941813	0	0	DONIS, CYNTHIA LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84133	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
347128	Ordering, Referring, Prescribing	N/A	1790972966	0	0	DAVIS, AMANDA PSYD	11/2/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25201	N/A	N/A	N/A	N/A	N/A	1119 E MONTE VISTA AVE	None	VACAVILLE	CA	95688	3009	00	06000	38.36024633	-121.9763983	Solano County
347156	Ordering, Referring, Prescribing	N/A	1801025879	0	0	DONOSO, OSCAR A PHD	3/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24553	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS# 53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
347200	Ordering, Referring, Prescribing	N/A	1801113535	0	0	DEROIAN, LIANA Y LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88009	N/A	N/A	N/A	N/A	N/A	15480 RAMONA AVE.	None	VICTORVILLE	CA	92392	2421	00	06000	34.50885704	-117.3259773	San Bernardino County
347235	Ordering, Referring, Prescribing	N/A	1801168208	0	0	DOMB, SARAH M MD	4/2/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A123197	N/A	N/A	N/A	N/A	N/A	6043 HOLLYWOOD BLVD	LOS ANGELES CA 90028	LOS ANGELES	CA	90028	5411	00	06000	34.1016835	-118.321569	Los Angeles County
347283	Ordering, Referring, Prescribing	N/A	1801233804	0	0	DARMAN, MOHAMMAD E LPCC	5/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6633	N/A	N/A	N/A	N/A	N/A	436 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
347287	Ordering, Referring, Prescribing	N/A	1801243852	0	0	DILLIHUNT, LARRELL	5/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122540	N/A	N/A	N/A	N/A	N/A	335 E. AVE I, AREA 12	None	LANCASTER	CA	93535	1234	00	06000	34.7041113	-118.1247548	Los Angeles County
347305	Ordering, Referring, Prescribing	N/A	1801268552	0	0	DOUKAS, HEYLEENKEN LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114809	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	None	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
347369	Ordering, Referring, Prescribing	N/A	1801348065	0	0	DOMINGUEZ, NATHALY LMFT	10/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135381	N/A	N/A	N/A	N/A	N/A	11800 CENTRAL AVE	225	CHINO	CA	91710	7200	00	06000	34.0388092	-117.689654	San Bernardino County
347371	Ordering, Referring, Prescribing	N/A	1801357181	0	0	DEROSE, LESJE MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL930	N/A	N/A	N/A	N/A	N/A	747 52ND STREET	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
347397	Ordering, Referring, Prescribing	N/A	1801422258	0	0	DALEY, SAFIYA D NP	6/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013555	N/A	N/A	N/A	N/A	N/A	2620 26TH AVE	None	OAKLAND	CA	94601	1907	00	06000	37.79088756	-122.2231716	Alameda County
347403	Ordering, Referring, Prescribing	N/A	1801429436	0	0	DUTTON, JENNIFER J LCSW	2/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW113868	N/A	N/A	N/A	N/A	N/A	455 K STREET	None	CRESCENT CITY	CA	95531	5950	00	06000	41.75468313	-124.1960818	Del Norte County
347420	Ordering, Referring, Prescribing	N/A	1801452651	0	0	DIAZ, VERONICA LCSW	3/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76667	N/A	N/A	N/A	N/A	N/A	11705 SLATE AVE	200	RIVERSIDE	CA	92505	5196	00	06000	33.9027276	-117.4928061	Riverside County
347442	Ordering, Referring, Prescribing	N/A	1801494315	0	0	DAVIS, CONNIE NP	11/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028141	N/A	N/A	N/A	N/A	N/A	500 W HOSPITAL RD	SUITE # A, B AND C	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
347461	Ordering, Referring, Prescribing	N/A	1801590161	0	0	DUONG, QUYNH	1/12/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PTL3157	N/A	N/A	N/A	N/A	N/A	455 O'CONNOR DR	None	SAN JOSE	CA	95128	0001	00	06000	37.326654	-121.939897	Santa Clara County
347476	Ordering, Referring, Prescribing	N/A	1801821459	0	0	DADBEH, CECILIA C	10/18/2004	Taxonomy not applicable	NA	n/a	099	DENTIST	D50452	N/A	N/A	N/A	N/A	N/A	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	00	06000	39.02117456	-122.0619172	Colusa County
347483	Ordering, Referring, Prescribing	N/A	1801839188	0	0	DUFFY, MICHAEL J PA-C	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	11368	N/A	N/A	N/A	N/A	N/A	10544 SPENCEVILLE ROAD	None	PENN VALLEY	CA	95946	9623	00	06000	39.19618415	-121.1776527	Nevada County
347546	Ordering, Referring, Prescribing	N/A	1811027311	0	0	DE LA YNCERA-OLIVA, MARIELA T LMFT	1/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	34064	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	0001	00	06000	33.86509452	-118.2762279	Los Angeles County
347556	Ordering, Referring, Prescribing	N/A	1811033517	0	0	DUONG, BAOCHAU DDS	8/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55112	N/A	N/A	N/A	N/A	N/A	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	00	06000	34.04452444	-118.2114844	Los Angeles County
347589	Ordering, Referring, Prescribing	N/A	1811100530	0	0	DAGUIO, AMY LYNN M MD	3/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A100543	N/A	N/A	N/A	N/A	N/A	5256 MISSION BLVD.	None	JURUPA VALLEY	CA	92509	4624	00	06000	33.99261717	-117.3987262	Riverside County
347598	Ordering, Referring, Prescribing	N/A	1811138712	0	0	DOOLIN, SHANA R NP	10/26/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	16037	N/A	N/A	N/A	N/A	N/A	22044 CEDAR RD	None	SONORA	CA	95370	5342	00	06000	37.98532934	-120.3651951	Tuolumne County
347619	Ordering, Referring, Prescribing	N/A	1811201924	0	0	DE SHAY, BELINDA D	4/27/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	433468	N/A	N/A	N/A	N/A	N/A	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	00	06000	35.14690796	-118.4506925	Kern County
347623	Ordering, Referring, Prescribing	N/A	1811204464	0	0	DRORI, MAYA D LMFT	3/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86035	N/A	N/A	N/A	N/A	N/A	13201 SAN PABLO AVE	316	SAN PABLO	CA	94806	3907	00	06000	37.95165516	-122.3328786	Contra Costa County
347743	Ordering, Referring, Prescribing	N/A	1811392087	0	0	DE LOS SANTOS, ELIDIA LCSW	12/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99289	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
347751	Ordering, Referring, Prescribing	N/A	1811407265	0	0	DIAKHATE, MOUSLY	9/28/2017	Taxonomy not applicable	NA	n/a	000	Unknown	54961	N/A	N/A	N/A	N/A	N/A	2023 VALE RD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
347756	Ordering, Referring, Prescribing	N/A	1811410202	0	0	DE LA TORRE, DIANA LMFT	2/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124331	N/A	N/A	N/A	N/A	N/A	4401 CRENSHAW BLVD	300	LOS ANGELES	CA	90043	1200	00	06000	34.00339495	-118.3318951	Los Angeles County
347800	Ordering, Referring, Prescribing	N/A	1811478035	0	0	DANIELS, JORDAN R PA	10/5/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56077	N/A	N/A	N/A	N/A	N/A	400 E OAK AVE	None	VISALIA	CA	93291	5034	00	06000	36.332253	-119.288691	Tulare County
347805	Ordering, Referring, Prescribing	N/A	1811481328	0	0	DELGADO, ANA G LCSW	6/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102273	N/A	N/A	N/A	N/A	N/A	155 N OCCIDENTAL BLVD	None	LOS ANGELES	CA	90026	4641	00	06000	34.07178779	-118.2787879	Los Angeles County
347852	Ordering, Referring, Prescribing	N/A	1811571748	0	0	DING, PEI PHARMD	6/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	69450	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD. M	None	BOISE	ID	83706	8940	00	06000	43.59860438	-116.1806635	Ada County
347883	Ordering, Referring, Prescribing	N/A	1811667827	0	0	DONFRIO, MADELINE LPCC	8/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC17224	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
347887	Ordering, Referring, Prescribing	N/A	1811692700	0	0	DACRE, MICHAEL MD	2/5/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A201013	N/A	N/A	N/A	N/A	N/A	3569 ROUND BARN CIRCLE	None	SANTA ROSA	CA	95403	5781	00	06000	38.479743	-122.729625	Sonoma County
347897	Ordering, Referring, Prescribing	N/A	1811696883	0	0	DOMINGO-JAVIER, CLARISSA	2/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024410	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	A-D	SACRAMENTO	CA	95820	4756	00	06000	38.526282	-121.471398	Sacramento County
347949	Ordering, Referring, Prescribing	N/A	1821124389	0	0	DACOSTA, RACHEL D	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29072	N/A	N/A	N/A	N/A	N/A	2325 CLEMENT AVE	None	ALAMEDA	CA	94501	7063	00	06000	37.77017367	-122.2389726	Alameda County
348031	Ordering, Referring, Prescribing	N/A	1821286311	0	0	DAHRIAN, KAIVA I LMFT	10/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51388	N/A	N/A	N/A	N/A	N/A	5168 HONPIE RD	None	PLACERVILLE	CA	95667	8682	00	06000	38.6943603	-120.9018271	El Dorado County
348108	Ordering, Referring, Prescribing	N/A	1821424623	0	0	DE LA ROSA, LOURDES M LMFT	6/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85375	N/A	N/A	N/A	N/A	N/A	680 FLETCHER PKWY	SUITE 200	EL CAJON	CA	92020	2516	00	06000	32.80780847	-116.970687	San Diego County
348110	Ordering, Referring, Prescribing	N/A	1821424003	0	0	DURRELL, BROOKE J	8/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79898	N/A	N/A	N/A	N/A	N/A	5100 BULLION ST	None	MARIPOSA	CA	95338	2411	00	06000	37.48928959	-119.9679953	Mariposa County
348121	Ordering, Referring, Prescribing	N/A	1821444183	0	0	DODGE, JAMES F DO	10/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	16382	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	180	WEST SACRAMENTO	CA	95605	2394	00	06000	38.58811316	-121.5270471	Yolo County
348158	Ordering, Referring, Prescribing	N/A	1821496027	0	0	DO, TRIET V PHARMD	8/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72164	N/A	N/A	N/A	N/A	N/A	3382 CASTRO VALLEY BLVD	None	CASTRO VALLEY	CA	94546	5623	00	06000	37.69560262	-122.0767052	Alameda County
348159	Ordering, Referring, Prescribing	N/A	1821499880	0	0	DENG, SUSAN PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71042	N/A	N/A	N/A	N/A	N/A	1800 HARRISON ST	None	OAKLAND	CA	94612	3466	00	06000	37.80593773	-122.2656714	Alameda County
348162	Ordering, Referring, Prescribing	N/A	1821499062	0	0	DIAZ, KYRENE PSYD	10/8/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	32134	N/A	N/A	N/A	N/A	N/A	919 1ST. ST.	None	SAN FERNANDO	CA	91340	2957	00	06000	34.28328995	-118.4389224	Los Angeles County
348220	Ordering, Referring, Prescribing	N/A	1821585308	0	0	DIAZ, DAVID A LMFT	11/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT129095	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
348262	Ordering, Referring, Prescribing	N/A	1821675174	0	0	DING, XIANG PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82620	N/A	N/A	N/A	N/A	N/A	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	00	06000	38.00403417	-121.8422798	Contra Costa County
348285	Ordering, Referring, Prescribing	N/A	1821744913	0	0	DAVIS, YESENIA I NP	11/21/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019085	N/A	N/A	N/A	N/A	N/A	18663 VENTURA BLVD	202	TARZANA	CA	91356	4151	00	06000	34.17051848	-118.5402557	Los Angeles County
348286	Ordering, Referring, Prescribing	N/A	1821752635	0	0	DAI, QIANGHUI NP	9/26/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018588	N/A	N/A	N/A	N/A	N/A	3831 HUGHES AVE	STE #105	CULVER CITY	CA	90232	6839	00	06000	34.02243278	-118.3981492	Los Angeles County
348310	Ordering, Referring, Prescribing	N/A	1831129311	0	0	DOWNS, SUSAN R MD	5/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G63882	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
348333	Ordering, Referring, Prescribing	N/A	1831211911	0	0	DEVINE, DANIE LMFT	12/21/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90935	N/A	N/A	N/A	N/A	N/A	760 MOUNTAIN VIEW ST	None	ALTADENA	CA	91001	4925	00	06000	34.19178664	-118.1657029	Los Angeles County
348334	Ordering, Referring, Prescribing	N/A	1831217595	0	0	DEUTSCH, DAVID LCSW	4/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66799	N/A	N/A	N/A	N/A	N/A	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	00	06000	34.15682212	-118.4871886	Los Angeles County
348352	Ordering, Referring, Prescribing	N/A	1831239599	0	0	DAVIS, JANINE R LCSW	2/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79524	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
348388	Ordering, Referring, Prescribing	N/A	1831342252	0	0	DAWSON-SITTRE, DIANE M LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT51458	N/A	N/A	N/A	N/A	N/A	3133 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
348423	Ordering, Referring, Prescribing	N/A	1831433580	0	0	DURRAH, ERIN PHD	6/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98508	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	BLD. 5, 6M	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
348451	Ordering, Referring, Prescribing	N/A	1831482629	0	0	DIAZ, AMILCAR MD	6/11/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155426	N/A	N/A	N/A	N/A	N/A	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
348496	Ordering, Referring, Prescribing	N/A	1831554682	0	0	DAUGHERTY, BRETTNEY R NP	6/15/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	802849	N/A	N/A	N/A	N/A	N/A	1711 OCEAN PARK BLVD	None	SANTA MONICA	CA	90405	4901	00	06000	34.0127217	-118.466458	Los Angeles County
348503	Ordering, Referring, Prescribing	N/A	1831565928	0	0	DANG, MAI THAO T PHARMD	2/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72834	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
348519	Ordering, Referring, Prescribing	N/A	1831590058	0	0	DUPREE, ERICA R LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115903	N/A	N/A	N/A	N/A	N/A	335 E AVENUE I	None	LANCASTER	CA	93535	1916	00	06000	34.7041113	-118.1247548	Los Angeles County
348556	Ordering, Referring, Prescribing	N/A	1831644996	0	0	DECOURSEY, SARA LMFT	6/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111716	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LN	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
348638	Ordering, Referring, Prescribing	N/A	1831749860	0	0	DE ANDA, YESENIA LCSW	8/11/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99836	N/A	N/A	N/A	N/A	N/A	732 MOTT	None	SAN FERNANDO	CA	91340	4240	00	06000	34.27661761	-118.4442372	Los Angeles County
348654	Ordering, Referring, Prescribing	N/A	1831782218	0	0	DONALDSON-FLETCHER, KATHERINE CNM	11/18/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236174	N/A	N/A	N/A	N/A	N/A	280 EL CERRITO PLAZA	SUITE J015A	EL CERRITO	CA	94530	0000	00	06000	37.89881448	-122.2994256	Contra Costa County
348655	Ordering, Referring, Prescribing	N/A	1831777481	0	0	DUAN, LINNA	10/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL6568	N/A	N/A	N/A	N/A	N/A	540 N 1ST ST	None	SAN JOSE	CA	95112	5319	00	06000	37.34571835	-121.8975601	Santa Clara County
348779	Ordering, Referring, Prescribing	N/A	1841382314	0	0	DU, ANN PA	2/4/2013	Taxonomy not applicable	NA	n/a	000	Unknown	00PA16705	N/A	N/A	N/A	N/A	N/A	7655 GREENLEAF AVE	None	WHITTIER	CA	90602	1626	00	06000	33.9719973	-118.0374206	Los Angeles County
348844	Ordering, Referring, Prescribing	N/A	1841493707	0	0	DIAZ, JAMES A	4/1/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	21944	N/A	N/A	N/A	N/A	N/A	6991 N STATE ST	None	REDWOOD VALLEY	CA	95470	9629	00	06000	39.2438212	-123.207113	Mendocino County
348921	Ordering, Referring, Prescribing	N/A	1841610219	0	0	DIAZ, JUDITH L NP	3/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000797	N/A	N/A	N/A	N/A	N/A	3636 CAMINO DEL RIO N	150	SAN DIEGO	CA	92108	1703	00	06000	32.778982	-117.1164717	San Diego County
348926	Ordering, Referring, Prescribing	N/A	1841618634	0	0	DAY, ROBERT C MD	7/19/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139689	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY DEPT	DEPT 384	SANTA CLARA	CA	94115	3358	00	06000	37.33636857	-121.9958111	Santa Clara County
348956	Ordering, Referring, Prescribing	N/A	1841676657	0	0	DAVIS-KHOROMANA, DANIELLE L PHARMD	4/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH68743	N/A	N/A	N/A	N/A	N/A	250 SOUTH G STREET	STE. 1400	SAN BERNARDINO	CA	92410	0100	00	06000	34.09693522	-117.2986838	San Bernardino County
348991	Ordering, Referring, Prescribing	N/A	1841724838	0	0	DELRIO, VANESSA	1/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	15649	N/A	N/A	N/A	N/A	N/A	333 S FARRELL DR	None	PALM SPRINGS	CA	92262	7905	00	06000	33.8189007	-116.51811	Riverside County
348996	Ordering, Referring, Prescribing	N/A	1841732351	0	0	DOMMERMUTH, MICHELLE M NP	6/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	NP95005476	N/A	N/A	N/A	N/A	N/A	441 E YOSEMITE AVE	None	MADERA	CA	93638	3604	00	06000	36.96460804	-120.055598	Madera County
349001	Ordering, Referring, Prescribing	N/A	1841739414	0	0	DUONG, HANH PHARMD	8/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76068	N/A	N/A	N/A	N/A	N/A	1718 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1306	00	06000	36.98138569	-122.002034	Santa Cruz County
349023	Ordering, Referring, Prescribing	N/A	1841760527	0	0	DALTON, LINDA LPCC	10/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	4370	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	None	SAN DIEGO	CA	92108	4711	00	06000	32.77025942	-117.2017196	San Diego County
349028	Ordering, Referring, Prescribing	N/A	1841773850	0	0	DUONG, ALEX DDS	1/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	103228	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
349040	Ordering, Referring, Prescribing	N/A	1841795119	0	0	DELPASAND, BRIAN H MD	7/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163272	N/A	N/A	N/A	N/A	N/A	265 S ANITA DRIVE	None	ORANGE	CA	92868	3355	00	06000	33.78499409	-117.8811837	Orange County
349041	Ordering, Referring, Prescribing	N/A	1841797644	0	0	D'ALONZO, SANDRA L LCSW	2/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82240	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
349043	Ordering, Referring, Prescribing	N/A	1841793619	0	0	DARMAHKASIH, ANDREW J MD	12/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164751	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
349077	Ordering, Referring, Prescribing	N/A	1841879756	0	0	DOAN, CHRISTINA PHARMD	11/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84202	N/A	N/A	N/A	N/A	N/A	22451 ANTONIO PKWY	None	RANCHO SANTA MARG	CA	92688	2813	00	06000	33.63642761	-117.5907276	Orange County
349093	Ordering, Referring, Prescribing	N/A	1841938057	0	0	DEL CHIARO, CARA N PA-C	5/24/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61149	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
349097	Ordering, Referring, Prescribing	N/A	1841952983	0	0	DATZ-GREENBERG, COREY LCSW	8/25/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110145	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	0000	00	06000	37.7813638	-122.4082438	San Francisco County
349100	Ordering, Referring, Prescribing	N/A	1841952520	0	0	DELFIN, FRENZ DAVE M NP	5/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019400	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
349113	Ordering, Referring, Prescribing	N/A	1841989555	0	0	DEL ROSARIO, ANIEL	6/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110245	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	315	LOS ANGELES	CA	90012	2343	00	06000	34.06255157	-118.2397077	Los Angeles County
349121	Ordering, Referring, Prescribing	N/A	1851010748	0	0	DRONBERGER, EVELYNN CNM	11/21/2023	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236311	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST.	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
349133	Ordering, Referring, Prescribing	N/A	1851048896	0	0	DUENAS, GRACE NP	6/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021200	N/A	N/A	N/A	N/A	N/A	1717 LAS VEGAS STREET	None	MODESTO	CA	95358	5500	00	06000	37.6052798	-121.0027523	Stanislaus County
349160	Ordering, Referring, Prescribing	N/A	1851313514	0	0	DUGGAN, JOHN W MD	9/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G068317	N/A	N/A	N/A	N/A	N/A	1180 N INDIAN CANYON DR	E130	PALM SPRINGS	CA	92262	4800	00	06000	33.839505	-116.5455735	Riverside County
349162	Ordering, Referring, Prescribing	N/A	1851321939	0	0	DE LA ROCHA, QUENBY T PA-C	10/31/2017	Taxonomy not applicable	NA	n/a	000	Unknown	17491	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
349170	Ordering, Referring, Prescribing	N/A	1851415889	0	0	DAM, THOMAS LMFT	3/29/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137436	N/A	N/A	N/A	N/A	N/A	2351 CARDINAL LN	None	SAN DIEGO	CA	92123	3743	00	06000	32.7867927	-117.1601935	San Diego County
349174	Ordering, Referring, Prescribing	N/A	1851419055	0	0	DALZIEL, MELISSA R LMFT	4/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114573	N/A	N/A	N/A	N/A	N/A	15740 TURNBERRY ST	None	MORENO VALLEY	CA	92555	4903	00	06000	33.89196689	-117.1891157	Riverside County
349188	Ordering, Referring, Prescribing	N/A	1851429286	0	0	DIMITRI-SALVATO, DOLORES D LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT43683	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVENUE	100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
349201	Ordering, Referring, Prescribing	N/A	1851452635	0	0	DASTA, SUSAN L DO	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A14537	N/A	N/A	N/A	N/A	N/A	1560 E CHEVY CHASE DR	STE 245	GLENDALE	CA	91206	4158	00	06000	34.15290734	-118.2302295	Los Angeles County
349203	Ordering, Referring, Prescribing	N/A	1851456685	0	0	DANIEL, ROSALIND M LMFT	8/31/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC33470	N/A	N/A	N/A	N/A	N/A	350 E K ST	None	BENICIA	CA	94510	3437	00	06000	38.05073543	-122.1514108	Solano County
349228	Ordering, Referring, Prescribing	N/A	1851505531	0	0	DEWAR, AMY MD	12/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97621	N/A	N/A	N/A	N/A	N/A	2351 CARDINAL LN	None	SAN DIEGO	CA	92123	3743	00	06000	32.7867927	-117.1601935	San Diego County
349242	Ordering, Referring, Prescribing	N/A	1851536353	0	0	DEVERS, CECIL W LCSW	10/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81539	N/A	N/A	N/A	N/A	N/A	9925 INTERNATIONAL BLVD	5	OAKLAND	CA	94603	2558	00	06000	37.74332565	-122.1698542	Alameda County
349248	Ordering, Referring, Prescribing	N/A	1851556435	0	0	DAVALOS, VERONICA J LCSW	7/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65479	N/A	N/A	N/A	N/A	N/A	22 CANYON TERRACE	None	AVALON	CA	90704	1601	00	06000	33.33990277	-118.324892	Los Angeles County
349251	Ordering, Referring, Prescribing	N/A	1851557532	0	0	DOMINICS JR, LUIS R	6/6/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D57246	N/A	N/A	N/A	N/A	N/A	6901 S ATLANTIC BLVD	None	BELL	CA	90201	3646	00	06000	33.97291242	-118.1878808	Los Angeles County
349265	Ordering, Referring, Prescribing	N/A	1851592406	0	0	DELGADO, MANUEL LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108137	N/A	N/A	N/A	N/A	N/A	10155 COLIMA RD.	None	WHITTIER	CA	90603	2042	00	06000	33.94349601	-118.0106968	Los Angeles County
349332	Ordering, Referring, Prescribing	N/A	1851698823	0	0	DANILOV, LILIA MD	12/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129893	N/A	N/A	N/A	N/A	N/A	14677 MERRILL AVE	None	FONTANA	CA	92335	4219	00	06000	34.09195549	-117.484956	San Bernardino County
349343	Ordering, Referring, Prescribing	N/A	1851709976	0	0	DO, LUAT	3/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	57097	N/A	N/A	N/A	N/A	N/A	26471 CARL BOYER DR	None	SANTA CLARITA	CA	91350	2996	00	06000	34.41445746	-118.5047459	Los Angeles County
349393	Ordering, Referring, Prescribing	N/A	1851775712	0	0	DURHAM, SARA LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85853	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
349394	Ordering, Referring, Prescribing	N/A	1851777882	0	0	DENG, BIN PHARMD	6/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	71460	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
349421	Ordering, Referring, Prescribing	N/A	1851821268	0	0	DING, JIA JENNIFER MD	2/6/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193714	N/A	N/A	N/A	N/A	N/A	518 GARDEN STREET	None	SANTA BARBARA	CA	93101	1606	00	06000	34.42054634	-119.6928135	Santa Barbara County
349424	Ordering, Referring, Prescribing	N/A	1851818181	0	0	DELGADO-JIMENEZ, JANA M LCSW	1/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76694	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BLDG A	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
349434	Ordering, Referring, Prescribing	N/A	1851836902	0	0	DARROW, MARJORIE LMFT	6/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91142	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5441	00	06000	38.425482	-122.75262	Sonoma County
349460	Ordering, Referring, Prescribing	N/A	1851882633	0	0	DE DIOS, JESUS LMFT	4/9/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132241	N/A	N/A	N/A	N/A	N/A	8825 AERO DR STE 315	STE 315	SAN DIEGO	CA	92123	2270	00	06000	32.80967216	-117.1384291	San Diego County
349493	Ordering, Referring, Prescribing	N/A	1851942569	0	0	DIEP, KAREN T OD	8/30/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34380	N/A	N/A	N/A	N/A	N/A	3508 MIRANDA AVE	None	PALO ALTO	CA	94301	0000	00	06000	37.40442413	-122.1454974	Santa Clara County
349507	Ordering, Referring, Prescribing	N/A	1851962062	0	0	DELAPAZ, ARLENE M NP	3/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016852	N/A	N/A	N/A	N/A	N/A	80495 HIGHWAY 111	None	INDIO	CA	92201	6534	00	06000	33.70724448	-116.260686	Riverside County
349522	Ordering, Referring, Prescribing	N/A	1861021222	0	0	DANIEL, SCOTT DO	4/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A22745	N/A	N/A	N/A	N/A	N/A	42135 10TH STREET WEST	SUITE 101	LANCASTER	CA	93534	7099	00	06000	34.648533	-118.1477975	Los Angeles County
349542	Ordering, Referring, Prescribing	N/A	1861058430	0	0	DE LEON, NICKOLAS P PA-C	4/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58866	N/A	N/A	N/A	N/A	N/A	344 E. SIXTH STREET	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
349563	Ordering, Referring, Prescribing	N/A	1861126286	0	0	DOYLE, CASSIDY PA-C	6/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62851	N/A	N/A	N/A	N/A	N/A	905 CALLE AMANECER	SUITE 115	SAN CLEMENTE	CA	92673	6226	00	06000	33.44951265	-117.6075825	Orange County
349576	Ordering, Referring, Prescribing	N/A	1861169187	0	0	DUCH, SOPHAY LCSW	9/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99584	N/A	N/A	N/A	N/A	N/A	39055 HASTINGS ST	208	FREMONT	CA	94538	1518	00	06000	37.55249404	-121.983385	Alameda County
349598	Ordering, Referring, Prescribing	N/A	1861464612	0	0	DINSAY, ROSELYN M MD	5/1/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G85448	N/A	N/A	N/A	N/A	N/A	435 W ARDEN AVE	#340	GLENDALE	CA	91203	4017	00	06000	34.15848148	-118.26288	Los Angeles County
349658	Ordering, Referring, Prescribing	N/A	1861607038	0	0	DAVIS-PACKER, RACHEL LMFT	3/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41363	N/A	N/A	N/A	N/A	N/A	2440 6TH ST	None	EUREKA	CA	95501	0788	00	06000	40.80368802	-124.1456878	Humboldt County
349684	Ordering, Referring, Prescribing	N/A	1861693145	0	0	DUMMAR, DAVID A LMFT	2/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124609	N/A	N/A	N/A	N/A	N/A	215 HUERTA AVE	None	GREENFIELD	CA	93927	5762	00	06000	36.3178728	-121.2373633	Monterey County
349700	Ordering, Referring, Prescribing	N/A	1861716722	0	0	DIAZ-SMOIRE, MARCELA LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77521	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD.	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
349712	Ordering, Referring, Prescribing	N/A	1861739393	0	0	DODSON, LORI M LMFT	10/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT53676	N/A	N/A	N/A	N/A	N/A	4001 MISSION OAKS BLVD	None	CAMARILLO	CA	93012	5121	00	06000	34.21641579	-119.0166203	Ventura County
349757	Ordering, Referring, Prescribing	N/A	1861805160	0	0	DEPRATTI, ALEXANDRA LMFT	12/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123824	N/A	N/A	N/A	N/A	N/A	600 G ST	None	UNION CITY	CA	94587	2400	00	06000	37.59996226	-122.0201927	Alameda County
349785	Ordering, Referring, Prescribing	N/A	1861844938	0	0	DE LEON, JENNIFER Y LCSW	4/28/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107858	N/A	N/A	N/A	N/A	N/A	180 UNION PL	None	LOS ANGELES	CA	90026	5715	00	06000	34.06186536	-118.2653898	Los Angeles County
349802	Ordering, Referring, Prescribing	N/A	1861869992	0	0	DUSTON, MIRIAM M LCSW	1/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	89000	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE RD	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
349813	Ordering, Referring, Prescribing	N/A	1861893554	0	0	DIXON, GENAVAE P LMFT	11/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102988	N/A	N/A	N/A	N/A	N/A	40849 FREMONT BLVD	None	FREMONT	CA	94538	4306	00	06000	37.53438356	-121.9618278	Alameda County
349839	Ordering, Referring, Prescribing	N/A	1861931834	0	0	DHAMMI, NAVJOT MD	3/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL853	N/A	N/A	N/A	N/A	N/A	747 52ND STREET	None	OAKLAND	CA	94609	1809	00	06000	37.83734639	-122.2672128	Alameda County
349866	Ordering, Referring, Prescribing	N/A	1861967432	0	0	DAO, KHUONG V PHARMD	7/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH78154	N/A	N/A	N/A	N/A	N/A	2589 JENSEN AVE	None	SANGER	CA	93657	2251	00	06000	36.7067485	-119.5739611	Fresno County
349889	Ordering, Referring, Prescribing	N/A	1871001529	0	0	DAR, TAJALLA M PHARMD	8/31/2020	Taxonomy not applicable	NA	n/a	000	Unknown	74728	N/A	N/A	N/A	N/A	N/A	3383 BASS LAKE RD	None	EL DORADO HILLS	CA	95762	6623	00	06000	38.67607992	-121.0295773	El Dorado County
349944	Ordering, Referring, Prescribing	N/A	1871083105	0	0	DIAZ, RAYMOND LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114815	N/A	N/A	N/A	N/A	N/A	1105 E FLORIDA AVE	None	HEMET	CA	92543	4512	00	06000	33.74750951	-116.960463	Riverside County
349945	Ordering, Referring, Prescribing	N/A	1871085670	0	0	DHILLON, RANDEEP DDS	7/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	49091	N/A	N/A	N/A	N/A	N/A	705 W PECAN AVE	None	MADERA	CA	93637	6254	00	06000	36.941103	-120.06729	Madera County
349961	Ordering, Referring, Prescribing	N/A	1871101428	0	0	DANG, BAOVY PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	82119	N/A	N/A	N/A	N/A	N/A	12475 RANCHO BERNARDO RD	None	SAN DIEGO	CA	92128	0000	00	06000	33.0185611	-117.0619766	San Diego County
349971	Ordering, Referring, Prescribing	N/A	1871121418	0	0	DACARETT GALEANO, DENNIS J MD MPH	12/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL5327	N/A	N/A	N/A	N/A	N/A	345 SAN PEDRO STREET	None	LOS ANGELES	CA	90013	1633	00	06000	34.04602976	-118.2429461	Los Angeles County
349976	Ordering, Referring, Prescribing	N/A	1871127258	0	0	DOSHI, PRIYANKA PSYD	3/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31045	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MAILSTOP #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
350009	Ordering, Referring, Prescribing	N/A	1871204412	0	0	DIAZ, ELINA NP	8/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95022253	N/A	N/A	N/A	N/A	N/A	7100 VAN NUYS BLVD	None	VAN NUYS	CA	91405	3063	00	06000	34.19957761	-118.4487663	Los Angeles County
350047	Ordering, Referring, Prescribing	N/A	1871372797	0	0	DOMINGUEZ, PRISCILLA NP	10/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026485	N/A	N/A	N/A	N/A	N/A	7100 VAN NUYS BLVD	108	VAN NUYS	CA	91405	0000	00	06000	34.19957761	-118.4487663	Los Angeles County
350117	Ordering, Referring, Prescribing	N/A	1871676734	0	0	DEL CARLO, DIANA MD	10/27/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G77216	N/A	N/A	N/A	N/A	N/A	330 E LIVE OAK AVE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
350125	Ordering, Referring, Prescribing	N/A	1871700203	0	0	DEVOSS, LUANN L PHD	6/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY13437	N/A	N/A	N/A	N/A	N/A	5275 CLAREMONT AVE	None	OAKLAND	CA	94618	1032	00	06000	37.8391822	-122.260841	Alameda County
350137	Ordering, Referring, Prescribing	N/A	1871735464	0	0	DE LEON, EDWIN ROMEL S MD	6/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118530	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
350169	Ordering, Referring, Prescribing	N/A	1871758912	0	0	DEL ROSARIO, CORINNE S	3/29/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0626465	N/A	N/A	N/A	N/A	N/A	200 MEDICAL PLAZA	STE 165-41	LOS ANGELES	CA	90095	1738	00	06000	34.06527974	-118.4462792	Los Angeles County
350219	Ordering, Referring, Prescribing	N/A	1871860916	0	0	DANEHY, MEGHAN E LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	99021	N/A	N/A	N/A	N/A	N/A	260 COHASSET RD	120	CHICO	CA	95926	2282	00	06000	39.754035	-121.851117	Butte County
350221	Ordering, Referring, Prescribing	N/A	1871871368	0	0	DEA, WENDY W PHARMD	3/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	44338	N/A	N/A	N/A	N/A	N/A	1000 N RENGSTORFF AVE	None	MOUNTAIN VIEW	CA	94043	1716	00	06000	37.42125982	-122.0936833	Santa Clara County
350228	Ordering, Referring, Prescribing	N/A	1871878017	0	0	DUONG, MICHELL M PHARMD	10/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH42768	N/A	N/A	N/A	N/A	N/A	976 LENZEN AVE	1400	SAN JOSE	CA	95126	2737	00	06000	37.33463902	-121.9121497	Santa Clara County
350234	Ordering, Referring, Prescribing	N/A	1871884619	0	0	DOAN, JAMES H PHARMD	7/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	63469	N/A	N/A	N/A	N/A	N/A	191 E YORBA LINDA BLVD	None	PLACENTIA	CA	92870	3328	00	06000	33.88786443	-117.8638701	Orange County
350255	Ordering, Referring, Prescribing	N/A	1871919209	0	0	DELGADILLO-PARAMO, ALBA S LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99958	N/A	N/A	N/A	N/A	N/A	820 E. GILBERT ST.	None	SAN BERNARDINO	CA	92415	0026	00	06000	34.1268333	-117.2687417	San Bernardino County
350261	Ordering, Referring, Prescribing	N/A	1871920462	0	0	DOHERTY, MISTY LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47374	N/A	N/A	N/A	N/A	N/A	2513 24TH ST.	None	SAN FRANCISCO	CA	94110	3556	00	06000	37.75308592	-122.4047531	San Francisco County
350313	Ordering, Referring, Prescribing	N/A	1871992552	0	0	D'AMBRA-SANCHEZ, BRITNEY L	7/27/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95034860	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
350314	Ordering, Referring, Prescribing	N/A	1881000917	0	0	DAVIS, VICKIE A LMFT	8/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134234	N/A	N/A	N/A	N/A	N/A	600 N ARROWHEAD AVE	300	SAN BERNARDINO	CA	92401	1164	00	06000	34.110486	-117.2896755	San Bernardino County
350322	Ordering, Referring, Prescribing	N/A	1881012433	0	0	DUFFY, KATHERINE MD MPH	11/26/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166886	N/A	N/A	N/A	N/A	N/A	1625 N. SCHRADER BLVD.	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
350348	Ordering, Referring, Prescribing	N/A	1881056844	0	0	DEKERMENDJIAN, VALENTINE	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72905	N/A	N/A	N/A	N/A	N/A	2235 MERCURY WAY	SUITE 145	SANTA ROSA	CA	95407	5473	00	06000	38.422404	-122.751261	Sonoma County
350363	Ordering, Referring, Prescribing	N/A	1881070159	0	0	DIAZ, VERONICA I DC	7/26/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC33342	N/A	N/A	N/A	N/A	N/A	14540 RAMONA BLVD	211	BALDWIN PARK	CA	91706	3386	00	06000	34.0868395	-117.9579434	Los Angeles County
350365	Ordering, Referring, Prescribing	N/A	1881071017	0	0	DIRR, MONICA C LCSW	8/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110003	N/A	N/A	N/A	N/A	N/A	832 FOLSOM ST	None	SAN FRANCISCO	CA	94107	4502	00	06000	37.78137302	-122.4020589	San Francisco County
350373	Ordering, Referring, Prescribing	N/A	1881077642	0	0	DANG, REBECCA MD	12/14/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146540	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
350375	Ordering, Referring, Prescribing	N/A	1881072577	0	0	DURAZO, ERIKA LMFT	3/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123839	N/A	N/A	N/A	N/A	N/A	17800 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
350409	Ordering, Referring, Prescribing	N/A	1881128254	0	0	DABU, LISA MD FAAP	3/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169566	N/A	N/A	N/A	N/A	N/A	502 S. EUCLID AVE	201	NATIONAL CITY	CA	91950	2931	00	06000	32.68505421	-117.0832793	San Diego County
350434	Ordering, Referring, Prescribing	N/A	1881172666	0	0	DENSEN, SAMUEL MD	1/22/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192871	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
350453	Ordering, Referring, Prescribing	N/A	1881199016	0	0	DAGGETT, ANTHONY MD	6/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164331	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
350479	Ordering, Referring, Prescribing	N/A	1881258747	0	0	DUONG, VI-KHOI K	2/8/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	104550	N/A	N/A	N/A	N/A	N/A	1454 E SECOND STREET	None	SAN BERNARDINO	CA	92408	0118	00	06000	34.1035953	-117.2563723	San Bernardino County
350489	Ordering, Referring, Prescribing	N/A	1881267938	0	0	DESAI, RADHA M PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78831	N/A	N/A	N/A	N/A	N/A	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	00	06000	37.94947636	-121.7752571	Contra Costa County
350514	Ordering, Referring, Prescribing	N/A	1881355709	0	0	DELGADO, JESSICA NP	10/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019353	N/A	N/A	N/A	N/A	N/A	2970 HILLTOP MALL RD	None	RICHMOND	CA	94806	5274	00	06000	37.97819764	-122.329244	Contra Costa County
350525	Ordering, Referring, Prescribing	N/A	1881424166	0	0	DINH, AIMEE NP	12/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95022442	N/A	N/A	N/A	N/A	N/A	2023 W VISTA WAY STE J	STE J	VISTA	CA	92083	6013	00	06000	33.1854871	-117.2850592	San Diego County
350553	Ordering, Referring, Prescribing	N/A	1881676302	0	0	DUA, CESAR MD	2/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A62556	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
350570	Ordering, Referring, Prescribing	N/A	1881724656	0	0	DI BATTISTA, MARIA J LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45095	N/A	N/A	N/A	N/A	N/A	5740 RALSTON STREET	STE. 201	SIMI VALLEY	CA	93003	6571	00	06000	34.26070802	-119.213699	Ventura County
350668	Ordering, Referring, Prescribing	N/A	1881952406	0	0	DEJARNETTE, JESSICA M MD	11/21/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140381	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
350672	Ordering, Referring, Prescribing	N/A	1881957959	0	0	DIAZ, AMELIA G LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76655	N/A	N/A	N/A	N/A	N/A	3625 14TH STREET	None	RIVERSIDE	CA	92501	3815	00	06000	33.97584034	-117.3775789	Riverside County
350689	Ordering, Referring, Prescribing	N/A	1881977700	0	0	DUCKLOW, GEORGA A	12/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63536	N/A	N/A	N/A	N/A	N/A	12350 CARMEL MOUNTAIN RD	None	SAN DIEGO	CA	92128	4616	00	06000	32.987565	-117.078192	San Diego County
350712	Ordering, Referring, Prescribing	N/A	1891028213	0	0	DANN, MARGARET R CNP	2/10/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21121	N/A	N/A	N/A	N/A	N/A	760 HARRISON ST	None	SAN FRANCISCO	CA	94107	1235	00	06000	37.78155484	-122.3987081	San Francisco County
350734	Ordering, Referring, Prescribing	N/A	1891067682	0	0	DURDIN, KIMBERLY A	7/29/2020	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM613	N/A	N/A	N/A	N/A	N/A	2610 SOUTHWEST DR	None	LOS ANGELES	CA	90043	4528	00	06000	33.98133663	-118.3219664	Los Angeles County
350752	Ordering, Referring, Prescribing	N/A	1891088100	0	0	DYKES, CARLA	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	95935	N/A	N/A	N/A	N/A	N/A	25170 HANCOCK AVE	None	MURRIETA	CA	92562	5969	00	06000	33.565149	-117.1823815	Riverside County
350753	Ordering, Referring, Prescribing	N/A	1891092136	0	0	DIAMOND, STEVEN LPCC	9/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13928	N/A	N/A	N/A	N/A	N/A	1202 MORENA BLVD	300	SAN DIEGO	CA	92110	3841	00	06000	32.77025942	-117.2017196	San Diego County
350772	Ordering, Referring, Prescribing	N/A	1891122024	0	0	DIROY, SARAH Y LCSW	8/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75201	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
350774	Ordering, Referring, Prescribing	N/A	1891121646	0	0	D'MARK, THELMA JOSE NP	10/3/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0753693	N/A	N/A	N/A	N/A	N/A	5519 E DEL AMO BLVD	None	LAKEWOOD	CA	90713	2307	00	06000	33.8471395	-118.1244195	Los Angeles County
350784	Ordering, Referring, Prescribing	N/A	1891137733	0	0	DALE, HEATHER J LCSW	9/5/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW27023	N/A	N/A	N/A	N/A	N/A	13300 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	2207	00	06000	33.7743865	-117.9001575	Orange County
350866	Ordering, Referring, Prescribing	N/A	1891263455	0	0	DEGANTEBLANCAS, NOEMI	9/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	149946	N/A	N/A	N/A	N/A	N/A	1260 N. DUTTON AVE.	230	SANTA ROSA	CA	95401	7161	00	06000	38.449197	-122.7320775	Sonoma County
350903	Ordering, Referring, Prescribing	N/A	1891340360	0	0	DENG, CRYSTAL S NP	7/23/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012315	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
350907	Ordering, Referring, Prescribing	N/A	1891350997	0	0	DAO, AMY N CNP	6/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011722	N/A	N/A	N/A	N/A	N/A	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8511	00	06000	32.773176	-115.5270465	Imperial County
350910	Ordering, Referring, Prescribing	N/A	1891359154	0	0	DAVIS, MORGAN E MD	9/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	A181809	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
350916	Ordering, Referring, Prescribing	N/A	1891368759	0	0	DOAN, JENNY PHARMD	11/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH84442	N/A	N/A	N/A	N/A	N/A	2605 MIDDLEFIELD RD	None	PALO ALTO	CA	94306	2516	00	06000	37.43410933	-122.1303843	Santa Clara County
350920	Ordering, Referring, Prescribing	N/A	1891380804	0	0	DALAL, ANISH PHARMD	9/8/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86745	N/A	N/A	N/A	N/A	N/A	5030 HAMNER AVE	None	EASTVALE	CA	91752	1009	00	06000	33.996744	-117.555534	Riverside County
350935	Ordering, Referring, Prescribing	N/A	1891435848	0	0	DANG, ARUN MD	9/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21672	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT. 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
350939	Ordering, Referring, Prescribing	N/A	1891437802	0	0	DAO, CASSANDRA	12/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188598	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
350946	Ordering, Referring, Prescribing	N/A	1891455382	0	0	DANG, CONNIE	10/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017680	N/A	N/A	N/A	N/A	N/A	2698 N BENTLEY ST	None	ORANGE	CA	92867	2260	00	06000	33.83355659	-117.8042496	Orange County
350948	Ordering, Referring, Prescribing	N/A	1891453304	0	0	DI RADO, KATHRYN NP	10/5/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018704	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
350971	Ordering, Referring, Prescribing	N/A	1891702122	0	0	DEV, VIPUL R MD	10/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63639	N/A	N/A	N/A	N/A	N/A	2901 SILLECT AVE	201	BAKERSFIELD	CA	93308	6371	00	06000	35.38611256	-119.0393796	Kern County
350997	Ordering, Referring, Prescribing	N/A	1891821112	0	0	DOTY, SHANNON C LMFT	6/11/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44926	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	110	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
351024	Ordering, Referring, Prescribing	N/A	1891862827	0	0	DAVIDSON, GEORGE P LCSW	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21627	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
351097	Ordering, Referring, Prescribing	N/A	1902052269	0	0	DAHABREH, MANAR F LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91141	N/A	N/A	N/A	N/A	N/A	14515 HAMLIN ST.	102	VAN NUYS	CA	91411	1694	00	06000	34.18869729	-118.4492498	Los Angeles County
351139	Ordering, Referring, Prescribing	N/A	1902133572	0	0	DEOLIVEIRA, BRIAN D LMFT	10/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96400	N/A	N/A	N/A	N/A	N/A	47825 OASIS ST	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
351204	Ordering, Referring, Prescribing	N/A	1902212798	0	0	DE LA CRUZ GARCIA, OMAR LMFT	9/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115663	N/A	N/A	N/A	N/A	N/A	1172 S MAIN ST	125	SALINAS	CA	93901	2204	00	06000	36.6581389	-121.659298	Monterey County
351206	Ordering, Referring, Prescribing	N/A	1902223688	0	0	DILAURA, ANGELA S NP	10/5/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95047523	N/A	N/A	N/A	N/A	N/A	678 N WILSON WAY	None	STOCKTON	CA	95205	4272	00	06000	37.962954	-121.2735326	San Joaquin County
351212	Ordering, Referring, Prescribing	N/A	1902230501	0	0	DABBS, MICHELLE R LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105119	N/A	N/A	N/A	N/A	N/A	12141 BROOKHURST ST	None	GARDEN GROVE	CA	92840	2865	00	06000	33.78614503	-117.9587915	Orange County
351245	Ordering, Referring, Prescribing	N/A	1902297369	0	0	DE LA TORRE, NANCY LCSW	10/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97910	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD	201	PACOIMA	CA	91331	6732	00	06000	34.27814981	-118.4055414	Los Angeles County
351255	Ordering, Referring, Prescribing	N/A	1902305980	0	0	DANIELS, QUYNH NHU N PHARMD	7/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78252	N/A	N/A	N/A	N/A	N/A	22 SAN PEDRO RD	None	DALY CITY	CA	94014	1020	00	06000	37.68893852	-122.4669569	San Mateo County
351266	Ordering, Referring, Prescribing	N/A	1902324429	0	0	DONABEDIAN, STEPHANIE LMFT	3/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124941	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
351305	Ordering, Referring, Prescribing	N/A	1902402902	0	0	DANG, MINH C PHARMD	1/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83596	N/A	N/A	N/A	N/A	N/A	20620 W HOMESTEAD RD	None	CUPERTINO	CA	95014	0000	00	06000	37.3374237	-122.0349941	Santa Clara County
351363	Ordering, Referring, Prescribing	N/A	1902583149	0	0	DIEP, NICOLE DMD	6/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108891	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD STE 225	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
351424	Ordering, Referring, Prescribing	N/A	1902951924	0	0	DONNELLY, EDWARD F PHD	12/2/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17387	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	1ST FLOOR	SAN PABLO	CA	94806	3804	00	06000	37.95651393	-122.3371491	Contra Costa County
351444	Ordering, Referring, Prescribing	N/A	1902978596	0	0	DUNLAP, DORA L	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW7990	N/A	N/A	N/A	N/A	N/A	735 STATE ST.	SUITE 514	SANTA BARBARA	CA	93101	5554	00	06000	34.41942344	-119.6991527	Santa Barbara County
351553	Ordering, Referring, Prescribing	N/A	1912238197	0	0	DE LEON, TYLER C LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88321	N/A	N/A	N/A	N/A	N/A	233 S QUINTANA DR	None	ANAHEIM	CA	92807	4029	00	06000	33.85230249	-117.7739305	Orange County
351585	Ordering, Referring, Prescribing	N/A	1912279027	0	0	DINH, KATHY T	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62276	N/A	N/A	N/A	N/A	N/A	1634 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	4616	00	06000	34.13588549	-117.2518245	San Bernardino County
351590	Ordering, Referring, Prescribing	N/A	1912287616	0	0	DIEUJUSTE, FEDELYNE PHARMD	8/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62275	N/A	N/A	N/A	N/A	N/A	8044 LIMONITE AVE	None	RIVERSIDE	CA	92509	7136	00	06000	33.97764677	-117.4608873	Riverside County
351607	Ordering, Referring, Prescribing	N/A	1912307687	0	0	DE LA ROSA, EVELYN J LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88663	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
351703	Ordering, Referring, Prescribing	N/A	1912439217	0	0	DUONG, RICHARDSARAK S	9/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	76700	N/A	N/A	N/A	N/A	N/A	1670 E 120TH ST	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
351708	Ordering, Referring, Prescribing	N/A	1912455098	0	0	DEW, SHANNA LMFT	6/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113757	N/A	N/A	N/A	N/A	N/A	4153 PIEDMONT AVE.	SUITE 1	OAKLAND	CA	94611	5108	00	06000	37.82707727	-122.2515819	Alameda County
351823	Ordering, Referring, Prescribing	N/A	1912689241	0	0	DANIELSEN, LANCE LMFT	6/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139811	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2317	00	06000	37.50572931	-122.2621879	San Mateo County
351838	Ordering, Referring, Prescribing	N/A	1912960873	0	0	DINKHA, ROMMEL DDS	12/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	57973	N/A	N/A	N/A	N/A	N/A	21175 N. 9TH PL	SUITE 100	PHOENIX	AZ	85024	5683	00	06000	33.678045	-112.0610115	Maricopa County
351843	Ordering, Referring, Prescribing	N/A	1922016294	0	0	DINAKAR, HASSAN MD	10/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51086	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
351863	Ordering, Referring, Prescribing	N/A	1922123512	0	0	DIXON, MATTHEW LCSW	12/27/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112853	N/A	N/A	N/A	N/A	N/A	11716 ENTERPRISE DRIVE	None	AUBURN	CA	95603	3732	00	06000	38.90720197	-121.0838099	Placer County
351882	Ordering, Referring, Prescribing	N/A	1922145374	0	0	DIAZ, CARLO LMFT	3/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47772	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	SUITE 200	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
351915	Ordering, Referring, Prescribing	N/A	1922246776	0	0	DE LOERA-MORALES, AMANDA E	2/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29727	N/A	N/A	N/A	N/A	N/A	3031 VERMONT AVE.	None	LOS ANGELES	CA	90007	3033	00	06000	34.02666679	-118.2915608	Los Angeles County
351941	Ordering, Referring, Prescribing	N/A	1922304443	0	0	DAM, EDWARD	1/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48837	N/A	N/A	N/A	N/A	N/A	6750 STANFORD RANCH RD	None	ROSEVILLE	CA	95678	1907	00	06000	38.780055	-121.2657575	Placer County
351980	Ordering, Referring, Prescribing	N/A	1922379684	0	0	DANG, LAWRENCE	2/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	65785	N/A	N/A	N/A	N/A	N/A	751 SOUTH BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
351999	Ordering, Referring, Prescribing	N/A	1922396514	0	0	DEDHIA, MONICA LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74476	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
352031	Ordering, Referring, Prescribing	N/A	1922454768	0	0	DAI, ZHI PENG DO	5/24/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	17205	N/A	N/A	N/A	N/A	N/A	211 EASTMOOR AVE	None	DALY CITY	CA	94015	2036	00	06000	37.6847337	-122.4787562	San Mateo County
352047	Ordering, Referring, Prescribing	N/A	1922477280	0	0	DEMIAN, JEFFREY DPM	11/19/2018	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5385	N/A	N/A	N/A	N/A	N/A	3820 DEL AMO BLVD	215	TORRANCE	CA	90503	2150	00	06000	33.84858354	-118.354707	Los Angeles County
352060	Ordering, Referring, Prescribing	N/A	1922488600	0	0	DEVINCENTIS, MICHELLE LMFT	12/14/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115286	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	0000	00	06000	33.92826552	-118.3092091	Los Angeles County
352078	Ordering, Referring, Prescribing	N/A	1922502202	0	0	DANAEI, BAHRAM DDS	3/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	104913	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
352103	Ordering, Referring, Prescribing	N/A	1922542596	0	0	DIESEL, KORTNEY E LMFT	3/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125163	N/A	N/A	N/A	N/A	N/A	9445 FARNHAM ST	SUITE 100	SAN DIEGO	CA	92123	1399	00	06000	32.83274967	-117.1248508	San Diego County
352127	Ordering, Referring, Prescribing	N/A	1922582337	0	0	DINH, JENNIFER PHARMD	1/17/2024	Taxonomy not applicable	NA	n/a	000	Unknown	78918	N/A	N/A	N/A	N/A	N/A	245 S. FETTERLY AVE	None	LOS ANGELES	CA	90022	1605	00	06000	34.03404953	-118.1609476	Los Angeles County
352158	Ordering, Referring, Prescribing	N/A	1922656560	0	0	DOMINGUEZ, IVETTE A LCSW	7/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	95399	N/A	N/A	N/A	N/A	N/A	12821 VICTORY BOULEVARD	None	NORTH HOLLYWOOD	CA	91606	3012	00	06000	34.18670951	-118.41246	Los Angeles County
352182	Ordering, Referring, Prescribing	N/A	1922724350	0	0	DOAN, FRANCINE	10/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87079	N/A	N/A	N/A	N/A	N/A	1476 W SAN CARLOS ST	None	SAN JOSE	CA	95126	3444	00	06000	37.32336194	-121.9167331	Santa Clara County
352245	Ordering, Referring, Prescribing	N/A	1932230562	0	0	DAVIS, BOBBY J LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24919	N/A	N/A	N/A	N/A	N/A	6010 WOOSTER AVE	None	LOS ANGELES	CA	90056	1434	00	06000	33.98664384	-118.3796609	Los Angeles County
352250	Ordering, Referring, Prescribing	N/A	1932236833	0	0	DE LEON, LISSETTE CA	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44041	N/A	N/A	N/A	N/A	N/A	16350 FILBERT STREET	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
352269	Ordering, Referring, Prescribing	N/A	1932272382	0	0	DENNIS-JOHNSON, DEBBIE A MD	8/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G69461	N/A	N/A	N/A	N/A	N/A	1500 6TH AVENUE	None	DELANO	CA	93215	3011	00	06000	35.76504054	-119.236779	Kern County
352334	Ordering, Referring, Prescribing	N/A	1932428927	0	0	DELA CRUZ, JEROME PHARMD	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	65024	N/A	N/A	N/A	N/A	N/A	2100 DR. MARTIN LUTHER K	None	CHICO	CA	95928	4422	00	06000	39.721077	-121.811508	Butte County
352349	Ordering, Referring, Prescribing	N/A	1932474673	0	0	DOLKHANI, ZOHREH PHARMD	3/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	45487	N/A	N/A	N/A	N/A	N/A	8810 TAMPA AVE	None	NORTHRIDGE	CA	91324	3519	00	06000	34.230771	-118.5510825	Los Angeles County
352357	Ordering, Referring, Prescribing	N/A	1932477502	0	0	DURAN-GOMEZ, BERENICE LMFT	12/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129876	N/A	N/A	N/A	N/A	N/A	5150 E. PACIFIC COAST HI	100	LONG BEACH	CA	90804	3394	00	06000	33.7831762	-118.1333125	Los Angeles County
352392	Ordering, Referring, Prescribing	N/A	1932531233	0	0	DURST, AMY LMFT	8/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102883	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
352428	Ordering, Referring, Prescribing	N/A	1932584430	0	0	DANG, LYDIA S RN PNP	2/9/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002749	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
352430	Ordering, Referring, Prescribing	N/A	1932584695	0	0	DE LA TORRE MARTINEZ, CLAUDIA LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115868	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
352436	Ordering, Referring, Prescribing	N/A	1932588985	0	0	DINH, CUC K PHARMD	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	49412	N/A	N/A	N/A	N/A	N/A	200 E SEPULVEDA BLVD	None	CARSON	CA	90745	6323	00	06000	33.80793675	-118.2727856	Los Angeles County
352457	Ordering, Referring, Prescribing	N/A	1932616638	0	0	DEL CASTILLO, ANDREA A LMFT	3/2/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145517	N/A	N/A	N/A	N/A	N/A	18350 MOUNT LANGLEY ST	220	FOUNTAIN VALLEY	CA	92708	6900	00	06000	33.69633523	-117.9420534	Orange County
352461	Ordering, Referring, Prescribing	N/A	1932623659	0	0	DEKEYAN, NSHAN D DPM	4/20/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5603	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
352514	Ordering, Referring, Prescribing	N/A	1932728821	0	0	DOMINGUEZ, ILIANA NP	10/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	NP95013270	N/A	N/A	N/A	N/A	N/A	8800 ALONDRA BLVD	STE C	BELLFLOWER	CA	90706	4355	00	06000	33.88918249	-118.1446785	Los Angeles County
352515	Ordering, Referring, Prescribing	N/A	1932730181	0	0	DARAKJIAN, CHRISTINA T PHARMD	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81965	N/A	N/A	N/A	N/A	N/A	38727 TIERRA SUBIDA AVE	None	PALMDALE	CA	93551	4248	00	06000	34.586091	-118.147518	Los Angeles County
352516	Ordering, Referring, Prescribing	N/A	1932724168	0	0	DHILLON, BALJIT S NP	11/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014720	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	SUITE 110	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
352530	Ordering, Referring, Prescribing	N/A	1932740214	0	0	DILLIS, MACKENZIE T	8/20/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	236202	N/A	N/A	N/A	N/A	N/A	1469 HUMBOLDT RD	SUITE 200	CHICO	CA	95928	9203	00	06000	39.73527137	-121.8156849	Butte County
352531	Ordering, Referring, Prescribing	N/A	1932738622	0	0	DELGADO, NICHOLAS A LCSW	3/11/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121514	N/A	N/A	N/A	N/A	N/A	405 W 5TH ST	SUITE 211	SANTA ANA	CA	92701	4599	00	06000	33.74893088	-117.8713859	Orange County
352533	Ordering, Referring, Prescribing	N/A	1932741212	0	0	DI LULO, KYLIE B NP	4/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020696	N/A	N/A	N/A	N/A	N/A	501 FOLSOM ST	1ST FLOOR	SAN FRANCISCO	CA	94105	3175	00	06000	37.78714838	-122.394673	San Francisco County
352542	Ordering, Referring, Prescribing	N/A	1932755741	0	0	DOUGHERTY, MEGAN LCSW	2/27/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113892	N/A	N/A	N/A	N/A	N/A	3665 KEARNY VILLA RD	SUITE 101	SAN DIEGO	CA	92123	1953	00	06000	32.80816826	-117.1510112	San Diego County
352543	Ordering, Referring, Prescribing	N/A	1932762382	0	0	DAO, RUBY NGOC PHARMD	10/11/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79724	N/A	N/A	N/A	N/A	N/A	999 STORY RD	9024	SAN JOSE	CA	95122	4604	00	06000	37.33121912	-121.8560786	Santa Clara County
352573	Ordering, Referring, Prescribing	N/A	1932868429	0	0	DAYMON, ANNA T NP	12/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019126	N/A	N/A	N/A	N/A	N/A	1695 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	00	06000	33.844239	-116.5282075	Riverside County
352585	Ordering, Referring, Prescribing	N/A	1932920204	0	0	DOMINIACK, ANJALI PT	1/9/2024	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	40987	N/A	N/A	N/A	N/A	N/A	880 THIRD AVE	None	CHULA VISTA	CA	91911	1305	00	06000	32.62153846	-117.0722021	San Diego County
352607	Ordering, Referring, Prescribing	N/A	1942224647	0	0	DAVENPORT, KELLI AU	1/13/2024	Taxonomy not applicable	NA	n/a	003	AUDIOLOGISTS	2649	N/A	N/A	N/A	N/A	N/A	4837 E MCKINLEY AVE	None	FRESNO	CA	93703	3532	00	06000	36.76523123	-119.734833	Fresno County
352626	Ordering, Referring, Prescribing	N/A	1942325543	0	0	DAVIS, BRAD R LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105562	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
352703	Ordering, Referring, Prescribing	N/A	1942481312	0	0	DOVERSPIKE, JEAN LMFT	11/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT43837	N/A	N/A	N/A	N/A	N/A	3121 PARK AVE	STE I	SOQUEL	CA	95073	2956	00	06000	36.9896384	-121.9356617	Santa Cruz County
352709	Ordering, Referring, Prescribing	N/A	1942488515	0	0	DE LOS REYES, LINAFLORE S PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58842	N/A	N/A	N/A	N/A	N/A	8010 PARKWAY DR	None	LA MESA	CA	91942	2104	00	06000	32.7749024	-117.0246371	San Diego County
352729	Ordering, Referring, Prescribing	N/A	1942539705	0	0	DAVIN, KAREN E NP	11/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008682	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	190	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
352754	Ordering, Referring, Prescribing	N/A	1942586425	0	0	DAVILA, CARLOS PHARMD	11/3/2019	Taxonomy not applicable	NA	n/a	000	Unknown	64776	N/A	N/A	N/A	N/A	N/A	3400 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	00	06000	34.02767826	-118.2008037	Los Angeles County
352805	Ordering, Referring, Prescribing	N/A	1942657697	0	0	DUN-MELLI, GEALINA O MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152217	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
352867	Ordering, Referring, Prescribing	N/A	1942750815	0	0	DOBBINS, SARAH NP	5/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009754	N/A	N/A	N/A	N/A	N/A	555 STEVENSON ST	None	SAN FRANCISCO	CA	94103	1606	00	06000	37.78070506	-122.41099	San Francisco County
352882	Ordering, Referring, Prescribing	N/A	1942776117	0	0	DEUNGRIA, TOM NP	6/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009881	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
352898	Ordering, Referring, Prescribing	N/A	1942808316	0	0	DELAUNAY, ANDREW PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH72839	N/A	N/A	N/A	N/A	N/A	100 SMITH RANCH RD	2039A	SAN RAFAEL	CA	94903	1900	00	06000	38.01968283	-122.5339655	Marin County
352905	Ordering, Referring, Prescribing	N/A	1942822663	0	0	DORSEY, KIRSTEN M PA-C	5/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58093	N/A	N/A	N/A	N/A	N/A	8233 E STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
352912	Ordering, Referring, Prescribing	N/A	1942838271	0	0	DADE, MAGGIE DO	9/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21307	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	MS #146	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
352933	Ordering, Referring, Prescribing	N/A	1942881206	0	0	DOMINGUEZ, ANGELICA LMFT	6/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147599	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
352939	Ordering, Referring, Prescribing	N/A	1942889670	0	0	DEBOLT, NAYELI A PA-C	8/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61478	N/A	N/A	N/A	N/A	N/A	1971 E 4TH ST	200	SANTA ANA	CA	92705	3917	00	06000	33.7482685	-117.83934	Orange County
352940	Ordering, Referring, Prescribing	N/A	1942899984	0	0	DAUGHENBAUGH, REBECCA J LCSW	10/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94098	N/A	N/A	N/A	N/A	N/A	975 WEST MORGAN STREET	None	PERRIS	CA	92571	3103	00	06000	33.83764414	-117.2475905	Riverside County
352944	Ordering, Referring, Prescribing	N/A	1942933833	0	0	DARWICH, SARAH LCSW	8/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117471	N/A	N/A	N/A	N/A	N/A	3845 SPRING DR	None	SPRING VALLEY	CA	91977	1030	00	06000	32.74889129	-117.0031816	San Diego County
352967	Ordering, Referring, Prescribing	N/A	1942999891	0	0	DE LA LUZ, MABEL DC	7/15/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36578	N/A	N/A	N/A	N/A	N/A	15898 GALE AVE	None	HACIENDA HEIGHTS	CA	91745	1601	00	06000	34.01001897	-117.9604613	Los Angeles County
353038	Ordering, Referring, Prescribing	N/A	1952431363	0	0	DAVIS, SUSAN PHD	3/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19405	N/A	N/A	N/A	N/A	N/A	3680 EAST IMPERIAL HWY.,	220	LYNWOOD	CA	90262	9999	00	06000	33.93211641	-118.2011728	Los Angeles County
353071	Ordering, Referring, Prescribing	N/A	1952507600	0	0	DE CASTRO, CLARISSA C	9/27/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D55693	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
353106	Ordering, Referring, Prescribing	N/A	1952582827	0	0	DE OLIVEIRA, OMAR G	3/13/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	101375	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	486	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
353112	Ordering, Referring, Prescribing	N/A	1952599078	0	0	DEMBINSKI, KAROLINA W DO MD	2/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12473	N/A	N/A	N/A	N/A	N/A	550 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8160	00	06000	41.77274546	-124.19892	Del Norte County
353122	Ordering, Referring, Prescribing	N/A	1952618035	0	0	DOWNES, MYLES LMFT	3/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48178	N/A	N/A	N/A	N/A	N/A	700 FREDERICK ST	103	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
353186	Ordering, Referring, Prescribing	N/A	1952746430	0	0	DICKSON GARCIA, JONI LMFT	1/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102382	N/A	N/A	N/A	N/A	N/A	359 W.11TH ST	A1	TRACY	CA	95376	3864	00	06000	37.7397196	-121.431262	San Joaquin County
353188	Ordering, Referring, Prescribing	N/A	1952747982	0	0	DUNCAN, SARAH E LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97185	N/A	N/A	N/A	N/A	N/A	1211 5TH STREET	None	EUREKA	CA	95501	0636	00	06000	40.80305422	-124.1581436	Humboldt County
353198	Ordering, Referring, Prescribing	N/A	1952753758	0	0	DITTUS-BLITZ, SUZANNE LMFT	3/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125130	N/A	N/A	N/A	N/A	N/A	1936 CARLOTTA DR	None	CONCORD	CA	94519	1358	00	06000	37.98614491	-122.0061167	Contra Costa County
353219	Ordering, Referring, Prescribing	N/A	1952761652	0	0	DIAMANTI, VALERIE R NP	7/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95003534	N/A	N/A	N/A	N/A	N/A	8221 ROCHESTER AVE STE 1	#120	RANCHO CUCAMONGA	CA	91730	0721	00	06000	34.104249	-117.5430105	San Bernardino County
353321	Ordering, Referring, Prescribing	N/A	1952953754	0	0	DUBE, KATE LCSW	5/23/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97772	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
353322	Ordering, Referring, Prescribing	N/A	1952951196	0	0	DING, YUNCHEN PHARMD	10/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	75625	N/A	N/A	N/A	N/A	N/A	751 S BASCOM AVE	None	SAN JOSE	CA	95128	5127	00	06000	37.313433	-121.9318385	Santa Clara County
353348	Ordering, Referring, Prescribing	N/A	1962023275	0	0	DIAZ, JONATHAN MD	4/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185279	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
353350	Ordering, Referring, Prescribing	N/A	1962026435	0	0	DEVANO, GLADYS B DO	5/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21044	N/A	N/A	N/A	N/A	N/A	5504 MONTEREY HWY	None	SAN JOSE	CA	95138	1529	00	06000	37.2546727	-121.8004013	Santa Clara County
353496	Ordering, Referring, Prescribing	N/A	1962610527	0	0	DALY, MAURA	11/15/2013	Taxonomy not applicable	NA	n/a	000	Unknown	LM210	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
353522	Ordering, Referring, Prescribing	N/A	1962662718	0	0	DALUGDUGAN, ESTHER MD	9/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112511	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
353525	Ordering, Referring, Prescribing	N/A	1962673178	0	0	DUFFIN, KATIE LCSW	10/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27652	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	165	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
353530	Ordering, Referring, Prescribing	N/A	1962673897	0	0	DIMARUCOT, CAROLINE P MD	10/3/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A86401	N/A	N/A	N/A	N/A	N/A	1110 W LA PALMA AVE	SUITE 6	ANAHEIM	CA	92801	2823	00	06000	33.84712953	-117.9320355	Orange County
353551	Ordering, Referring, Prescribing	N/A	1962710277	0	0	DODD, DENNIS E NP	2/3/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019929	N/A	N/A	N/A	N/A	N/A	2760 3RD STREET	None	CERES	CA	95307	3220	00	06000	37.591929	-120.9545125	Stanislaus County
353556	Ordering, Referring, Prescribing	N/A	1962720706	0	0	DURAND, ANISA C MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128821	N/A	N/A	N/A	N/A	N/A	280 W MACARTHUR BLVD	11TH FLOOR	OAKLAND	CA	94611	5642	00	06000	37.8242017	-122.2578306	Alameda County
353561	Ordering, Referring, Prescribing	N/A	1962735522	0	0	DONOVAN, CARI L LCSW	4/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68044	N/A	N/A	N/A	N/A	N/A	755 S VAN NESS AVE	None	SAN FRANCISCO	CA	94110	1908	00	06000	37.76103073	-122.4170932	San Francisco County
353605	Ordering, Referring, Prescribing	N/A	1962790592	0	0	DEMISSIE, ELIAS DDS	11/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS61816	N/A	N/A	N/A	N/A	N/A	14550 HAYNES ST	FL 3	VAN NUYS	CA	91411	4116	00	06000	34.18967817	-118.4506446	Los Angeles County
353610	Ordering, Referring, Prescribing	N/A	1962794776	0	0	DAVIS, FIONNA M LCSW	6/19/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26783	N/A	N/A	N/A	N/A	N/A	1644 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	4342	00	06000	40.935078	-124.100947	Humboldt County
353636	Ordering, Referring, Prescribing	N/A	1962828244	0	0	DERMANBERGER, MICHELLE D NP	12/10/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95045426	N/A	N/A	N/A	N/A	N/A	678 N WILSON WAY	25	STOCKTON	CA	95205	4272	00	06000	37.962954	-121.2735326	San Joaquin County
353640	Ordering, Referring, Prescribing	N/A	1962836528	0	0	DAVISON, SELAH G LCSW	4/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101306	N/A	N/A	N/A	N/A	N/A	1005 ATLANTIC AVE	None	ALAMEDA	CA	94501	1148	00	06000	37.78080326	-122.2676078	Alameda County
353663	Ordering, Referring, Prescribing	N/A	1962866103	0	0	DIAZ, KAREN MSW LCSW	2/3/2025	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	128473	N/A	N/A	N/A	N/A	N/A	241 N SHAFFER ST	None	ORANGE	CA	92866	1111	00	06000	33.79048611	-117.8487133	Orange County
353690	Ordering, Referring, Prescribing	N/A	1962899062	0	0	D'OYEN, KENNETH A MD	7/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150120	N/A	N/A	N/A	N/A	N/A	1425 MONTGOMERY RD.	None	RED BLUFF	CA	96080	0001	00	06000	40.157883	-122.2250685	Tehama County
353706	Ordering, Referring, Prescribing	N/A	1962926006	0	0	DEARINGER, AMANDA PA-C	12/4/2018	Taxonomy not applicable	NA	n/a	000	Unknown	54842	N/A	N/A	N/A	N/A	N/A	700 S TUSTIN ST	None	ORANGE	CA	92866	3425	00	06000	33.77685748	-117.8357804	Orange County
353724	Ordering, Referring, Prescribing	N/A	1962966069	0	0	DAO, THI V DDS	6/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	103368	N/A	N/A	N/A	N/A	N/A	1133 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05124618	-119.0425626	Tulare County
353728	Ordering, Referring, Prescribing	N/A	1962967778	0	0	DE LA ROSA, MICHELLIN NP	2/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010751	N/A	N/A	N/A	N/A	N/A	7211 VAN NUYS BLVD	None	VAN NUYS	CA	91405	2256	00	06000	34.20181593	-118.4487631	Los Angeles County
353758	Ordering, Referring, Prescribing	N/A	1972015451	0	0	DE YOUNG, ALICE L LAC	6/27/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC17824	N/A	N/A	N/A	N/A	N/A	1735 MISSION ST	None	SAN FRANCISCO	CA	94103	2417	00	06000	37.76957692	-122.4199811	San Francisco County
353780	Ordering, Referring, Prescribing	N/A	1972057545	0	0	DECOS, KEYLA LCSW	12/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112463	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
353808	Ordering, Referring, Prescribing	N/A	1972097822	0	0	DUARTE, MATTHEW J LMFT	6/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140184	N/A	N/A	N/A	N/A	N/A	120 SOUTH STATE COLLEGE	150	BREA	CA	92821	5837	00	06000	33.92111797	-117.8828786	Orange County
353831	Ordering, Referring, Prescribing	N/A	1972164499	0	0	DIMANNO, NATALIE LPCC	10/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	17779	N/A	N/A	N/A	N/A	N/A	27699 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	2697	00	06000	33.51449799	-117.1593524	Riverside County
353834	Ordering, Referring, Prescribing	N/A	1972165306	0	0	DAYRIT, ARLENE LMFT	4/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114146	N/A	N/A	N/A	N/A	N/A	303 W LINCOLN AVE	None	ANAHEIM	CA	92805	2936	00	06000	33.83508976	-117.9177981	Orange County
353844	Ordering, Referring, Prescribing	N/A	1972186179	0	0	DO, NGOC NGA T CNP	5/3/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017255	N/A	N/A	N/A	N/A	N/A	9862 CHAPMAN AVE	None	GARDEN GROVE	CA	92841	2711	00	06000	33.78849558	-117.9607338	Orange County
353846	Ordering, Referring, Prescribing	N/A	1972199552	0	0	DELCHIARO, STEPHANIE	10/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT80922	N/A	N/A	N/A	N/A	N/A	1000 BROADWAY	SUITE 460	OAKLAND	CA	94607	4099	00	06000	37.80185548	-122.2726866	Alameda County
353856	Ordering, Referring, Prescribing	N/A	1972235539	0	0	DUONG, TINH	1/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	86976	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
353904	Ordering, Referring, Prescribing	N/A	1972603009	0	0	DEGUZMAN, LYNN FRANCES H PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	54711	N/A	N/A	N/A	N/A	N/A	1800 HARRISON STREET	13TH FLOOR	OAKLAND	CA	94612	3867	00	06000	37.80593773	-122.2656714	Alameda County
353919	Ordering, Referring, Prescribing	N/A	1972632495	0	0	DUNN, TONI N LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49894	N/A	N/A	N/A	N/A	N/A	2621 OSWELL ST	None	BAKERSFIELD	CA	93306	3172	00	06000	35.393283	-118.9496505	Kern County
353968	Ordering, Referring, Prescribing	N/A	1972720597	0	0	DE LA O, JESSE PA	3/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA17807	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
353984	Ordering, Referring, Prescribing	N/A	1972751139	0	0	DAYE, MELANIE E PHD	3/9/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY25688	N/A	N/A	N/A	N/A	N/A	780 E GILBERT ST	None	SAN BERNARDINO	CA	92415	1003	00	06000	34.1268333	-117.2705634	San Bernardino County
354018	Ordering, Referring, Prescribing	N/A	1972817526	0	0	DUPUIS, WILLIAM C	2/10/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	D29040	N/A	N/A	N/A	N/A	N/A	480 1ST AVE	None	PORTOLA	CA	96122	9405	00	06000	39.80603471	-120.463888	Plumas County
354043	Ordering, Referring, Prescribing	N/A	1972864296	0	0	DIAZ, JANETTE LCSW	9/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101491	N/A	N/A	N/A	N/A	N/A	4723 W MAIN ST	STE H	GUADALUPE	CA	93434	1787	00	06000	34.9576413	-120.5778803	Santa Barbara County
354053	Ordering, Referring, Prescribing	N/A	1972881035	0	0	DEYOUNG, ELLIOT MD	4/15/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130456	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
354079	Ordering, Referring, Prescribing	N/A	1972917672	0	0	DOMINGUEZ, FERNANDO A MD	2/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154708	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
354090	Ordering, Referring, Prescribing	N/A	1972928190	0	0	DUNN, ASHLEY LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93634	N/A	N/A	N/A	N/A	N/A	5550 TELEGRAPH RD	C3	VENTURA	CA	93003	0000	00	06000	34.27717324	-119.2199411	Ventura County
354170	Ordering, Referring, Prescribing	N/A	1982028445	0	0	DUONG, AI-QUYEN T	3/18/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D63772	N/A	N/A	N/A	N/A	N/A	8787 HALL RD	None	LAMONT	CA	93241	1953	00	06000	35.25969451	-118.908099	Kern County
354228	Ordering, Referring, Prescribing	N/A	1982133435	0	0	DHATT, KEERAT K MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170252	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BOULEVARD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
354285	Ordering, Referring, Prescribing	N/A	1982209151	0	0	DESAI, NIRALI P PHARMD	9/18/2020	Taxonomy not applicable	NA	n/a	000	Unknown	83348	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
354295	Ordering, Referring, Prescribing	N/A	1982236089	0	0	DALY, NICOLE M LCSW	4/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24534	N/A	N/A	N/A	N/A	N/A	31 TOWER ROAD	None	SAN MATEO	CA	94402	0000	00	06000	37.51232162	-122.3333429	San Mateo County
354305	Ordering, Referring, Prescribing	N/A	1982246161	0	0	DEMPSTER, METTE LMFT	12/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130072	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	SUITE 100	LONG BEACH	CA	90804	3394	00	06000	33.7831762	-118.1333125	Los Angeles County
354349	Ordering, Referring, Prescribing	N/A	1982483186	0	0	DHALIWAL, HARVIR NP	6/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025691	N/A	N/A	N/A	N/A	N/A	4505 PRECISSI LN	A	STOCKTON	CA	95207	6232	00	06000	37.98851034	-121.3149434	San Joaquin County
354354	Ordering, Referring, Prescribing	N/A	1982623971	0	0	DAVIS, ANISSA D MD MPH	1/30/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71328	N/A	N/A	N/A	N/A	N/A	2525 GRAND AVENUE	None	LONG BEACH	CA	90815	1765	00	06000	33.8026265	-118.1480993	Los Angeles County
354359	Ordering, Referring, Prescribing	N/A	1982637880	0	0	DESAI, AANAL J MD	10/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A83108	N/A	N/A	N/A	N/A	N/A	23413 LYONS AVE	None	SANTA CLARITA	CA	91355	3028	00	06000	34.37974287	-118.5428596	Los Angeles County
354362	Ordering, Referring, Prescribing	N/A	1982635058	0	0	DALEY, MELITA L MD	11/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A71939	N/A	N/A	N/A	N/A	N/A	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90024	5055	00	06000	34.06633181	-118.4451729	Los Angeles County
354363	Ordering, Referring, Prescribing	N/A	1982643433	0	0	DEMARTINI, CHRISTOPHER E DC	12/27/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	29961	N/A	N/A	N/A	N/A	N/A	2800 RIVERSIDE AVE	None	PASO ROBLES	CA	93446	1311	00	06000	35.64351546	-120.6888699	San Luis Obispo County
354402	Ordering, Referring, Prescribing	N/A	1982757514	0	0	DOLCE, LYNN R LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT32386	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
354439	Ordering, Referring, Prescribing	N/A	1982823027	0	0	DHAH, MANJIT S NP	4/30/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	498727	N/A	N/A	N/A	N/A	N/A	811 E 11TH ST	None	REEDLEY	CA	93654	2527	00	06000	36.60347345	-119.4404912	Fresno County
354452	Ordering, Referring, Prescribing	N/A	1982850723	0	0	DIAZ, OSLEYDIS M	8/28/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D57413	N/A	N/A	N/A	N/A	N/A	2710 MIDDLEFIELD RD	None	REDWOOD CITY	CA	94063	3404	00	06000	37.47644946	-122.2110919	San Mateo County
354471	Ordering, Referring, Prescribing	N/A	1982896221	0	0	DUNCAN, KIMBERLY C	5/28/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0369550	N/A	N/A	N/A	N/A	N/A	518 GARDEN ST	None	SANTA BARBARA	CA	93101	1606	00	06000	34.42054634	-119.6928135	Santa Barbara County
354497	Ordering, Referring, Prescribing	N/A	1982953816	0	0	DIAZ, SABRINA D LMFT	11/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT94048	N/A	N/A	N/A	N/A	N/A	3200 MOTOR AVE	None	LOS ANGELES	CA	90034	3710	00	06000	34.03321301	-118.4109122	Los Angeles County
354508	Ordering, Referring, Prescribing	N/A	1982968186	0	0	DINH, ANH T PHARMD	12/16/2019	Taxonomy not applicable	NA	n/a	000	Unknown	51449	N/A	N/A	N/A	N/A	N/A	143 N MAIN ST	None	MILPITAS	CA	95035	4322	00	06000	37.43224087	-121.9073351	Santa Clara County
354573	Ordering, Referring, Prescribing	N/A	1992073159	0	0	DO, MARY H PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48210	N/A	N/A	N/A	N/A	N/A	1510 N SANTA FE AVE	None	VISTA	CA	92083	2001	00	06000	33.22189891	-117.2454882	San Diego County
354612	Ordering, Referring, Prescribing	N/A	1992120067	0	0	DI PIERO, DANIELA LMFT	11/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT88547	N/A	N/A	N/A	N/A	N/A	547 UREN ST	None	NEVADA CITY	CA	95959	2360	00	06000	39.26841435	-121.0124412	Nevada County
354630	Ordering, Referring, Prescribing	N/A	1992146211	0	0	DECKER, DANA DMD	8/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63241	N/A	N/A	N/A	N/A	N/A	1110 N DUTTON AVENUE	None	SANTA ROSA	CA	95401	4606	00	06000	38.446731	-122.729859	Sonoma County
354669	Ordering, Referring, Prescribing	N/A	1992223242	0	0	DENOVA, JENNIFER R LMFT	3/6/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145637	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
354689	Ordering, Referring, Prescribing	N/A	1992255715	0	0	DO, JEANNE D PHARMD	3/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	75337	N/A	N/A	N/A	N/A	N/A	4950 MISSION STREET	None	SAN FRANCISCO	CA	94112	3416	00	06000	37.71976803	-122.4385969	San Francisco County
354727	Ordering, Referring, Prescribing	N/A	1992341721	0	0	DILLINGHAM, MELESSA J LCSW	9/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	110351	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
354756	Ordering, Referring, Prescribing	N/A	1992369748	0	0	DUPONT, JILL LPCC	8/11/2020	Taxonomy not applicable	NA	n/a	000	Unknown	8287	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
354765	Ordering, Referring, Prescribing	N/A	1992392583	0	0	DOUMA, ANGELA LMFT	2/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116662	N/A	N/A	N/A	N/A	N/A	21380 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	3050	00	06000	34.41078438	-118.510775	Los Angeles County
354771	Ordering, Referring, Prescribing	N/A	1992423487	0	0	DIOSES, CALYNN J PHARMD	8/10/2023	Taxonomy not applicable	NA	n/a	000	Unknown	88183	N/A	N/A	N/A	N/A	N/A	1111 COLUMBUS ST	None	BAKERSFIELD	CA	93305	1936	00	06000	35.39744148	-118.9822815	Kern County
354812	Ordering, Referring, Prescribing	N/A	1992750053	0	0	DESAI, RUPAL MD	8/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A82877	N/A	N/A	N/A	N/A	N/A	1642 E CAPITOL EXPY	None	SAN JOSE	CA	95121	1800	00	06000	37.3061289	-121.8119182	Santa Clara County
354837	Ordering, Referring, Prescribing	N/A	1992836340	0	0	DEAN, ROXANNE J LCSW	3/12/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	17401	N/A	N/A	N/A	N/A	N/A	1290 COMMODORE DRIVE	None	SAN BRUNO	CA	94066	2382	00	06000	37.63134914	-122.4260472	San Mateo County
354860	Ordering, Referring, Prescribing	N/A	1992861082	0	0	DUKE, ROGER S LMFT	6/18/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36504	N/A	N/A	N/A	N/A	N/A	18880 CHERRY VALLEY BLVD	None	TUOLUMNE	CA	95379	0000	00	06000	37.96511668	-120.2399015	Tuolumne County
354864	Ordering, Referring, Prescribing	N/A	1992863955	0	0	DANG, CAT T DO	2/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A9377	N/A	N/A	N/A	N/A	N/A	12141 BROOKHURST ST	None	GARDEN GROVE	CA	92840	2865	00	06000	33.78614503	-117.9587915	Orange County
354879	Ordering, Referring, Prescribing	N/A	1992895155	0	0	DUONG, NGAN B PHARMD	4/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	53400	N/A	N/A	N/A	N/A	N/A	5901 REDWOOD DR	None	ROHNERT PARK	CA	94928	2076	00	06000	38.35201427	-122.7156861	Sonoma County